【摘要】 背景异位妊娠(EP)是导致妊娠早期孕妇死亡的主要原因之一,其患病状况及相关危险因素随性文化理念、生育政策的改变、医学科学的进步等有所改变,但未检索到全面二孩生育政策下EP患病状况的相关研究。目的探讨全面二孩政策对河北省EP患者的患病状况的影响。方法根据河北省各地级市GDP排名及地域分布等因素,随机选取2015—2017年3年间河北省4家医院妇产科EP住院患者作为研究对象,对其患病情况、年龄、孕产史及既往病史等病历资料进行回顾性分析,并比较二孩政策施行前后(2015年与2017年)的差异,分析2015—2017年的变化趋势。结果本研究共调查EP患者1 760例,占同期住院妊娠患者的4.68%(1 760/37 635)。全面二孩政策施行后,EP患病率较施行前降低(χ2=57.866,P<0.001)。2015—2017年,EP患者阴道分娩次数、盆腹腔手术史、重复异位妊娠(REP)、盆腔炎性疾病(PID)比例逐年增加(P<0.05)。全面二孩政策施行后EP患者阴道分娩次数(χ2=6.151,P=0.046)、剖宫产次数(χ2=7.135,P=0.028)、盆腹腔手术史(χ2=6.300,P=0.012)、REP(χ2=4.659,P=0.031)、PID比例(χ2=12.183,P<0.001)均较施行前增加。REP患者盆腹腔手术史、剖宫产、输卵管手术、吸烟史比例高于首次EP患者(P<0.05)。结论全面二孩政策施行后EP患病率降低,但患病年龄、阴道分娩次数、剖宫产次数、盆腹腔手术史、REP、PID比例均增加。更多还原

【Abstract】 Background Ectopic pregnancy(EP)is one of the leading causes for mortality in the first trimester of pregnancy,whose prevalence and related risk factors change with the change of concepts of sexual culture,fertility policy,and the development of medical sciences.However,there have been no studies about the prevalence of the disease since the universal two-child policy implemented in 2016 in China.Objective To explore the influence of the implementation of universal twochild policy on EP prevalence in Hebei Province.Methods This study was conducted in a random sample of four hospitals,which were extracted from four prefecture-level cities(using a 1∶1 ratio)sampled from Hebei Province by GDP ranking and geographical location.Participants were EP patients who hospitalized in department of obstetrics and gynecology of these hospitals during 2015-2017.Clinical medical records(including age,disease prevalence,gravidity,parity,and medical history)were collected,and major changes in these data before and after the implementation of universal two-child policy(2015 and 2017)were compared,and analyzed the change trend from 2015 to 2017.Results 1 760 EP patients were included,accounting for 4.68%(1 760/37 635)of the total hospitalized pregnant patients in the same period.The prevalence of EP was much lower after the implementation of the universal two-child policy than before(χ2=57.866,P<0.001).The number of vaginal deliveries,prevalence of pelvic and abdominal surgery,recurrent EP,and pelvic inflammatory disease increased successively in participants enrolled in 2015,2016 and 2017(P<0.05).After the implementation of the policy,the number of vaginal(χ2=6.151,P=0.046) and cesarean deliveries(χ2=7.135,P=0.028),prevalence of pelvic and abdominal surgery(χ2=6.300,P=0.012),REP(χ2=4.659,P=0.031)and pelvic inflammatory disease increased significantly(P<0.05).Those with REP showed higher prevalence of pelvic and abdominal surgery,cesarean section,fallopian tube surgery,and the ratio of smoking history than those with first EP(P<0.05).Conclusion In Hebei,the prevalence of EP decreased after the implementation of the universal two-child policy,but the age of onset,number of vaginal and cesarean deliveries,prevalence of pelvic and abdominal surgery,REP and pelvic inflammatory disease all increased.更多还原