超声测量宫颈长度与剖宫产术后阴道分娩成功的相关性  

Relationship between cervical length by ultrasonic measurement and successful vaginal birth after cesarean section

作　　者：康苏娅[1] 周丽屏[1] 

机构地区：[1]南京医科大学附属苏州医院妇产科,苏州215002

出　　处：《现代妇产科进展》2016年第9期676-679,共4页Progress in Obstetrics and Gynecology

基　　金：苏州市妇产疾病临床医学中心(No:SZZX201505)

摘　　要：目的:分析剖宫产术后阴道分娩(VBAC)的影响因素。方法:选取剖宫产术后阴道试产(TOLAC)的114例孕妇。超声测定其宫颈长度,根据最终是否成功VBAC分为成功组和失败组,采用单因素和多因素Logistic回归分析影响VBAC的因素,观察宫颈长度是否是影响VBAC的独立因素。结果:TOLAC成功率为46.49%。单因素分析显示,成功组和失败者的年龄、出血量、孕产次、距上次剖宫产时间、上次是否进入产程、分娩孕周、阴道分娩史等比较,差异均无统计学意义(均P>0.05);成功组的自然临产率和分娩镇痛率均较失败组高(均P<0.05),新生儿体重低于失败组(P<0.05)。Logistics多因素分析显示,自然临产和宫颈长度为VBAC的独立影响因素,自然临产(B=3.014,P<0.001,OR=20.372)为TOLAC成功的保护因素,宫颈长度为TOLAC成功的危险因素(B=-0.091,P<0.05,OR=0.913)。成功组的平均宫颈长度(19.86±11.05)mm,明显短于失败组[(28.61±7.75)mm](P<0.01)。宫颈长度每减少1mm对TOLAC成功的优势比为1.095。结论:自然临产是TOLAC成功的有利因素,超声测量的宫颈长度为TOLAC成功率的独立影响因素。Objective：To explore the influencing factors affecting vaginal birth after ce-sarean section （ VBAC） . Methods：114 cases of pregnant women willing to trial of labor after cesarean （ TOLAC） were concluded. The cervix length was measured by ultrasound examina-tion. These cases were divided into successful group and fail group according to whether suc-cessful VBAC finally. Single factor analysis and multivariable Logistic regression analysis about the influencing factors affecting VBAC were conducted. The relationship between cervical length and VBAC was observed emphatically. Results：Success rate of TOLAC was 46. 49%. Single factor analysis showed no significant difference between the successful group and fail group in age,amount of bleeding,gravidity and parity history,time from last cesarean,whether having en-tered stages of labor last time,gestational age of delivery,vaginal delivery history,etc（all P〉0 . 05 ） . The rate of spontaneous parturition and labor analgesia were both higher in successful group than that of fail group （both P〈0. 05）,while the weight of neonates was lower in success-ful group（P〈0. 05）. Logistics analysis showed spontaneous parturition and cervix length were independent factors influencing VBAC. Spontaneous parturition was a protection factor for suc-cess of TOLAC（B=3. 014,P〈0. 001,OR= 20. 372）;while cervix length was a risk factor for success of TOLAC （B=-0. 091,P〈0. 05,OR=0. 913）. Average cervical length of successful group was （19. 86±11. 05）mm,significantly shorter than length of fail group[（28. 61±7. 75） mm]（P〈0. 01）. For each reduction of 1 mm in the cervical length,the odds ratio for successful VBAC was 1 . 095 （ P〈0 . 05 ） . Conclusions：Spontaneous parturition is favorable factors for suc-cess of TOLAC,and cervix length measured by ultrasound is an independent factor influencing success rate of TOLAC. Cervical length is shorter,the better for VBAC.

关 键 词：宫颈长度 超声测量 剖宫产后阴道试产( TOLAC) 剖宫产术后阴道分娩( VBAC) 影响因素 

分 类 号：R714.7[医药卫生—妇产科学]