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目的探讨剖宫产手术情况对下次妊娠并发胎盘植入(placenta implantation,PI)程度的影响。方法选择2012年5月至2016年5月在成都市妇女儿童中心医院分娩的瘢痕子宫(前次剖宫产术)11 025例为观察组(剖宫产组),同期经产妇(前次均为顺产)8 320例为对照组(阴道分娩组),比较不同分娩方式再次妊娠PI的发生率及植入程度,分析前次剖宫产是否伴有产后出血、是否为产程中转急诊手术以及前次剖宫产距离本次妊娠时间与PI程度的关系。结果剖宫产组再次妊娠时PI发生率高于阴道分娩组(2.5%vs1.8%,P<0.05),且植入型与穿透型PI发生率比阴道分娩组更高,差异有统计学意义(9.9‰vs 6.6‰、5.8‰vs 0.9‰,P均<0.05)。剖宫产组中前次剖宫产伴产后出血,再次妊娠时PI发生率高于无产后出血组,尤其粘连型与植入型发生率更高,差异有统计学意义(14.6‰vs 8.2‰、14.2‰vs 8.7‰,P均<0.05);前次为产程中转剖宫产时,此次妊娠穿透型PI发生率高于非中转组(7.5‰vs 4.5‰,P<0.05);前次剖宫产距离本次妊娠时间,与PI发生率及植入程度比较差异无统计学意义(P>0.05)。结论前次剖宫产术,术后并发产后出血及产程中转剖宫产是再次妊娠发生PI的高危因素,应加强此类孕妇的孕期管理。
Objective To investigate the effect of cesarean section operation on the level of placenta implantation (PI) in the next pregnancy. Methods From May 2012 to May 2016, 11 025 cases of scarring uterus (previous cesarean section) giving birth in Chengdu Women and Children’s Hospital were treated as observation group (cesarean section) 8 320 as control group (vaginal delivery group), compared with different delivery methods of pregnancy PI incidence and implantation, analysis of the previous cesarean section is associated with postpartum hemorrhage, is the midwifery emergency surgery and before The incidence of cesarean section between the time of pregnancy and PI level. Results The PI incidence of cesarean section group was higher than that of vaginal delivery group (2.5% vs 1.8%, P <0.05), and the incidence of implantable and penetrating PI was higher than vaginal delivery group with statistical difference Significance (9.9 ‰ vs 6.6 ‰, 5.8 ‰ vs 0.9 ‰, P <0.05). The cesarean section in the previous cesarean section with postpartum hemorrhage, pregnancy PI again higher than the incidence of postpartum hemorrhage group, in particular the incidence of adhesions and implants were higher, the difference was statistically significant (14.6 ‰ vs 8.2 ‰ , 14.2 ‰ vs 8.7 ‰, all P <0.05). The incidence of penetrating PI during pregnancy was higher than that of non-transfected group (7.5 ‰ vs 4.5 ‰, P <0.05) There was no significant difference in the incidence of cesarean section between this pregnancy time and the PI incidence and implantation (P> 0.05). Conclusions The previous cesarean section, postoperative postpartum hemorrhage and labor-induced cesarean delivery were the risk factors of PI in the second trimester pregnancy. Pregnancy management should be strengthened.