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目的通过病例对照研究,分析剖宫产后瘢痕子宫患者再次妊娠并发前置胎盘对围生期母儿结局的影响。方法以2014年6月-2016年6月住院分娩的剖宫产后瘢痕子宫并发前置胎盘的131例孕妇为研究对象,根据前次剖宫产原因将孕妇分为两组:前次为择期剖宫产的102例孕妇为A组,并依据前置胎盘程度,将本组凶险型前置胎盘设为A组凶险亚组,将本组非凶险型前置胎盘设为A组非凶险亚组;前次为阴道试产失败转剖宫产的29例孕妇设为B组,将本组凶险型前置胎盘设为B组凶险亚组,将本组非凶险型前置胎盘设为B组非凶险亚组。比较各组孕妇的一般情况、术中及术后并发症发生率、母儿结局。结果 A组发生凶险型前置胎盘46例,发生非凶险型前置胎盘56例;B组发生凶险型前置胎盘5例,发生非凶险型前置胎盘24例。两组凶险型前置胎盘发生率比较,差异有统计学意义(P<0.05)。两组孕妇的年龄、平均孕次、妊娠天数、高龄比例、产前出血发生率、宫腔手术≥3次比例比较,差异均无统计学意义(均P>0.05)。A组凶险亚组孕妇的妊娠天数显著低于A组非凶险亚组,而年龄、平均孕次、产前出血发生率、宫腔手术≥3次比例显著高于A组非凶险亚组,差异均有统计学意义(P<0.05)。B组两亚组上述指标比较差异均无统计学意义(P>0.05)。结论前次择期剖宫产后再次妊娠并发凶险型前置胎盘的风险显著高于前次阴道试产失败的剖宫产孕妇,而且母儿不良结局发生率较高。
OBJECTIVE: To analyze the effect of pre-pregnancy placenta accreta on perinatal maternal and neonatal outcomes in post-cesarean scar patients with uterine cesarean section through a case-control study. Methods 131 pregnant women with postpartum cesarean scar with uterine placenta previa in June 2014 to June 2016 were divided into two groups according to the reasons of previous cesarean section: the last was elective 102 cases of cesarean section of pregnant women for the A group, and based on the level of the placenta previa, this group of dangerous placenta previa as A group of dangerous subgroups, this group of non-dangerous placenta previa as A non-dangerous sub-group Group; the last vaginal trial fails to turn cesarean delivery of 29 pregnant women as Group B, the group of dangerous placenta previa as a group B dangerous subgroups, the group of non-threatening placenta previa as B Group non-destructive subgroups. Compare the general situation of pregnant women in each group, intraoperative and postoperative complications, maternal and child outcomes. Results A group of 46 cases of dangerous placenta previa occurred in 56 cases of non-dangerous type of placenta previa; Group B occurred in 5 cases of precarious placenta previa placenta occurred in 24 cases. The incidence of malignant placenta previa in both groups was significantly different (P <0.05). There were no significant differences in the age, average gestational age, number of gestational days, proportion of advanced age, incidence of prenatal bleeding and uterine cavity ≥ 3 times in both groups (all P> 0.05). In group A, the number of gestational days of pregnant women in dangerous subgroup was significantly lower than that of non-destructive subgroups in group A, while the average age of pregnant women, the incidence of prenatal bleeding, the number of uterine cavity surgery≥3 times were significantly higher than those in group A, All were statistically significant (P <0.05). There was no significant difference between the two subgroups in group B (P> 0.05). Conclusion The risk of pre-cesarean section with recurrent pregnancy associated with risk placenta previa is significantly higher than that of cesarean section with failed vaginal trial, and the incidence of maternal and child adverse outcomes is high.