探讨先天性生殖器官异常孕妇的围生结局。

选择2009年1月至2019年12月，于四川大学华西第二医院活产分娩的99 779例单胎妊娠孕妇为研究对象。根据是否合并先天性生殖器官异常，将其分为观察组(n＝324，合并)及对照组(n＝99 455，未合并)。回顾性分析2组孕妇的临床病例资料，总结观察组不同类型先天性生殖器官异常孕妇的围生结局特点。采用χ²检验及独立样本t检验，对2组孕妇妊娠期各并发症发生率、剖宫产率及新生儿出生体重等，进行统计学分析。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。

①观察组孕妇最常见先天性生殖器官异常前3位依次为纵隔子宫、单角/残角子宫及弓形子宫，分别占35.2%(114/324)、26.2%(85/324)及13.9%(45/324)。包括既往妊娠次数在内，观察组孕妇共计妊娠571次，其中弓形子宫、纵隔子宫孕妇的自然流产率位列前2位，分别为38.5%(35/91)、28.6%(61/213)；阴道畸形孕妇足月产率(70.0%)，高于子宫畸形者(52.8%)，并且差异有统计学意义(χ²＝4.432、P＝0.035)。②观察组孕妇早产、胎膜早破、胎位异常、胎盘早剥、胎儿生长受限(FGR)、胎盘黏连/植入、子宫破裂及剖宫产率分别为29.6%、29.3%、36.1%、5.9%、2.5%、21.0%、3.4%、78.7%，均分别高于对照组孕妇的9.8%、22.3%、5.7%、1.2%、1.0%、11.5%、1.5%、62.0%；而羊水过少率(0.9%)及新生儿出生体重[(2 913±652) g]，则显著低于对照组的2.9%、(3 254±445) g，并且上述差异均有统计学意义(均为P<0.05)。2组孕妇前置胎盘、妊娠期高血压疾病(HDCP)、产后出血(PPH)及子宫切除率比较，差异均无统计学意义(P>0.05)。

先天性生殖器官异常孕妇的母、胎围生期并发症发生风险高。提高该病孕妇的孕前及早孕期诊断率，加强围生期保健及处理，可改善其围生结局。

To investigate perinatal outcomes of pregnant women with congenital anomalies of genital organ.

From January 2009 to December 2019, a total of 99 779 cases of single pregnancy women who delivered live births in West China Second University Hospital, Sichuan University, were selected as research subjects. According to whether combined with congenital anomalies of genital organ or not, they were divided into observation group (n=324, combined) and control group (n=99 455, uncombined). Clinical data of two groups were retrospectively analyzed, and perinatal outcome of pregnant women in observation group were summarized. The incidence of complications during pregnancy, cesarean section rate and neonatal birth weight were statistically compared between two groups by chi-square test and independent-samples t test. The procedures followed in this study were in accordance with the World Medical Association Declaration of Helsinki revised in 2013.

① In observation group, top three most common congenital anomalies of genital organ of pregnant women were septate uterus, unicornuate/rudimentary horn uterus and arcuate uterus, accounting for 35.2%(114/324), 26.2%(85/324) and 13.9%(45/324), respectively. The pregnant women in observation group had a total of 571 pregnancies including previous pregnancies, the rates of spontaneous abortion of pregnant women with arcuate uterus and septate uterus were the top two, which were 38.5% (35/91) and 28.6% (61/213), respectively. The full term birth rate of pregnant women with vaginal anomalies (70.0%) was higher than that of pregnant women with uterine anomalies (52.8%), and the difference was statistically significant (χ²=4.432, P=0.035). ② The preterm birth rate, incidence of premature rupture of membranes, malpresentation, placental abruption, fetal growth restriction (FGR), placenta adhesions/accreta and uterine rupture, and cesarean section rate of pregnant women in observation group were 29.6%, 29.3%, 36.1%, 5.9%, 2.5%, 21.0%, 3.4%, 78.7%, respectively, which were statistically higher than those of 9.8%, 22.3%, 5.7%, 1.2%, 1.0%, 11.5%, 1.5%, 62.0% in control group, while the rate of oligohydramnios and neonatal birth weight were 0.9% and (2 913±652) g, which were significantly lower than those of 2.9% and (3 254±445) g in control group, and all the differences above were statistically significant (all P<0.05). There were no significant differences in rate of placenta previa, hypertensive disorder complicating pregnancy (HDCP) and postpartum hemorrhage (PPH), and hysterectomy rate between two groups (P>0.05).

Pregnant women with congenital anomalies of genital organ are at high risk of maternal and fetal perinatal complications. The pre-pregnancy and early pregnancy diagnosis rate of congenital anomalies of genital organ should be improved in pregnant women, and strengthening perinatal care and perinatal management can improve perinatal outcomes.