刘小媚++袁秀英++刘燕燕

[摘要] 目的 探讨剖宫产术后瘢痕处妊娠的高危因素，提高诊断水平。 方法 剖宫产手术史且合并瘢痕处妊娠的患者34例纳入瘢痕妊娠组，同期在我院接受剖宫产手术但未合并瘢痕处妊娠的产妇34例，纳入对照组。比较两组的手术指征、人工流产次数、手术医院级别等。结果 两组的产程延长例次、胎儿宫内窘迫例次、产科合并症例次、剖宫产次数及反复宫腔操作例次比较，差异均有统计学意义。两组接受最近一次剖宫产手术的医院级别、人工流产平均次数比较，差异有统计学意义。Logistic回归分析结果显示，产程延长、胎儿窘迫、产科合并症、反复宫腔操作、剖宫产2次以上均是影响瘢痕处妊娠的高危因素。结论 产程延长、胎儿窘迫、产科合并症、剖宫产次数、反复宫腔操作均是影响瘢痕处妊娠的高危因素。

[关键词] 瘢痕处妊娠；手术指征；高危因素

[中图分类号] R719.8；R714.2[文献标识码] B[文章编号] 1673-9701（2014）18-0129-03

Study on high risk factors of pregnancy at the scar after cesarean section

LIU Xiaomei YUAN Xiuying LIU Yanyan

Department of Gynecology，Shilong People's Hospital of Dongguan City in Guangdong Province，Dongguan 523321，China

[Abstract] Objective To explore the high risk factors of pregnancy at the scar after cesarean section，and improve the diagnostic level. Methods A total of 34 patients of cesarean section operation with scar pregnancy were arranged in scar pregnancy group，in the same period，34 patients who received cesarean operation but not with scar pregnancy were arranged in the control group. Results The production processextension number，fetal distress number，obstetric complications number，fetal breech number，repeated uterine cavity operation number ，comparison difference had statistics significance. Recent cesarean operation of hospital level， the average number of artificial abortion of two groups had statistical significancedifferences. The results of logistic regression analysis display， prolonged labor， fetal distress， obstetric complications， recurrentuterine cavity operation， cesarean section 2 above are all risk factors influencing the scar pregnancy. Conclusion Prolonged labor， fetal distress， obstetric complications， breech presentation，recurrent uterine cavity operation are risk factors of scar pregnancy.

[Key words] Scar pregnancy； Operation indication； Risk factors

剖宫产术后产妇子宫会留下手术瘢痕，当此产妇再次妊娠且受精卵在子宫瘢痕处着床时，就称为瘢痕处妊娠，这种情况属于异位妊娠。受精卵进入瘢痕的微小裂隙着床于子宫肌层。受精卵发育早期，着床部位的子宫肌层被滋养细胞不断侵蚀，导致这一部位组织薄弱，如果未能尽早诊断，产妇会出现子宫破裂或大出血，轻者失去生育能力，严重者甚至危及生命[1]。近年来，剖宫产术后子宫瘢痕处妊娠发生率有逐年上升的趋势，但对于这种情况的处理目前还没有统一的方法。……