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目的分析前置胎盘合并胎盘植入患者的高危因素和妊娠结局。方法收集2010年1月至2015年1月189例前置胎盘患者,根据是否合并胎盘植入分为胎盘植入组(34例)、非胎盘植入组(155例),分析孕产次、剖宫产次数、前置胎盘类型、胎盘位置与胎盘植入的相关性。结果与非胎盘植入组比较,胎盘植入组产次、剖宫产次数、流产次数明显增多,差异有统计学意义(P均<0.05);胎盘位置在前壁发生胎盘植入明显高于胎盘位于后壁者,差异有统计学意义(P<0.05);将单因素分析有统计学意义的变量进行非条件Logistic回归模型的多因素分析发现,与非胎盘植入组比较,发生胎盘植入的危险因素有产次、流产次数、剖宫产次数,(OR均>1,P<0.05或P<0.01);与非胎盘植入组比较,胎盘植入组产后出血率、子宫切除率、产时出血量明显增加,差异有统计学意义(P均<0.01);而两组早产率、分娩方式、新生儿窒息率比较差异无统计学意义(P均>0.05)。多因素结果分析胎盘植入组较非胎盘植入组产后出血的风险增加2.56倍,子宫切除的风险增加5.29倍。结论剖宫产次数、流产次数、分娩次数是胎盘植入的高危因素,前置胎盘合并胎盘植入产时出血量大,子宫切除的风险高。
Objective To analyze the risk factors and pregnancy outcome in patients with placenta previa and placenta accreta. Methods A total of 189 patients with placenta accreta from January 2010 to January 2015 were enrolled and divided into placenta accreta (34 cases) and non-placenta accreta (155 cases) Cesarean section frequency, type of placenta previa, location of placenta and placenta accreta. Results Compared with non-placenta accreta, placenta accreta, cesarean section and miscarriage times were significantly increased (all P <0.05). Placenta placenta was placenta accreta in the anterior wall Placenta located in the posterior wall, the difference was statistically significant (P <0.05); univariate analysis of statistically significant variables of non-conditional Logistic regression model of multivariate analysis found that placenta accreta compared with non-placenta accreta The risk factors for admission were the number of miscarriage, the number of miscarriage and the number of cesarean section (OR> 1, P <0.05 or P <0.01). Compared with non-placenta group, the rate of postpartum hemorrhage, (P all <0.01). There was no significant difference in preterm birth rate, delivery mode and neonatal asphyxia between the two groups (all P> 0.05). Multivariate analysis of the risk of postpartum hemorrhage 2.56-fold increased risk of hysterectomy placenta accreta compared with non-placenta accreta group 5.29 times. Conclusion The number of cesarean section, the number of miscarriage and the number of deliveries are the risk factors of placenta accreta. The bleeding volume of placenta accreta with placenta accreta is large and the risk of hysterectomy is high.