剖宫产术后瘢痕子宫并发前置胎盘87例临床分析

目的探讨剖宫产术后瘢痕子宫再次妊娠时并发前置胎盘对孕产妇和围产儿的影响，为临床提供参考。方法将我院87例因剖宫产术致瘢痕子宫并发前置胎盘患者作为研究组，随机选取同期因多次妊娠、多次人工流产、多次刮宫操作所致前置胎盘患者70例作为对照组，并将研究组按照此次与上次分娩间隔时间分为研究1组（≤2年）和研究2组（〉2年）。对比对照组与研究组，及研究1组与研究2组孕产妇和围产儿的临床表现。结果研究组剖宫产率明显高于对照组，差异具有统计学意义（P〈0．05）；研究组孕产妇胎盘植入发生率、产后出血量和子宫破裂发生率均明显高于对照组（P〈0．05）；研究1组孕产妇子宫破裂发生率较研究2组更高（P〈O．05）；在围产儿早产率、胎儿窘迫率和围产儿死亡率方面，研究组高于对照组（P〈0．05），研究1组与研究2组未见明显差异（P〉0．05）。结论剖宫产术后瘢痕子宫并发前置胎盘可增加孕产妇和围产儿的并发症与风险的发生率，两次分娩间隔时间短者更易发生子宫破裂，临床应严格把握剖宫产指征，并指导剖宫产术后再次妊娠的合理间隔时间。

Clinical analysis of 87 cases of cesarean scar uterus complicated with placenta previa

Objective To explore the effects of cesarean scar uterus complicated with placenta previa on the maternal and perinatal. Methods Eighty-seven patients（study group） with cesarean scar uterus complicated with placenta previa in our hospital were divided into two groups according to the interval between the last two deliveries：study group 1 （ ~〈2 years） and study group 2（ 〉2 years）. Seventy patients with placenta previa caused by multiple pregnancy, abortion, repeated curettage operation were chosen as control group. The clinical features of the maternal and perinatal were compared between control group and study group, and between two study subgroups. Results The cesarean section rate was significantly higher in study group than in control group（ P 〈 0.05 ）. The incidences of maternal placenta implantation, rupture of uterus, and the postpartum hemorrhage were significantly higher in study group than in control group（P 〈0.05）. The incidence of rupture of uterus was higher in study group 1 than in study group 2 （P 〈0.05）. Perinatal premature delivery, fetal distress rate and perinatal mortality were higher in study group than in control group （P 〈 0.05 ）, and there was no significant difference between two study subgroups （ P 〉 O. 05 ）. Conclusion The placenta previa caused by cesarean section scar can increase the incidence of complications and the risk of the maternal and perinatal. The patients with short interval of delivery are more susceptible to the rupture of uterus. The indications for cesarean section should be strictly complied, and the secondary pregnancy after cesarean section should choose the reasonable interval.