目的:确定未进行剖宫产(CS)的妇女发生胎盘植入谱(PAS)障碍的危险因素。
方法:这项回顾性病例对照研究调查了2015年1月1日至2021年12月31日在北京大学第三医院分娩的无CS患者。纳入符合2019年国际妇产科联合会(FIGO)分类临床诊断标准的PAS患者作为研究组。根据分娩日期和前置胎盘配对为对照组,以1:2的分配比例。比较两组产妇的特征。
结果:该研究包括研究组348例患者和对照组696例患者。多因素分析显示,宫腔镜手术是PAS的独立危险因素(一次:校正比值比[aOR]2.38,95%CI1.28-4.24,P=0.006;两次或更多次:aOR5.43,95%CI1.04-28.32,P=0.045)。刮宫(一次:aOR2.54,95%CI1.80-3.58,P<0.001;两次:aOR3.01,95%CI1.81-5.02,P<0.001;三次或更多次:aOR9.18,95%CI4.64-18.18,P<0.001),多胎妊娠(aOR5.64,95%CI3.01-10.57,P<0.001),子宫腺肌病(aOR2.77,95%CI1.23-6.22,P=0.014),体外受精(aOR1.51,95%CI1.04-2.20,P=0.030)和先兆子痫(aOR2.72,95%CI1.36-5.45,P=0.005),且独立保护因素为多胎性(aOR0.37,95%CI0.25-0.54,P<0.001)。
结论:控制前置胎盘的影响后,我们发现,没有既往CS的PAS患者具有独特的母体特征.他们经历的宫内手术的分类和量化对于识别高危患者至关重要。通过危险因素早期识别高危人群有可能大大改善预后。
OBJECTIVE: To identify the risk factors for placenta accreta spectrum (PAS) disorders in women without prior cesarean section (CS).
METHODS: This retrospective case-control study investigated patients without prior CS who gave birth at Peking University Third Hospital between January 1, 2015 and December 31, 2021. Patients diagnosed with PAS according to the clinical diagnostic criteria of the 2019 International Federation of Gynecology and Obstetrics (FIGO) classification were included as the study group. Patients were matched as the control group according to delivery date and placenta previa, in a 1:2 allocation ratio. Maternal characteristics were compared between the two groups.
RESULTS: The study included 348 patients in the study group and 696 in the control group. The multivariate analysis showed that the independent risk factors of PAS consisted of operative hysteroscopy (once: adjusted odds ratio [aOR] 2.38, 95% CI 1.28-4.24, P = 0.006; twice or more: aOR 5.43, 95% CI 1.04-28.32, P = 0.045), uterine curettage (once: aOR 2.54, 95% CI 1.80-3.58, P < 0.001; twice: aOR 3.01, 95% CI 1.81-5.02, P < 0.001; three or more times: aOR 9.18, 95% CI 4.64-18.18, P < 0.001), multifetal pregnancy (aOR 5.64, 95% CI 3.01-10.57, P < 0.001), adenomyosis (aOR 2.77, 95% CI 1.23-6.22, P = 0.014), in vitro fertilization (aOR 1.51, 95% CI 1.04-2.20, P = 0.030) and pre-eclampsia (aOR 2.72, 95% CI 1.36-5.45, P = 0.005), and the independent protective factor was being multiparous (aOR 0.37, 95% CI 0.25-0.54, P < 0.001).
CONCLUSIONS: After controlling the effect of placenta previa, we found that patients with PAS without prior CS had unique maternal characteristics. Classification and quantification of the intrauterine surgeries they have undergone is essential for identifying high-risk patients. Early identification of high-risk groups by risk factors has the potential to improve the prognosis considerably.