瘢痕子宫再次妊娠孕产妇选择分娩方式的影响因素  

Investigation and Analysis of the Influencing Factors for Delivery Mode Selection in Pregnant Women with Scarred Uterus after Cesarean Section

作　　者：熊海燕[1] 钟敏[1] 付朝霞[1] 杨新凰 王芬[1] 

机构地区：[1]南方医科大学附属深圳市龙华区人民医院产科,广东深圳518109

出　　处：《医学临床研究》2017年第7期1284-1287,共4页Journal of Clinical Research

摘　　要：【目的】探讨瘢痕子宫再次妊娠孕产妇选择分娩方式的影响因素分析。【方法】制定问巷，选择2016年1月至2016年12月深圳市10个医院产科产检、住院待产、分娩的瘢痕子宫再次妊娠的孕产妇、家属及各级医院的妇产科医务人员为调查对象。分别发放问卷调查表，调查孕产妇及家属对瘢痕子宫再次妊娠顺产、剖宫产知识的知晓情况及妇产科医务人员的剖宫产后阴道分娩（VBAC）的知晓情况，采用I。ogistic回归分析影响孕产妇选择分娩方式的因素。【结果】993例孕产妇选择VBAC，其中648例试产成功（占65．26o．4），其比例明显高于选择再次剖宫产在待产期自然分娩的孕产妇（占11．01％）（Х^2=31．22，P=0．000）；孕妇居住地、对顺产及剖宫产知识的认知、对顺产的紧张度、既往有阴道分娩史、家属建议阴道分娩等对孕产妇分娩方式的选择均有影响（P〈0．05）；在回收的738份有效调查问卷中，医生认为可以阴道分娩的知晓率为61．65％（328／532），明显高于护士21．19％（50／236），其差异有统计学意义（Х^2=93．37，P=0．000）；三级医院医生对VBAC的知晓率为68．46％，明显高于二级（46．62％）和一级医院（20．69％），其差异有统计学意义（Х^2=45．26，P=0．000），其中专科医院医生和护士的知晓率均高于综合医院（P〈0．05）；具有高级职称的医务人员对VBAC的认知率明显高于初、中级职称的医务人员（P—0．000）。【结论】对瘢痕子宫再次妊娠阴道分娩知识及再次剖宫产史知识的认知对分娩方式的选择有影响，需加强此方面知识的宣传。[Objective]To understand the influencing factors of delivery mode selection in pregnant women with scarred uterus after cesarean section. [Methods]The pregnant women with scarred uterus after cesarean section and their family members, and medical staff in the Department of Obstetrics and Gynecology from 10 hospitals in Shenzhen were selected as the research subjects during January to December,2016. The awareness of delivery modes （ natural labor and cesarean section） for pregnant women with scarred uterus and their family members and the knowledge of vaginal birth after cesarean section （VBAC）for medical staff were surveyed by questionnaire. The influencing factors of delivery mode selection for pregnant women with scarred uterus were analyzed by Logistic regression . [Results]Among 993 pregnant women who chose VBAC for baby delivery, 648 cases were successful（65.25 %）. It was obviously much higher than pregnant women with repeated cesarean section（11.01%, Х^2 = 31.22, P = 0.000）.Many factors such as living place of pregnant women, awareness of natural labor and cesarean section,tension about natural labor, previous history of vaginal delivery, and family members＂ suggestion for vaginal delivery had influence on the delivery mode selection（all P〈0.05）.In the 738 effective questionnaires, the awareness rate of va ginal delivery by doctors was 61.65% （328/532）, which was significantly higher than that of nurses （21.19%, 50/236）. The difference was statistically significant （Zz= 93.37, P = 0.000）.The awareness degree of VBAC by medical staff from tertiary hospitals was 68.46 % ,which was obviously higher than those from secondary （46.62 %） and primary hospitals （20.69 % ） ; the difference was statistically significant（Xz = 45.26, P = 0.000）.Furthermore, the VBAC awareness degree of medical staff in specialized hospitals was higher than that of general hospitals（ P〈0.05） ;and the awareness degree of medical staff with senior professional title was higher than t

关 键 词：瘢痕 子宫 剖宫产术 自然分娩 危险因素 

分 类 号：R714.4[医药卫生—妇产科学]