上海某区疤痕子宫妊娠风险分级管理效果评估

摘要

目的评估上海市闵行区实施疤痕子宫孕产妇妊娠风险评估及分级管理的实践效果.方法选取2014年1月至2017年12月在上海市闵行区各助产医疗机构产检并院内分娩的疤痕子宫孕产妇为研究对象,2016年1月至2017年12月在闵行区内建立疤痕子宫孕产妇妊娠风险评估及分级管理体系,完善管理路径,实施风险评估及分级管理,对比分析疤痕子宫妊娠风险评估及分级管理实施前后各年度的阴道分娩率、产后出血率、子宫切除病例数,评估实施效果.结果2014—2017年各年度疤痕子宫产妇阴道分娩率分别为0.51％、0.45％、1.04％、1.40％,其中2017年度阴道分娩率与2014年度、2015年度相比较有明显上升,差异均有统计学意义(χ2值分别为11.97、11.95,均P＜0.01);各年度产后出血率分别为2.99％、3.72％、4.47％、4.97％,其中2017年度产后出血率与2014年度、2015年度相比较有明显上升,差异均有统计学意义(χ2值分别为76.92、23.31,均P＜0.01);各年度疤痕子宫产妇产后出血率分别为2.98％、2.40％、2.01％、1.85％,其中2017年度产后出血率与2014年度相比较有明显下降,差异有统计学意义(χ2=7.51,P＜0.01);各年度疤痕子宫产妇中经危重抢救最终行子宫切除术的病例数分别为4例、1例、1例、2例,死亡病例数均为0例.结论闵行区探索实施的针对疤痕子宫妊娠风险评估及分级管理项目可规范疤痕子宫孕产期管理,降低了疤痕子宫妊娠风险,减少了不良妊娠结局的发生,值得进一步推广.%Objective To validate the effect of risk assessment and grading management on scar uterus pregnancy in Minhang District of Shanghai.Methods Pregnant women with scar uterus undergoing antenatal check and childbirth in various medical institutions in Minhang District in Shanghai from January 2014to December 2017were selected as study objects.We established and implemented a risk assessment and grading management system for scar uterus pregnancy from January 2016to December 2017to improve management path and realize risk assessment and grading management.Vaginal delivery rate, postpartum hemorrhage rate and number of hysterectomy in each year were compared and analyzed before and after implementation of assessment and grading management for scar uterus to evaluate effectiveness of the system.Results During the period from 2014to 2017, vaginal delivery rates of pregnant women with scar uterus were 0.51％, 0.45％, 1.04％, and 1.40％, respectively.We observed a statistically significant increase in vaginal delivery rate in 2017compared to that in 2014and 2015, and difference was significant (χ2 value was11.97and 11.95, respectively, both P＜0.01).Postpartum hemorrhage rates in each year were 2.99％, 3.72％, 4.47％and4.97％, respectively.That in 2017was significantly increased compared to that in 2014and 2015, and difference had statistical significance (χ2 value was 76.92and 23.31, respectively, both P＜0.01).Postpartum hemorrhage rates of pregnant women with scar uterus in each year were 2.98％, 2.40％, 2.01％and 1.85％, respectively, with decrease of postpartum hemorrhage rate in2017compared to that in 2014, and the difference had statistical significance (χ2=7.51, P＜0.01).Number of pregnant women with scar uterus undergoing hysterectomy due to emergency treatment in each year were 4, 1, 1and 2, respectively, and no dead case was reported.Conclusion Risk assessment and grading management system for scar uterus established in Minhang District can regulate pregnancy management for women with uterus scar and significantly reduce the risk of scar uterus pregnancy and adverse pregnancy outcomes.It is worth of further popularization.