剖宫产瘢痕妊娠保守治疗失败危险因素分析

目的 探讨剖宫产瘢痕部位妊娠(CSP)保守治疗失败的相关危险因素.方法 采用病例对照研究方法,病例组为53例CSP保守治疗失败的患者,对照组为115例CSP保守治疗成功的患者,用剖宫产瘢痕妊娠调查表对研究对象进行调查资料收集.结果 单因素分析发现:剖宫产次数、前次剖宫产距此次妊娠的间隔时间>5年、停经天数、超声分型、孕囊或包块大小是CSP保守治疗失败的相关危险因素(OR值分别为16.544、2.284、2.494、8.432、1.376,均P<0.05),前次剖宫产距此次妊娠的间隔时间(2年≤时间≤5年)、术前血β-hCG值是保护因素(OR值分别为0.199、0.550,均P<0.05).多因素分析发现:剖宫产次数、超声分型均是CSP保守治疗失败的相关危险因素(OR值分别为16.323、8.390,95%CI=2.260~20.124、3.144~12.947),前次剖宫产距此次妊娠的间隔时间(2年≤时间≤5年)、术前血β-hCG值越高均是保护因素(OR值分别为0.200、0.555,95%CI=0.058~0.234、0.313~0.657).结论 严格把握剖宫产指征,加强超声诊断,定期监测血β-hCG值、再孕与剖宫产时间间隔合理,可以减低CSP保守治疗的失败率,保障育龄女性的健康安全.

Risk factors analysis for failure of conservative treatment of caesarean scar pregnancy

Objective To explore the risk factors for failure of conservative treatment of caesarean scar pregnancy ( CSP) .Methods Case control method was used including 53 failed cases in conservative treatment of CSP in case group and 115 successful cases in control group. The data of research objects were collected by using the questionnaire of CSP.Results Single factor analysis showed that number of cesarean section, interval of over 5 years between previous cesarean section production and the pregnancy, menopausal days, ultrasonic classification, the gestational sac or package block size were risk factors for failure of conservative treatment associated with CSP ( OR value was 16.544, 2.284, 2.494, 8.432 and 1.376, respectively, all P<0.05) , while the interval of 2 to 5 years between previous cesarean section and the pregnancy, preoperative serumβ-HCG value were protective factors (OR value was 0.199 and 0.550, respectively, both P<0.05).Multiple factor analysis showed that number of cesarean section and ultrasonic classification were risk factors for failure of conservative treatment associated with CSP (OR value was 16.323 and 8.390, respectively, 95%CI ranged 2.260-20.124 and 3.144-12.947, respectively) , while the interval of 2 to 5 years between previous cesarean section and the pregnancy, and higher preoperative serumβ-HCG value were protective factors (OR value was 0.200 and 0.555,respectively, 95%CI ranged 0.058-0.234 and 0.313-0.657, respecitvley).Conclusion Strict monitor of caesarean birth indication, strengthening ultrasonic diagnosis, regular monitoring bloodβ-HCG value, and reasonable control of interval between pregnancy and cesarean section can reduce the failure rate of conservative treatment of CSP and protect the health and safety of women of childbearing age.