关键词: 异位妊娠, 相关因素, 剖宫产术, 患病率, 二孩政策

Abstract: Background　Ectopic pregnancy（EP）is one of the leading causes for mortality in the first trimester of pregnancy，whose prevalence and related risk factors change with the change of concepts of sexual culture，fertility policy，and the development of medical sciences.However，there have been no studies about the prevalence of the disease since the universal two-child policy implemented in 2016 in China.Objective　To explore the influence of the implementation of universal two-child policy on EP prevalence in Hebei Province.Methods　This study was conducted in a random sample of four hospitals，which were extracted from four prefecture-level cities（using a 1∶1 ratio）sampled from Hebei Province by GDP ranking and geographical location.Participants were EP patients who hospitalized in department of obstetrics and gynecology of these hospitals during 2015-2017.Clinical medical records（including age，disease prevalence，gravidity，parity，and medical history）were collected，and major changes in these data before and after the implementation of universal two-child policy （2015 and 2017）were compared，and analyzed the change trend from 2015 to 2017.Results　1 760 EP patients were included，accounting for 4.68%（1 760/37 635）of the total hospitalized pregnant patients in the same period.The prevalence of EP was much lower after the implementation of the universal two-child policy than before（χ2=57.866，P<0.001）.The number of vaginal deliveries，prevalence of pelvic and abdominal surgery，recurrent EP，and pelvic inflammatory disease increased successively in participants enrolled in 2015，2016 and 2017（P<0.05）.After the implementation of the policy，the number of vaginal（χ2=6.151，P=0.046） and cesarean deliveries（χ2=7.135，P=0.028），prevalence of pelvic and abdominal surgery（χ2=6.300，P=0.012），REP（χ2=4.659，P=0.031）and pelvic inflammatory disease increased significantly（P<0.05）.Those with REP showed higher prevalence of pelvic and abdominal surgery，cesarean section，fallopian tube surgery，and the ratio of smoking history than those with first EP（P<0.05）.Conclusion　 In Hebei，the prevalence of EP decreased after the implementation of the universal two-child policy，but the age of onset，number of vaginal and cesarean deliveries，prevalence of pelvic and abdominal surgery，REP and pelvic inflammatory disease all increased.

Key words: Ectopic pregnancy, Related factors, Cesarean section, Prevalence, Two-child policy