剖宫产术后再次妊娠经阴道分娩成功的因素及母婴结局分析  

Influencing factors of vaginal birth after cesarean in re-pregnancy puerperae and mother-infant outcomes analysis

作　　者：张丽萍[1] 杨玉娇 曾雯琼 李晓琼[1] ZHANG Liping;YANG Yujiao;ZENG Wenqiong;LI Xiaoqiong(Department of Obstetrics,Huai′an Maternal and Child Health Care Hospital,Huai′an,Jiangsu,223002)

机构地区：[1]江苏省淮安市妇幼保健院产科,江苏淮安223002

出　　处：《实用临床医药杂志》2018年第7期78-81,共4页Journal of Clinical Medicine in Practice

摘　　要：目的分析剖宫产术后再次妊娠经阴道分娩(VBAC)成功的影响因素,探讨其对母婴结局的影响。方法选取290例行阴道试产的剖宫产术后再次妊娠孕妇,其中210例孕妇成功阴道分娩,选取180例作为观察组,80例试产失败行剖宫产术孕妇作为对照组,分析剖宫产术后再次妊娠经阴道分娩成功的影响因素,比较2组母婴结局。结果经单因素分析,2组胎头方位、胎儿腹围、胎儿双顶径、宫高、胎膜早破、Bishop评分、产时硬膜外麻醉等因素比较,差异有统计学意义(P<0.05);多因素Logistic回归分析显示,Bishop评分、胎儿腹围、胎头方位、产时硬膜外麻醉为VBAC成功的独立影响因素(P<0.05);2组产妇子宫破裂发生率、新生儿窒息率、住院率、Apgar评分比较,差异无统计学意义(P>0.05);观察组产妇产后2、24 h出血量显著低于对照组(P<0.05)。结论影响剖宫产术后再次妊娠经阴道分娩成功的因素较多,产前应科学评估,若未出现剖宫产术指征,应在密切监护下指导产妇进行阴道分娩,改善母婴结局,提升母婴生存质量。Objective To analyze the influencing factors of vaginal birth after cesarean(VBAC)in re-pregnancy puerperae and mother-infant outcomes.Methods A total of 290 re-pregnant women after cesarean were enrolled in the study,and 210 pregnant women were successfully given vaginal delivery,among whom 180 cases with vaginal birth were selected as the observation group,and 80 cases with cesarean section were as control group.The factors affecting the success of vaginal delivery after cesarean section were analyzed,and the maternal and neonatal outcomes between the two groups were compared.Results The univariate analysis showed that fetal head position,fetal abdominal circumference,fetal biparietal diameter,uterine height,premature rupture of membranes,Bishop score,and epidural anesthesia of two groups were statistically significant(P<0.05);Multivariate logistic regression analysis showed that Bishop score,fetal abdominal circumference,fetal head position,and epidural anesthesia were independent influencing factors of VBAC success(P<0.05).The incidence rates of uterine rupture,the rate of neonatal asphyxia,hospitalization rate,Apgar score of two groups showed no significant difference(P>0.05).The bleeding rates at 2,24 h in the observation group were lower than that in the control group(P<0.05).Conclusion There are various factors that affect the success of vaginal delivery after cesarean section,and prenatal examination should be scientifically evaluated.If there is no indication of cesarean section,maternal vaginal delivery should be guided to improve the maternal and child outcomes and life quality of mother and child.

关 键 词：剖宫产后阴道分娩 影响因素 母婴结局 子宫破裂 新生儿窒息率 

分 类 号：R714.15[医药卫生—妇产科学]