胎盘植入性疾病的危险因素及妊娠结局分析

目的探讨胎盘植入性疾病的危险因素及妊娠结局。 方法回顾性分析2009年1月至2017年12月广州医科大学附属第三医院/广州重症孕产妇救治中心围产资料数据库中信息完整的单胎妊娠孕妇48 650例临床资料，将这些孕妇分为胎盘植入性疾病组和非胎盘植入性疾病组，分析胎盘植入性疾病的危险因素及其妊娠结局。 结果单因素分析显示，年龄≥35岁、高中教育水平及以下、孕次≥3次、经产妇、人工流产史、剖宫产史、体外受精－胚胎移植受孕、合并前置胎盘是胎盘植入性疾病的相关危险因素(P<0.05)。多因素logistic回归分析显示，胎盘植入性疾病的独立危险因素为剖宫产史(OR＝2.254，95%CI：1.917～2.650)、体外受精－胚胎移植受孕(OR＝1.591，95%CI：1.212～2.089)、合并前置胎盘(OR＝28.282，95%CI：24.338～32.866)；与非胎盘植入性疾病产妇相比，患有胎盘植入性疾病产妇早产、剖宫产、产后出血、弥散性血管内凝血、产褥期感染、子宫切除、低出生体重儿、新生儿Apgar评分相对较低(1 min)、产妇入住重症监护病房的发生率明显升高(P<0.05)。 结论剖宫产史、辅助生殖受孕、合并前置胎盘是引起胎盘植入性疾病的独立危险因素，胎盘植入性疾病的妊娠结局不良。

Risk factors and pregnancy outcomes of placenta accreta spectrum disorders.

Objective To investigate the risk factors and pregnancy outcome of placental accreta spectrum disorders.Methods This is a retrospective cohort study of singleton pregnant women(n=48650),who gave birth in the Third Affiliated Hospital of Guangzhou Medical University from January 2009 to December 2017.The pregnant women were divided into the PAS(placenta accrete spectrum)group and the control group,and the risk factors and pregnancy outcomes of the two groups were compared.Results Univariate analysis showed that age(≥35 years old),high school education level and below,pregnancy times(>3 times),multipara,history of induced abortion,history of cesarean section,in vitro fertilization-embryo transfer(IVF-ET)and placenta previa were the related risk factors for placenta accreta spectrum disorders(P<0.05).Multivariate logistic regression analysis showed that the independent risk factors for placenta accreta spectrum disorders were the history of cesarean section(OR=2.254,95%CI:1.917-2.650),IVF-ET(OR=1.591,95%CI:1.212-2.089),placenta previa(OR=28.282,95%CI:24.338-32.866).Compared with the control group,the incidence rate of premature delivery,cesarean section,postpartum hemorrhage,diffused intravascular coagulation,puerperal infection,hysterectomy,low birth weight infants,low neonatal Apgar score(1 minute),and ICU admission in the PAS group were significantly higher(P<0.05).Conclusions The history of cesarean section,IVF-ET and placenta previa are independent risk factors for pregnancies with placenta accreta spectrum disorders,and the pregnancy outcome is poor.