既往分娩史对剖宫产后阴道试产结局的影响  

The Influence of Previous Delivery History on TOLAC

作　　者：屈在卿[1] 马润玫[1] 杜明钰[1] 李航[1] 王名芳 胡晏馨 李颖[1] 

机构地区：[1]昆明医科大学第一附属医院,云南昆明650032

出　　处：《实用妇产科杂志》2017年第3期223-225,共3页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:探讨既往分娩史对剖宫产后阴道试产(TOLAC)患者成功率的影响。方法:回顾性分析2013年7月至2016年3月尝试TOLAC的瘢痕子宫孕妇的资料(妊娠≥28周),共506例,其中阴道分娩成功414例(TOLAC成功组),中转剖宫产92例(TOLAC中转剖宫产组)。比较两组前次剖宫产时间、剖宫产指征、阴道分娩史、新生儿存活情况等。结果:TOLAC中转剖宫产组的孕前体质量指数(BMI)及新生儿出生体质量大于TOLAC成功组(P<0.05),两组平均妊娠间隔时间比较差异无统计学意义(P>0.05),两组在妊娠间隔<1年、1~2年、2~3年、>3年的比例分别比较,差异无统计学意义(P>0.05)。两组的前次剖宫产指征分别比较,差异均无统计学意义(P>0.05)。TOLAC成功组有阴道分娩史患者比例明显高于TOLAC中转剖宫产组(P<0.05),新生儿未存活的比较差异无统计学意义(P>0.05)。结论:既往有阴道分娩史是TOLAC成功的有利因素,而既往分娩史的其他因素对TOLAC的成功率影响较小。Objective：To explore the impact of childbirth history on trial of labor after cesarean section （TOLAC）. Methods：A total of 506 patients with scarred uterus who tried TOLAC since July 2013 to March 2016 were recruited in this study. Results：Among the 506 patients, there were 414 patients with successful vaginal delivery （successful TOLAC group） and 92 patients with repeated cesarean section （CS） after failed TOLAC （failed TOLAC group）. The previous CS time and CS indications,vaginal delivery history and neonatal survival condition were compared between the two groups. The outcomes were as followes：The pre-pregnancy BMI and neonatal birth weight of failed TOLAC group were significantly higher than those of successful TOLAC group（ P 〈 0. 05）. The averaged pregnant interval time and the rates of the pregnant interval time （ 〈 1 year, 1 ~ 2 years,2 ~ 3 years, 〉3 years） in two groups had no significant difference（ P 〉 0. 05）. The previous CS indications of two groups including cephalopelvic disproportion had no significant differences （ P 〉 0. 05）. The proportion of patients with vaginal birth history in successful TOLAC group was significantly higher than that of failed TOLAC group（ P 〈 0. 05）, and the comparison of the other factors had no significant difference （ P 〉 0. 05）. Conclusions： Previous vaginal childbirth history is a favorable factor for the success of TOLAC. The other factors about previous delivery history had few influence on success of TOLAC.

关 键 词：剖宫产后阴道试产 既往分娩史 妊娠间隔 

分 类 号：R714.3[医药卫生—妇产科学]