本文選題：剖宮產(chǎn)瘢痕部位妊娠　切入點：生育能力　出處：《山西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討剖宮產(chǎn)瘢痕部位妊娠(CSP)患者再次妊娠結(jié)局。方法:從2006年4月到2016年4月,共327名CSP患者在我院接受B超引導(dǎo)下清宮術(shù)/負壓吸引術(shù)(DC)、雙側(cè)子宮動脈栓塞術(shù)(UAE)、局部病灶清除等治療。2016年6月至2016年9月期間對上述患者進行了電話隨訪,隨訪內(nèi)容主要包括:再次妊娠與否、再次妊娠與CSP間隔時間、再次妊娠母胎結(jié)局、分娩方式等。結(jié)果:共有47名患者失訪,我們對剩下的280例患者資料進行收集整理。74名患者希望再次生育,但其中一半患者(50%,37/74)因害怕復(fù)發(fā)性剖宮產(chǎn)瘢痕部位妊娠(rCSP)及胎盤植入、前置胎盤、子宮破裂等并發(fā)癥而嚴格避孕,拒絕嘗試再次妊娠;另一半患者(50%,37/74)則積極備孕,并有21名(56.7%,21/37)患者成功分娩21名足月健康活嬰(順產(chǎn)4名,剖宮產(chǎn)娩出17名)�？偣灿�54名患者再次妊娠(計劃內(nèi)或計劃外)。9名(16.7%,9/54)患者再次發(fā)生CSP。結(jié)論:大部分CSP患者可以再次妊娠,其生殖結(jié)局包括:正常宮內(nèi)妊娠、流產(chǎn)、復(fù)發(fā)性CSP、不孕等。胎盤植入為再次妊娠可能要面臨的一個嚴重并發(fā)癥,并且在產(chǎn)前檢查中有可能被漏診。CSP患者子宮下段可能會形成憩室或缺陷,對子宮下段的缺陷進行修補既不能保證治愈下段的瘢痕,也不能保證有良好的妊娠結(jié)局。對有生育需求及意愿的有CSP史的患者需要進行適當(dāng)?shù)男�。一旦她們受�?則需要盡早轉(zhuǎn)診至三甲醫(yī)院并嚴密門診隨診。最終我們僅收集到280名CSP患者的數(shù)據(jù),我們的結(jié)果雖不能代表真正的復(fù)發(fā)率,但可以在此類患者再次妊娠的風(fēng)險評估及不同診療方案對后續(xù)生育影響的可能性等方面提供一些證據(jù)。
[Abstract]:Objective: to investigate the repregnancy outcome of patients with cesarean scar (CSP). Methods: from April 2006 to April 2016, A total of 327 patients with CSP were treated with B-ultrasound guided hysteroscopy / negative pressure aspiration, bilateral uterine artery embolization and local focus clearance. The patients were followed up by telephone from June 2016 to September 2016. The main contents of follow-up included: re pregnancy or not, interval between re pregnancy and CSP, maternal and fetal outcome of re pregnancy, delivery mode, etc. Results: 47 patients were not visited. We collected and sorted out the data of the remaining 280 patients. 74 patients wanted to have a baby again, but half of them were 50 percent 37 / 74) afraid of recurrent cesarean scar pregnancy rCSP), placenta previa, placenta accreta, placenta previa. Complications such as uterine rupture were strictly contraceptive and refused to try to get pregnant again. The other half of the patients were actively preparing for pregnancy, and 21 patients with complications such as rupture of the uterus and 21 out of 37 patients gave birth to 21 healthy full-term live babies (4 live births). A total of 54 patients (planned or unplanned) had a second pregnancy (planned or unplanned). Conclusion: most CSP patients can be pregnant again, and their reproductive outcomes include: normal intrauterine pregnancy, miscarriage. Recurrent CSP, infertility, etc. Placenta accreta may be a serious complication of a second pregnancy, and may be missed in antenatal examination. The lower segment of the uterus in patients with CSP may develop diverticulum or defect. Repairing the defects in the lower segment of the uterus does not guarantee the healing of the scar in the lower segment, nor does it guarantee a good pregnancy outcome. Patients with a history of CSP who have the need and desire to have children need to be properly educated. Once they conceive, Then we need to be referred to the third Class Hospital as soon as possible and follow up closely. In the end, we collected only 280 patients with CSP, and our results do not represent the true recurrence rate. However, some evidence can be provided on the risk assessment of re-pregnancy and the possibility of the effect of different diagnosis and treatment programs on subsequent fertility in such patients.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.22

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