目的 探讨瘢痕子宫(前次剖宫产史)对再次妊娠的分娩方式和结局的影响。方法 回顾性分析2012-01至2014-03于北京军区总医院妇产科初诊建档、定期产检,并于该院分娩的瘢痕子宫妊娠病例322例(瘢痕组),随机抽取同期非瘢痕子宫妊娠病例328例(非瘢痕组),比较两组的分娩方式和妊娠结局。结果 瘢痕组和非瘢痕组孕妇年龄、分娩孕周、孕次、产次、分娩前体重指数比较,差异均无统计学意义。瘢痕组剖宫产261例,占81.1%;非瘢痕组剖宫产173例,占52.7%;两组差异有统计学意义(χ²=58.70,P＜0.01)。瘢痕组的前置胎盘、胎盘粘连(植入)的发生率为13.7%、9.0%,均高于非瘢痕组的0.9%、0.6%(χ²分别为39.38、25.22,P均＜0.01);而瘢痕组和非瘢痕组的胎盘早剥发生率比较,差异无统计学意义(χ²=2.76,P>0.05)。瘢痕组子宫破裂(1.6%)、产后出血(10.9%)、产褥发热(11.5%)等发生率均高于非瘢痕组(分别是0、2.7%和5.5%),差异有统计学意义(χ²分别为5.13、17.00、7.56,P均＜0.01)。结论 瘢痕子宫妊娠的并发症发生率高于非瘢痕子宫妊娠,其前置胎盘、胎盘粘连(植入)、产后出血的风险性明显升高。瘢痕子宫孕妇再次妊娠的分娩方式仍以剖宫产为主。

Objective To study the influence of the uterine scar pregnancy on the ways of delivery and outcome. Methods A retrospective survey was conducted of the patients who had been admitted to the obestetrics department of this hospital, all of whom had been under rules of regular inspection and had given birth to baby in the same hospital. The total sample included 322 cases of uterine scar pregnancy as the observation group, and 328 patients without uterine scar pregnancy as the control group by random. Comparison was made between the two groups in the ways of delivery and outcome of pregnancy. Results The comparisons of average age, average week of delivery, mean gravidity, mean parity between the two groups did not show statistically significant differences. 261 cases (81.1%) underwent cesaran section in the observation group, 173 cases (52.7%) did so in the control group, with statistically significant difference between the two groups. The incidence rates of placenta praevia and adherent placenta/implantation in the observation group were 13.7% and 9.0%, whereas those the incidences in the control group were 0.9% and 0.6%, the differences were statistically significant (χ²= 39.38, 25.22, P＜0.01). The incidence of hysterorrhexis and postpartum hemorrhage in the observation group was 1.6% and 10.9%, while those incidences in the control group was 0% and 2.7% in control group, the differences was statistically significant (χ²=5.13 and χ²=17.00, P＜0.05). The incidence of puerperal fever in the observation group was 11.5% and that incidence in the control group was 5.5%, the difference was statistically significant (χ²=7.56, P＜0.01). Conclusions The incidences of hysterorrhexis, postpartum hemorrhage, placenta praevia and adherent placenta/implantation in scarred uterus pregnancy is higher than those in the non-scarred uterus pregnancy. We advocate uterine still cesarean section deliveries for scar pregnant patients.