中文摘要：

目的 探讨剖宫产后瘢痕子宫再次妊娠并发前置胎盘对孕妇和围产儿结局的影响。方法 回顾性分析2014年1月至2015年6月于重庆医科大学附属第一医院、重庆市妇幼保健院、重庆市急救医疗中心产科住院分娩的剖宫产后瘢痕子宫合并前置胎盘的孕妇197例,对其一般情况、术中情况、母儿结局等进行比较。结果 前次择期剖宫产较阴道试产失败后剖宫产再生育时更易并发凶险型前置胎盘（45.1%vs.15.9%,P〈0.05）。前次择期剖宫产后再次妊娠并发凶险型前置胎盘的孕妇发生胎盘植入、产后出血、大出血（〉1000 m L/24 h）、子宫切除、弥漫性血管内凝血（DIC）、输血及新生儿重症监护病房（NICU）入住率和早产儿发生率显著高于并发非凶险型前置胎盘的孕妇（68.1%vs.31.0%,36.2%vs.3.6%,31.9%vs.3.6%,26.1%vs.0,10.1%vs.1.2%,40.6%vs.4.8%,30.4%vs.6%,44.9%vs.14.3%,均P〈0.05）。结论前次择期剖宫产后再次妊娠并发凶险型前置胎盘的风险显著高于前次阴道试产失败的剖宫产孕妇,而且前次择期剖宫产孕妇再次妊娠合并前置胎盘的母儿不良结局发生率高。

英文摘要：

Objective To explore the influence of cesarean scar uterus with pernicious placenta previa on gravidas and fetus. Methods Clinical data of 197 pregnant women with scarred uterus with placenta previa, who delivered from January 2014 to June 2015 in the Department of Obstetrics of the First Affiliated Hospital of Chongqing Medical University, Chongqing Maternity and Child Care and Chongqing Emergency Medical Center, was retrospectively analyzed. Compari- sons among the cases on general condition, changes during operation, as well as maternal and fetal outcome were also performed.Results Pernicious placenta previa was less likely to appear in subsequent pregnant women who received a cesarean after a failure of vaginal delivery than selective cesarean section （45.1% vs.15.9%, P〈 0.05）.The pernicious group with previous cesarean after failure of vaginal delivery significantly outnumbered the non-pernicious group con- cerning the rates of placental implantation, postpartum hemorrhage, postpartum massive hemorrhage, hysterectomy, DIC, blood transfusion, NICU occupancy, and premature infant （ 68.1%vs.31.0%, 36.2%vs.3.6%, 31.9%vs.3.6%, 26.1%vs.0, 10.1%vs. 1.2%, 40.6%vs.4.8%, 30.4%vs.6%, 44.9%vs. 14.3 %, P 〈 0.05 ）. Conclusion The risk of pregnancy complicated with pernicious placenta previa in the group of previous elective cesarean delivery is significantly higher than the group of previous cesarean after failure of vaginal delivery. The maternal and neonatal results are also worse in the previous elective cesarean delivery group.