Analysis of influencing factors on drug abortion outcome of early pregnancy with cesarean scar uterus after cesarean section
Objective To analyse the outcome of drug abortion of early pregnancy with cesarean scar uterus after cesarean section and its influencing factors.Methods 272 pregnant women with scarred uterus after cesarean section due to accidental pregnancy requiring medication abortion in the hospital from January 2019 to December 2023 were selected as research subjects.The patients were divided into ineffective group and effective group based on the results of medication abortion.Data on body mass index,number of preg-nancies,duration of amenorrhea,contraceptive methods,early pregnancy during lactation,history of pre-vious abortions,number of cesarean sections,uterine position,history of chronic pelvic inflammatory dis-ease,diameter of gestational sac,distance between gestational sac and scar,time since the previous cesare-an section,follicle-stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2),progesterone(P),and scar healing condition were collected.Multivariate Logistic regression analysis was used to inves-tigate the influencing factors of medical abortion outcomes in early pregnancy with scarred uterus after ce-sarean section,and a Logistic(P)regression equation model was established.Receiver operating charac-teristic(ROC)curve analysis was performed to evaluate the predictive value of Logistic(P)for the out-come of medical abortion in early pregnancy with scarred uterus after cesarean section.Results A total of 252 pregnant women completed the effective investigation.The results of drug abortion showed that 41 ca-ses were invalid and 211 cases were effective,accounting for 16.27％and 83.73％respectively.The num-ber of early pregnancy during lactation,the number of cesarean section ≥2 times,the number of non-hori-zontal uterine position,the number of chronic pelvic inflammatory history,the diameter of the gestational sac,the serum P level,and the number of scar healing condition in the ineffective group were higher than those in the effective group,and the distance between the gestational sac and scar was lower than that in the effective group(P＜0.05).The distance between pregnant sac and scar and scar healing condition were independent protective factors for drug abortion failure in early pregnancy with cesarean scar uterus after cesarean section,and serum P level was independent risk factor for drug abortionfailure in early preg-nancy with cesarean scar uterus after cesarean section(P＜0.05).Based on the variable regression coeffi-cient table,a regression equation model was established:Logistic(P)=-4.033-0.546 × spacing be-tween pregnant sac and scar+0.192×p-1.125Xscar healing condition,with good fit.TheROC curve for predicting the outcome of medical abortion in early pregnancy with scarred uterus after cesarean section was plotted based on the Logistic regression model.The results showed that the area under the ROC curve(AUC)was 0.875,with a 95％CI of 0.828 to 0.913,a sensitivity of 85.37％,and a specificity of 72.04％.Conclusion The failure rate of drug abortion in the early stage of cesarean scar uterus after cesarean section is high,so the distance between pregnant sac and scar,scar defect and serum P level should be con-sidered in the planning of drug abortion.
NETL
NSTL
万方数据
