疤痕子宫再次妊娠孕产妇的妊娠结局分析

金龙妹; 张晓华; 姚雁; 王秀蕊; 杨慧宾; 张蕾; 曹晶; 蒋泓

doi:10.19428/j.cnki.sjpm.2020.20015

疤痕子宫再次妊娠孕产妇的妊娠结局分析

Pregnancy outcome analysis on second pregnancy women with scarred uterus

摘要

摘要:
目的分析二孩政策后疤痕子宫再次妊娠孕产妇的妊娠结局。
方法以2015年1月—2018年12月上海市闵行区6家助产医疗机构分娩的51 308例孕产妇为研究对象，分析疤痕子宫孕产妇的分娩方式和妊娠结局。
结果① 2015—2018年闵行区疤痕子宫孕产妇共9 762例，占分娩产妇总数的19.03%，仅有91例(0.93%)阴道分娩。疤痕子宫居于剖宫产指征首位(42.06%)。②严重产后大出血(出血量≥2 000 mL)发生率：疤痕子宫组高于非疤痕子宫组(χ²=8.268，P=0.004)。③不良妊娠结局：疤痕子宫组发生凶险性前置胎盘42例(4.30‰)、子宫切除6例(0.61‰)、危重抢救22例(2.25‰)，风险均高于非疤痕子宫组(χ²=178.9，P < 0.001；Fisher确切概率法，P=0.000；χ²=4.272，P=0.039)；疤痕子宫组和非疤痕子宫组围产儿死亡率差异无统计学意义(χ²=3.240，P=0.072)，孕产妇死亡率均为0。
结论随着生育政策的调整，疤痕子宫再次妊娠人数增多、妊娠风险增高，需加强疤痕子宫再次妊娠孕产期风险预警评估管理, 通过有效控制初次剖宫产以避免疤痕子宫再次妊娠的风险。

Abstract:
ObjectiveTo analyse the pregnant outcome of second pregnancy women with scarred uterus after two-child policy was issued.
MethodsIn this study, 51 308 pregnant women who gave birth in 6 hospitals in Minhang District from Jan 2015 to Dec 2018 were studied to analyze the delivery mode and pregnancy outcome in women with scarred uterus.
Results① From 2015 to 2018, there were 9 762 (19.03%) pregnant women with scarred uterus in Minhang District and 91 (0.93%) of them delivered vaginally.Scarred uterus was the most frequent indication of cesarean section (42.06%).② The incidence of severe postpartum hemorrhage (bleeding volume≥2 000 mL) in scarred uterus group was higher than that in no-scar uterus group(χ²=8.268, P=0.004).③ Adverse pregnancy outcomes were noted:there were 42 cases of pernicious placenta previa (4.30‰), 6 cases of hysterectomy (0.61‰) and 22 cases of critical rescue (2.25‰) in scarred uterus group, with higher risk than those in no-scar uterus group(χ²=178.9, P < 0.001;Fisher exact probability method P=0.000;χ²=4.272, P=0.039).There was no significant difference in perinatal mortality between scarred uterus group and no-scar uterus group (χ²=3.240, P=0.072);The maternal mortality rate among both groups was 0.
ConclusionWith the adjustment of fertility policy, the number of pregnant women with scarred uterus and the risk of pregnancy increase.It is necessary to strengthen the management of early warning and assessment of risk during pregnancy of scarred uterus.By effectively controlling the first cesarean section, the risk of scarred uterus re-pregnancy should be avoided.

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