剖宫产术后非计划妊娠人工流产术中大出血的高危因素分析

High-risk factors for massive hemorrhage during induced abortion for unplanned pregnancy after cesarean section

摘要:

目的 分析剖宫产术后非计划宫内妊娠人工流产术中发生大出血的高危因素。方法 采用前瞻性队列研究，纳入2022年1月至2023年4月在重庆市人民医院妇产科门诊接受人工流产手术的228例剖宫产术后非计划宫内妊娠患者的临床信息和影像学资料，采用单因素分析和多因素Logistic回归分析人流术中发生大出血的危险因素。结果 228例病例中，术中大出血59例，占25.87％。单因素分析结果显示：生产次数、剖宫产次数、孕囊最大直径、孕囊距离子宫切口瘢痕距离、胚胎停育以及妊娠时间是剖宫产术后非计划宫内妊娠人工流产术中发生大出血的危险因素（P<0.05）。多因素Logistic回归分析结果显示：剖宫产次数、孕囊最大直径、孕囊距离子宫切口瘢痕距离，胚胎停育以及妊娠时间是剖宫产术后非计划宫内妊娠人工流产术中发生大出血的独立危险因素（P<0.05）。结论 降低剖宫产率，落实剖宫产后高效避孕，有助于降低该类人群人流术中大出血发生风险。

Abstract:

Objective To investigate the high-risk factors for massive hemorrhage during induced abortion for unplanned pregnancy after cesarean section.Methods A prospective cohort study was conducted for the clinical information and imaging data of 228 patients with unplanned pregnancy after caesarean section who underwent induced abortion at the outpatient service of Department of Obstetrics and Gynecology in Chongqing General Hospital from January 2022 to April 2023. Univariate analysis and multivariate logistic regression analysis were used to investigate the risk factors for massive hemorrhage during induced abortion.Results Among the 228 patients，59 experienced massive intraoperative hemorrhage，accounting for 25.87%. The univariate analysis showed that number of births，number of cesarean sections，maximum gestational sac diameter，distance from the gestational sac to the uterine incision scar，cessation of embryonic development，and pregnancy time were risk factors for massive hemorrhage during induced abortion for unplanned pregnancy after cesarean section（P<0.05）. The multivariate logistic regression analysis showed that number of cesarean sections，maximum gestational sac diameter，distance from the gestational sac to the uterine incision scar，cessation of embryonic development，and pregnancy time were independent risk factors for massive hemorrhage during induced abortion for unplanned pregnancy after cesarean section（P<0.05）.Conclusion The risk of massive hemorrhage during induced abortion can be reduced by decreasing the rate of cesarean section and implementing efficient contraception after cesarean section.