先兆流产患者保胎成功影响因素分析

Analysis of Influencing Factors on Successful Pregnancy Preservation in Patients with Threatened Abortion

摘要: 目的：探讨影响先兆流产患者保胎成功的相关因素，为临床早期识别高危人群、制定个体化干预方案提供参考依据。方法：采用回顾性队列研究方法，收集2022年1月至2025年5月于本院收治的70例先兆流产患者的临床资料。根据妊娠结局分为保胎成功组(n = 54)与保胎失败组(n = 16)。比较两组患者的基线资料，并采用单因素及多因素Logistic回归分析筛选影响保胎结局的独立因素。结果：本研究保胎成功率为77.14% (54/70)。单因素分析显示，保胎成功组与失败组在初始孕酮、雌二醇、D-二聚体水平及既往流产史 ≥ 2次的占比上差异均有统计学意义(均P < 0.05)。多因素Logistic回归分析证实，较低的初始孕酮水平(OR = 0.72, 95% CI: 0.61~0.84, P < 0.01)是保胎成功的保护因素，而既往流产次数 ≥ 2次(OR = 3.50, 95% CI: 1.23~9.95, P < 0.05)和较高的D-二聚体水平(OR = 4.35, 95% CI: 1.14~16.59, P < 0.05)是保胎失败的独立危险因素。结论：初始孕酮水平、D-二聚体水平及既往流产史是影响先兆流产患者保胎结局的关键独立因素。临床应对存在上述高危因素的患者加强监测，并及时采取针对性的孕激素补充及抗凝管理等干预措施，以期改善妊娠预后。

Abstract: Objective: To explore the related factors influencing the success of pregnancy preservation in patients with threatened abortion, and to provide a reference basis for the early clinical identification of high-risk groups and the formulation of individualized intervention plans. Methods: A retrospective cohort study was conducted to collect the clinical data of 70 patients with threatened abortion admitted to our hospital from January 2022 to May 2025. According to the pregnancy outcomes, they were divided into the successful pregnancy preservation group (n = 54) and the failed pregnancy preservation group (n = 16). The baseline data of the two groups of patients were compared, and univariate and multivariate Logistic regression analyses were used to screen the independent factors influencing the outcome of pregnancy protection. Result: The success rate of fetal protection in this study was 77.14% (54/70). Univariate analysis showed that there were statistically significant differences between the successful pregnancy maintenance group and the failed group in the levels of initial progesterone, estradiol, D-dimer, and the proportion of previous miscarriage history ≥ 2 times (all P < 0.05). Multivariate Logistic regression analysis confirmed that a lower initial progesterone level (OR = 0.72, 95% CI: 0.61~0.84, P < 0.01) was a protective factor for successful pregnancy maintenance. However, the number of previous miscarriages ≥ 2 times (OR = 3.50, 95% CI: 1.23~9.95, P < 0.05) and a higher D-dimer level (OR = 4.35, 95% CI: 1.14~16.59, P < 0.05) were independent risk factors for failed pregnancy maintenance. Conclusion: The initial progesterone level, D-dimer level and previous history of miscarriage are the key independent factors affecting the pregnancy preservation outcome of patients with threatened miscarriage. Clinical monitoring should be strengthened for patients with the above-mentioned high-risk factors, and targeted intervention measures such as progesterone supplementation and anticoagulation management should be taken in a timely manner to improve the prognosis of pregnancy.