摘要目的：通过回顾性研究3840例前置胎盘（PP）孕妇，探讨PP孕妇围产期行子宫切除术的危险因素。方法收集四川大学华西第二医院2005年1月至2014年6月收治的3840例PP孕妇的临床资料，回顾性分析PP孕妇年龄、居住地、产次、人工流产刮宫手术次数、既往剖宫产次数、双胎或多胎妊娠、产前阴道流血、PP类型、胎盘位于子宫前壁、胎盘植入征象、产前血红蛋白水平、分娩孕周与围产期行子宫切除术的关系。结果（1）PP的发生率为4.84%（3840/79304），PP孕妇的子宫切除率为2.76%（106/3840）。（2）影响PP孕妇行子宫切除术的危险因素单因素分析显示，居住地、产次、人工流产刮宫手术次数、既往剖宫产次数、产前阴道流血、PP类型、胎盘位于子宫前壁、胎盘植入征象、产前血红蛋白水平、分娩孕周均为PP孕妇行子宫切除术的危险因素（P<0.01）。多因素logistic回归分析显示，既往剖宫产史1次（OR=12.9，95%CI为6.3～26.3）、剖宫产史≥2次（OR=14.4，95%CI为3.9～53.2）、胎盘位于子宫前壁（OR=4.8，95%CI为2.1～10.7）、中央性PP（OR=5.9，95%CI为1.8～42.5）、胎盘植入征象（OR=11.2，95%CI为6.8～18.6）、分娩前血红蛋白<100 g/L（OR=1.7，95%CI为1.0～2.8）、分娩孕周<34周（OR=3.2，95%CI为1.6～6.3）是PP孕妇行子宫切除术的独立危险因素，子宫切除率风险明显增高（P<0.05）。结论既往剖宫产次数、胎盘位于子宫前壁、PP类型为中央性、胎盘植入、产前贫血、孕周<34周是PP孕妇围产期行子宫切除术的独立危险因素；因PP而行子宫切除术的患者占围产期行子宫切除术患者的比例较大，重视产前保健、术前风险评估，对减少子宫切除、改善PP母儿预后至关重要。

abstractsObjective To investigate the risk factors of peripartum hysterectomy in placenta previa through retrospective study of 3 840 placenta previa cases. Methods The clinical data of 3 840 patients with placenta previa who delivered in West China Second University Hospital between Jan 2005 and June 2014 were analyzed retrospectively. The relationship of certain factors and peripartum hysterectomy was analyzed, including maternal age, residence place, parity, prior curettage, prior cesarean section, twin or multiple pregnancy, antenatal vaginal bleeding, type of placenta previa, suspected placenta accreta, antenatal level of hemoglobin and gestational age at delivery. Results The prevalence of placenta previa was 4.84% (3 840/79 304) in West China Second University Hospital during the study period, and the incidence of preipartum hysterectomy in patients with placenta previa was 2.76% (106/3 840). One-factor analysis demonstrated that residence place, parity, times of prior curettage, prior cesarean section, prenatal vaginal bleeding, anterior placenta, type of placenta previa, placenta accreta, antenatal anemia and gestational age at delivery were potential risk factors for peripartum hysterectomy (P<0.01). Variables with P<0.1 in one-factor analysis were introduced to multi-factor logistic regression analysis, which suggested that one prior cesarean section (OR=12.9,95%CI:6.3-26.3), two or more prior cesarean sections (OR=14.4,&nbsp;95%CI:3.9-53.2), anterior placenta (OR=4.8, 95%CI:2.1-10.7), complete placenta previa (OR=5.9, 95%CI:1.8-42.5), placenta accreta (OR=11.2, 95%CI:6.8-18.6), antenatal hemoglobin<100 g/L (OR=1.7, 95%CI:1.0-2.8) and delivery before 34 gestational weeks (OR=3.2, 95%CI:1.6-6.3) were independent risk factors of peripartum hysterectomy in patients with placenta previa (P<0.05). Conclusions Prior cesarean section, anterior placenta, complete placenta previa, placenta accreta, antenatal anemia and delivery before 34 gestational weeks are high risk factors of peripartum hysterectomy in placenta previa patients. Perinatal care and risk evaluation before cesarean section are important to improve perinatal outcomes and reduce peripartum hysterectomy.