高龄瘢痕子宫再妊娠孕产妇剖宫产术终止妊娠直接病因及预后影响因素分析

摘要 目的：探讨高龄瘢痕子宫再妊娠孕产妇剖宫产术终止妊娠直接病因及预后影响因素分析。方法：回顾性分析2016年1月-2020年10月在我院收治的400例高龄瘢痕子宫再妊娠孕妇。按照是否终止妊娠将400例孕妇分为终止妊娠组（200例）和未终止妊娠组（200例）。并对200例终止妊娠孕妇进行2年随访，按照2年内再妊娠情况分为再妊娠成功组（150例）和再次终止妊娠组（50例）。采用Spearman检验进行相关性分析；采用logistics回归模型进行回归分析。结果：200例终止妊娠孕妇中瘢痕妊娠60（30.00 %）例，死胎13（6.50 %）例，胎儿畸形25（12.50 %）例，子痫前期81（40.50 %）例，胎膜早破11（5.50%）例，妊娠意外事件10（5.00 %）例。高龄瘢痕子宫孕妇终止妊娠后再妊娠与教育水平、是否有固定职业、家庭月收入无关（P＞0.05）；与年龄、孕次、产次、剖宫产手术史、终止妊娠病因有关（P<0.05）；200例终止妊娠孕妇预后再妊娠与年龄、孕次、产次、剖宫产手术史、终止妊娠病因密切相关（P<0.05）；多因素分析结果显示，年龄、孕次、产次、剖宫产手术史、终止妊娠病因是独立危险因素（P<0.05）。结论：高龄瘢痕子宫孕妇终止妊娠的主要病因为瘢痕妊娠，死胎，胎儿畸形例，子痫前期，胎膜早破，妊娠意外事件。年龄、孕次、产次、剖宫产手术史、终止妊娠病因是影响高龄瘢痕子宫孕妇预后再妊娠的独立危险因素。

Analysis of the Direct Etiology and Prognostic Factors of Caesarean Section Termination in Pregnant Women with Cicatricial Uterus Repregnancy

ABSTRACT Objective: To explore the analysis of the direct etiology and prognostic factors of caesarean section termination of pregnancy in elderly women with cicatricial uterus repregnancy. Methods: Retrospective analysis was performed on 400 pregnant women with cicatricial uterus who were admitted to our hospital from January 2016 to October 2020. According to whether the pregnancy was terminated or not, 400 pregnant women were divided into the termination group (200 cases) and the non-termination group (200 cases). In addition, 200 pregnant women with termination of pregnancy were followed up for 2 years, and were divided into successful pregnancy group (150 cases) and pregnancy termination group (50 cases). Spearman test was used for correlation analysis. The logistic regression model was adopted for regression analysis. Results: Among the 200 pregnant women with termination of pregnancy, 60(30.00 %) cases of scar pregnancy, 13 (6.50 %) cases of stillbirth, 25 (12.50 %) cases of fetal malformation, 81 (40.50 %) cases of preeclampsia, 11 (5.50 %) cases of premature rupture of membranes, 10(5.00 %) cases of pregnancy accidents. Pregnancy after termination of pregnancy was not related to education level, fixed occupation or family monthly income(P>0.05). It was related to age, gestational time, delivery time, cesarean section operation history and cause of termination of pregnancy(P<0.05). Pregnancy was closely related to age, gestational number, delivery number, cesarean section history and cause of termination of pregnancy(P<0.05). The results of multivariate analysis showed that age, gestational number, delivery number, cesarean section history and the cause of termination of pregnancy were independent risk factors(P<0.05). Conclusion: The main causes of termination of pregnancy in elderly women with cicatricial uterus are cicatricial pregnancy, stillbirth, fetal malformation, preeclampsia, premature rupture of membranes, and pregnancy accidents. Age, number of pregnancies, number of births, history of cesarean section and cause of termination of pregnancy are independent risk factors affecting prognosis of repregnancy in elderly pregnant women with cicatricial uterus.