An Analysis On Related Risk Factors And Pregnancy Outcomes Of Placenta Accreta

Objective: It is to retrospectively investigate the general life characteristics as well as the relevant medical records of the research objects,and to explore the relevant risk factors of the placental accreta as well as its influence on maternal and fetal outcomes.Methods: In this thesis,434 placental-accreta parturients in Gansu Provincial Maternity and Child-care Hospital from February 1,2011 to August 31,2017,were selected as the case group.868 non-placental accreta parturients who gave birth in Gansu Provincial Maternity and Child-care Hospital during the same period were selected as the control group.Adopting the research method of comparing cases,it analyzes the relevant risk factors of placental-accreta with the Logistic regression model,and compares the difference of pregnancy outcome between groups.Results:(1)During the period from February 1,2011 to August 31,2017,there were total 77,891 cases of parturients in Gansu Provincial Maternity and Child-care Hospital,among which 446 cases were patients with placental accrete and the incidence rate was 0.57%.Cases are classified according to the accrete degree.Among 434 placental-accreta patients in this research,138 cases(31.80%)were adhesive placental accretion,247 cases(56.91%)were accretive placental accretion,and 49 cases(11.29%)were penetrating placental accretion.(2)The results of Univariate Analysis revealed that there was statistically significant difference between the case group and the control group in age,the history of progestogen use at the early pregnancy stage,birth-giving frequency,abortion history,cesarean-section history,the operation history of induced abortion,and the combined placenta previa(P<0.05).The results of further Multivariate Logistic Regression Analysis showed that the age(more than 35 years old),frequent abortion history,the previous cesarean-section history,and the combined placenta previa were all independent risk factors for the occurrence of placental accreta(P<0.05).(3)After the hierarchical analysis to the types of the placental accreta,the results indicated that the age(more than 35 years old),the history of progestogen use at the early pregnancy stage,frequent abortion history,the previous cesarean-section history,frequent history of induced abortion,and the combined placenta previa were independent risk factors for the occurrence of implantable placental accrete(P< 0.05);the age(more than 35 years old),frequent abortion history,the previous cesarean-section history,and the combined placenta previa were the independent risk factors of the occurrence of the placental accreta(P<0.05);the previous cesarean-section history and the combined placenta previa were the independent risk factors of the occurrence of the penetrating placental accrete.(4)After the stratified analysis on whether it was the placenta previa,it was founded that the pregnant women with placenta previa had a higher risk of the placental accrete,providing that they have the following attributes: old age,frequent birth-giving,frequently abortion history,previous cesarean-section history,frequent history of induced abortion,having the history of progestogen use at the early pregnancy stage(P<0.05).The risk of placental accreta for the pregnant women with the placenta previa who had cesarean section once is 8.207 times higher than that of pregnant women without a history of cesarean section(95% CI:4.171~16.147),and the risk of placental accreta for the pregnant women with the placenta previa who had cesarean section twice or more times is 23.31 times higher than that of pregnant women without a history of cesarean section(95% CI:4.171~16.147).(5)The incidence of postpartum hemorrhage,DIC,hemorrhagic shock,postpartum transfusion,hysterectomy,ICU stay,premature delivery,low birth weight,neonatal asphyxia,and perinatal death in the case group were significantly higher than those in the control group,and the length of staying in hospital was significantly longer than that in the control group.The difference was statistically significant(P< 0.05).(6)After the analysis on whether the postpartum hemorrhage is layered or not,the results showed the differences between the placenta-accreta postpartum hemorrhage group and the placenta-accreta non-postpartum hemorrhage group in the age,the history of progestogen use at the early pregnancy stage,pregnancy frequency,birth-giving frequency,abortion history,previous cesarean-section history,history of induced abortion,the premature rupture of combined membranes,and the degree of placental accrete,are statistically significant(P < 0.05).The results of influencing factor analysis revealed that frequent birth-giving,the frequent abortion history,previous cesarean-section history,the combined placenta previa,the degree of placental accrete were all independent risk factors for the postpartum hemorrhage of pregnant women with placenta accreta(P<0.05).After the analysis on whether the rhysterectomy and stratification was conducted,there were statistically significant differences between the hysterectomy group and the non-hysterectomy group in the birth-giving frequency,the abortion history,the previous cesarean-section history,the combined placenta previa,the regular antenatal examination,and the degree of placental accreta(P<0.05).The results of influencing factor analysis revealed that the previous cesarean-section history,the combined placenta previa,and the degree of placental accreta were all independent risk factors for the rhysterectomy of pregnant women with placenta accreta(P<0.05).Conclusion:(1)the independent risk factors for the placenta accrete include old age,the abortion history,the previous cesarean-section history,and the combined placenta previa.There are differences in independent risk factors for the placental accrete of different types,and the placental accrete has adverse effects on pregnancy outcome.(2)The independent risk factors for the postpartum hemorrhage of pregnant women with placenta accreta include frequent birth-giving,the abortion history,previous cesarean-section history,the combined placenta previa,and the degree of placental accrete;the risk factors for the rhysterectomy include the combined placenta previa,frequent cesarean-section history,and the degree of the placental accrete.(3)Aiming at the independent risk factors of the placental accrete,we should formulate intervention measures for key population,and reduce the occurrence of the placental accrete as well as adverse pregnancy outcome,so as to better maintain the health of women and ensure the health of mother and child.