剖宫产术后阴道分娩成功的影响因素  

Factors affecting success of trial of labor after cesarean delivery

作　　者：罗漫灵[1] 陈旭菲 于燕[1,3] 钟梅[1] 汪丽萍[1] 黎静[1] 行李琳[1] 李佳[1] 殷为[1] 杨师琪 

机构地区：[1]南方医科大学南方医院妇产科,广州510515 [2]广东省东莞市石龙镇人民医院妇产科,523321 [3]广东省深圳市宝安区妇幼保健院妇产科,518100

出　　处：《中华围产医学杂志》2016年第2期99-103,共5页Chinese Journal of Perinatal Medicine

摘　　要：目的探讨剖宫产术后阴道分娩（vaginal birth after cesarean，VBAC）成功的影响因素。方法2009年1月至2013年12月，在南方医科大学南方医院妇产科住院分娩的孕妇中，纳入435例剖宫产术后阴道试产的孕妇为研究对象。纳入标准为：单次剖宫产史，无阴道分娩绝对禁忌证并自愿要求阴道试产；足月妊娠、单胎妊娠、头位、自然临产；不合并内外科疾病。根据人院时体重指数、年龄、本次分娩距前次剖宫产时间、人院时宫口开大及宫颈管消失情况、是否有阴道分娩史、前次剖宫产指征是否为复发型以及新生儿出生体重分组，比较组间VBAC成功率。采用单因素和多因素Logistic回归分析影响VBAC成功的因素。结果435例孕妇中，成功阴道分娩315例（72．4％）。单因素分析结果显示，与对照组比较，人院时体重指数〈28[60．9％（56／92）与75．5％（259／343）]、本次分娩距前次剖宫产时间〉2年[64．1％（59／92）与74．6％（256／343）]、人院时宫口开大〉3cm[67．1％（235／350）与94．1％（80／85）]、宫颈管消失〉50％[59．7％（117／196）与82．8％（198／239）]、有阴道分娩史[66．0％（212／321）与90．4％（103／114）]、前次剖宫产指征为非复发型[59．6％（31／52）与74．2％（284／383）]、新生儿出生体重〈3500g[66．2％（92／139）与75．3％（223／296）]的孕妇，VBAC成功率相对较高，差异均有统计学意义[OR值（95％CI）分别为1．982（1．220-3．221）、1．644（1．008-2．688）、7．830（3．087～19．875）、3．261（2．098-5．069）、4．814（2．480～9．345）、1．943（1．067～3．538）和1．561（1．005～2．422），P值均〈0．051。孕妇年龄≥35岁与〈35岁者比较，VBAC成功率[75．0％（36／48）与72．1％（279／387）]差异无统计学意义（OR=0．861，95％CI：0．432～1．717，P〉0．05）。Logistic多因素分析结果�Objective To explore the influencing factors affecting the success of trial of labor after cesarean （TOLAC）. Methods Delivery outcomes of 435 pregnant women after cesarean section who had TOLAC in Nanfang Hospital of Southern Medical University between January 2009 and December 2013 were retrospectively analyzed. All of the recruited women were term singleton pregnant with cephalic presentation, spontaneous labor, history of single cesarean section （CS）, but without medical problems or contraindications of vaginal delivery, and they were willing to have a trial of labor. Factors including maternal body mass index （BMI）, age, interval between this delivery and last cesarean delivery, cervix dilation and effacement on admission, history of vaginal delivery, presentation of previous cesarean delivery indication, and neonatal birth weight were analyzed by bivariate analysis and multivariable logistic regression. Results Among the 435 gravidas, 315（72.4%） succeeded in vaginal birth after cesarean （VBAC）, whereas 120 failed. Compared with the corresponding controls, those women whose BMI at admission 〈28 [75.5% （259/343） vs 60.9% （56/92）], interval between this delivery and last cesarean delivery 〉2 years [74.6% （256/343） vs 64.1% （59/92）] , cervix dilation 〉3 cm at admission [94.1% （80/85） vs 67.1%（235/350）], cervical effacement 〉50% at admission [82.8% （198/239） vs 59.7%（117/196）], and those who had history of vaginal birth [90.4% （103/114） vs 66.0% （212/321）], repeated indications of previous CS [74.2% （284/383） vs 59.6% （31/52）], gave birth to a baby less than 3 500 g [75.3%（223/296） vs 66.2%（92/139）] showed significantly higher VBAC successful rate [adjusted 0R（95%CI）： 1.982（1.220-3.221）, 1.644（1.008-2.688）, 7.830（3.087-19.875）, 3.261（2.098-5.069）, 4.814（2.480-9.345）, 1.943（1.067-3.538）, 1.561（1.005-2.422）, all P〈0.05]. However, the VBAC success rate showed no difference between women ≥ 35 and

关 键 词：剖宫产后阴道分娩 接生 产科 预后 

分 类 号：R714.3[医药卫生—妇产科学]