摘要
目的回顾分析侵入性胎盘植入性疾病(PAS)孕妇急诊剖宫产的高危因素与母婴结局,为探索侵入性PAS的孕期管理模式及终止妊娠时机提供理论依据。方法选择2018年1月—2022年12月于本院分娩并诊断为侵入性PAS(胎盘植入超声评分≥5分,术后胎盘病检证实植入性或穿透性胎盘植入)的孕妇共163例进行回顾性病例对照研究。分析孕妇围产期变量与术中出血量的关系、侵入性PAS患者急诊剖宫产的危险因素、孕周与急诊剖宫产的相关性等。结果侵入型PAS孕妇中患有妊娠期高血压疾病(GHD)、妊娠期肝内胆汁淤积症(ICP)及既往剖宫产次数>1次的患者发生急诊剖宫产的风险分别增加98%、112%、124%。当孕前BMI增加1 kg/m^(2)时,急诊剖宫产的风险降低5%(OR:0.95,95%CI:0.82~0.98,P=0.038)。结论GHD、ICP和既往剖宫产次数大于1次是侵入性PAS急诊剖宫产的独立危险因素,而急诊剖宫产与孕周之间没有显著的线性相关性。因此孕36周前,建议在孕妇病情稳定时尽可能延长孕周,以减少不良胎儿结局。
Objective To analyze the high-risk factors,maternal and infant outcomes of emergency cesarean section in pregnant women with invasive placenta accreta spectrum disorders retrospectively and provide theoretical basis for exploring pregnancy management models and termination time for pregnant woman with invasive placenta accreta spectrum disorders.Methods A retrospective case-control study was conducted on pregnant women diagnosed with invasive placenta accreta spectrum disorders(the ultrasound score of placenta acrreta≥5,placental pathology revealed placenta increta or placenta percreta)from January 2018 to December 2022 at Chengdu Women and Children's Center Hospital.The relationship between perinatal variables and intraoperative bleeding in pregnant women,risk factors for emergency cesarean section in patients with invasive PAS and the correlation between gestational age and emergency cesarean section were analyzed.Results Gestational hypertension disease(GHD),intrahepatic cholestasis of pregnancy(ICP)and more than once of previous cesarean section had an increased risk of emergency cesarean section by 98%,112%and 124%.While the BMI prepregnancy increases by 1 kg/m^(2),the risk of emergency cesarean section is reduced by 5%(OR:0.95,CI:0.82-0.98,P=0.038).Conclusion GHD,ICP and more than once of previous cesarean section are independent risk factors for invasive PAS emergency cesarean section.There is no significant linear correlation between emergency cesarean section and gestational age.Therefore,in order to reduce adverse fetal outcomes,it is recommended to extend the gestational age before 36 weeks of gestation as much as possible.
作者
吴藤岚
李鑫
金莹
熊雯
罗丹
WU Tenglan;LI Xin;JIN Ying;XIONG Wen;LUO Dan(Department of Obstetrics and Gynecology,Chengdu Women's and Children's Central Hospital,School of Medicine,University of Electronic Science and Technology of China,Chengdu 610091,China)
出处
《西部医学》
2025年第9期1380-1385,共6页
Medical Journal of West China
基金
四川省科技厅科研课题(2023YFS0219)。
关键词
胎盘植入性疾病
回顾性病例对照研究
急诊剖宫产
高危因素
母婴结局
Placenta accreta spectrum disorders
Retrospective case-control study
Emergency cesarean section
High-risk factors
Maternal and infant outcomes
