晚期自然流产的预测因素取决于流产的表型

T. V. Rachenkova, Y. Dudareva
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引用次数: 0

摘要

目的根据流产的临床表型评估晚期流产的风险因素。研究包括 156 名妇女。主组包括 66 名胎龄在 12.0-21.6 周的晚期自然流产患者,其中 47 名因宫颈峡部不全或羊水早破而流产,19 名因血性分泌物而晚期流产。对照组--90 名妊娠足月分娩的患者。对生殖器外病变发病率的分析表明,晚期流产妇女中贫血(31.8%;P = 0.000)、肥胖(12.12%;P = 0.013)和胃肠道疾病(12.12%;P = 0.004)的发病率较高。在分析妇科病理学时发现,与对照组相比,主要组患者接受宫颈手术治疗的比例高出 9.6 倍(分别为 10.6%和 1.1%;p = 0.008;OR = 10.68 CI 1.28-89.04),与宫颈峡部发育不全患者相比,出血组患者出现子宫发育异常的频率高出 7.5 倍(分别为 15.8%和 2.1%;p = 0.008)。1 %;P = 0.035;OR = 8.63 CI 0.84-88.97)。晚期流产的重要风险因素包括早产(18.2%,p = 0.000)、未发育妊娠(18.2%;p = 0.026)和药物流产(42.6%;p = 0.003)。在对妊娠过程进行分析时,发现了不利于流产的预后指标:威胁终止妊娠(53.0%;p = 0.000)、宫颈峡部不全(19.1%:p = 0.000)和阴道生物狭窄(71.2%,p = 0.000)。因此,晚期自然流产患者存在典型的生殖器外病变、产科病史加重和妊娠过程复杂的情况,这就要求在孕前准备阶段对这类患者进行监测,治疗生殖器外病变,并及时预防、诊断和治疗妊娠不同阶段的并发症。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Predictors of late spontaneous miscarriages depending on the phenotype of abortion
The aim. Assessment of risk factors for late miscarriages depending on the clinical phenotype of abortion.Materials and methods. The study included 156 women. The main group consisted of 66 patients with late spontaneous abortion at a gestational age of 12,0–21,6 weeks, 47 of them with miscarriage on the background of isthmic-cervical insufficiency or premature rupture of amniotic fluid, 19 with late miscarriage against the background of blood discharge. Control group – 90 patients whose pregnancy ended in term delivery.Results. Analysis of the prevalence of extragenital pathology revealed a high incidence of anemia (31,8 %; p = 0,000), obesity (12,12 %, p = 0,013), and gastrointestinal diseases (12,12 %; p = 0,004) in women with late miscarriage. When analyzing gynecological pathology, it was revealed that surgical treatment of the cervix was 9,6 times more common in patients of the main group compared to the control group (10,6 and 1,1 %; p = 0,008; OR = 10,68 CI 1,28–89,04), the frequency of abnormalities in the development of the uterus – 7,5 times more often in the group with bleeding compared to the group of patients with isthmic-cervical insufficiency (15,8 and 2.1 %; p = 0,035; OR = 8,63 CI 0,84–88,97). Significant risk factors for late miscarriages are preterm birth (18,2 %, p = 0,000), non-developing pregnancy (18,2 %; p = 0,026), medical abortions (42,6 %; p = 0,003). When analyzing the course of pregnancy, prognostically unfavorable markers of miscarriage were identified: the threat of termination of a real pregnancy (53,0 %; p = 0,000), isthmic-cervical insufficiency (19,1 %: p = 0,000) and violations of the vaginal biocenosis (71,2 %, p = 0,000).Conclusion. Thus, the presence of extragenital pathology, aggravated obstetric anamnesis and complicated course of pregnancy is typical for patients with late spontaneous abortions, which requires monitoring of this category of patients at the stage of preconception preparation, treatment of extragenital pathology, as well as timely prevention, diagnosis and treatment of complications at different stages of pregnancy.
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