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目的研究剖宫产切口瘢痕妊娠发病的相关影响因素,为临床防治剖宫产术后瘢痕妊娠提供参考依据。方法选取宜宾市第二人民医院2015年3月-2016年8月诊治的40例剖宫产切口瘢痕妊娠患者作为研究组,选取同期收治的40例瘢痕子宫宫内正常妊娠患者作为对照组。两组患者临床资料完整,均伴有子宫下段剖宫产既往史。对两组患者年龄、孕产史、前次剖宫产指征、前次剖宫产子宫切口的缝合方式、剖宫产时机等临床资料进行回顾性分析,分析其与剖宫产瘢痕妊娠(CSP)发病相关性。结果两组患者在年龄、孕次、产程停滞、头盆不称、社会因素及其他因素方面比较,差异均无统计学意义(均P>0.05);两组患者在人工流产次数、剖宫产次数、子宫切口缝合方式、胎儿宫内窘迫、臀位剖宫产、脐带绕颈、距离前次剖宫产间隔时间、剖宫产时机方面比较,差异有统计学意义(P<0.05);通过多因素Logistic回归分析发现,人工流产次数、剖宫产次数、子宫切口缝合方式、胎儿宫内窘迫、臀位剖宫产、脐带绕颈、距离前次剖宫产间隔时间、剖宫产时机与剖宫产瘢痕妊娠发病相关(P<0.05)。结论多次人工流产及剖宫产、子宫切口缝合方式、胎儿宫内窘迫、臀位剖宫产、剖宫产间隔时间、剖宫产时机是剖宫产瘢痕妊娠的相关影响因素,针对具备上述因素的患者需进行及早干预,减少剖宫产术后瘢痕妊娠发生风险。
Objective To study the influencing factors of cesarean scar incision pregnancy and provide reference for clinical prevention and treatment of scar pregnancy after cesarean section. Methods Forty cases of cesarean scar pregnancy patients treated by the Second People’s Hospital of Yibin from March 2015 to August 2016 were selected as the study group and 40 cases of normal pregnant women with uterine scar within the same period were selected as the control group. Two groups of patients with complete clinical data, are associated with the history of the lower uterine cesarean section. The clinical data of two groups, including age, history of maternal history, previous cesarean section indications, previous cesarean section incision suture method, cesarean section timing were retrospectively analyzed, and analyzed with cesarean scar pregnancy ( CSP) incidence. Results There was no significant difference in age, gestational age, labor stagnation, headache, social factors and other factors between the two groups (all P> 0.05). There was no significant difference in the number of induced abortion, cesarean section (P <0.05), the number of cesarean section suture, fetal distress, cesarean section of the breech, umbilical cord around the neck, distance from the previous cesarean section, cesarean delivery timing was statistically significant (P <0.05) Multivariate logistic regression analysis found that the number of induced abortion, the number of cesarean section, uterine incision suture, fetal distress, cesarean section of the breech, umbilical cord around the neck, the distance from the previous cesarean section, cesarean section timing and Cesarean scar pregnancy related (P <0.05). Conclusions Multiple abortion and cesarean section, uterine incision suture, fetal distress, breech cesarean section, cesarean section interval, cesarean section timing cesarean scar pregnancy related factors, with the above Factors in patients with early intervention to reduce the risk of scar pregnancy after cesarean section.