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目的探讨胎盘附着位置异常对妊娠期高血压-子痫前期发病的影响。方法回顾性分析2010年1月至2012年12月同济大学附属第一妇婴保健院满足入选标准的胎盘附着位置异常的孕妇813例(研究组,其中前置胎盘247例,低置胎盘566例)和胎盘位置正常孕妇813例(对照组)。比较两组孕妇妊娠期高血压-子痫前期、胎盘粘连和胎儿生长受限等发病情况。结果 (1)研究组与对照组妊娠期高血压-子痫前期发生率差异有统计学意义(4.4%vs.8.1%,P<0.05);前置胎盘组、低置胎盘组的妊娠期高血压-子痫前期发生率均比对照组低(2.8%vs.8.1%,5.1%vs.8.1%,P<0.05);而前置胎盘组妊娠期高血压-子痫前期发生率比低置胎盘组更低(AOR 0.36,95%CI 0.15~0.86)。(2)与对照组相比,低置胎盘能降低妊娠期高血压发病风险(AOR 0.5,95%CI 0.3~0.9),前置胎盘也能降低妊娠期高血压发病风险(AOR0.27,95%CI 0.09~0.83)。(3)与对照组相比,前置胎盘组子痫前期发生率降低87%(AOR 0.13,95%CI 0.04~0.48),但低置胎盘组子痫前期发生率并不低于对照组(2.8%vs.3.7%,P>0.05);而与低置胎盘组相比,前置胎盘组子痫前期发生率更加低(AOR 0.25,95%CI 0.07~0.89)。(4)胎盘粘连孕妇妊娠期高血压-子痫前期发生率较无胎盘粘连者低(4.1%vs.4.5%,P>0.05),但差异无统计学意义。(5)各组之间胎儿生长受限发生率差异无统计学意义。结论胎盘附着位置异常尤其前置胎盘可能会减少妊娠期高血压-子痫前期发生。
Objective To investigate the effect of abnormal placental attachment on the incidence of gestational hypertension-preeclampsia. Methods A retrospective analysis of 813 pregnant women (study group, 247 cases of placenta previa, 566 cases of placenta accreta) who met the inclusion criteria for the first maternal and child hospital attached to Tongji University from January 2010 to December 2012 was retrospectively analyzed ) And 813 pregnant women with normal placenta position (control group). The incidence of gestational hypertension - preeclampsia, placental adhesion and fetal growth restriction were compared between the two groups. Results (1) There was a significant difference between pre-eclampsia and gestational hypertension in study group and control group (4.4% vs.8.1%, P <0.05). In preimplantation placenta group and low placenta group, gestational hypertension The incidence of prehypertension was lower in the prehypertension group than in the control group (2.8% vs.8.1%, 5.1% vs.8.1%, P <0.05), while the prevalence of gestational hypertension-preeclampsia in the placenta previa group was lower than that in the control group The placenta group was lower (AOR 0.36, 95% CI 0.15 to 0.86). (2) Compared with the control group, low placenta reduced the risk of gestational hypertension (AOR 0.5, 95% CI 0.3-0.9), placenta previa could also reduce the risk of gestational hypertension (AOR0.27, 95 % CI 0.09 ~ 0.83). (3) Compared with the control group, preeclampsia in pre-placental group decreased 87% (AOR 0.13, 95% CI 0.04-0.48), but the incidence of preeclampsia in low placenta group was not lower than that in control group 2.8% vs.3.7%, P> 0.05). Compared with the low placenta group, preeclampsia in the placenta previa group was even lower (AOR 0.25, 95% CI 0.07-0.89). (4) The incidence of gestational hypertension in pregnant women with placental adhesion - the incidence of preeclampsia was lower than that without placenta adhesion (4.1% vs.4.5%, P> 0.05), but the difference was not statistically significant. (5) There was no significant difference in the incidence of fetal growth restriction between groups. Conclusion Abnormal placental attachment especially placenta previa may reduce gestational hypertension - preeclampsia.