剖宫产术后再次妊娠阴道试产151例临床分析  

Clinical analysis of 151 cases of trial of labor after cesarean section

作　　者：杨玉侠[1] 王小新[2] 张诚燕[2] 邹丽颖[2] YANG Yuxia;WANG Xiaoxin;ZHANG Chengyan;ZOU Liying(Tangshan Maternal and Child Health Care Hospital, Hebei Province, Tangshan 063000, China;Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China)

机构地区：[1]河北省唐山市妇幼保健院,河北唐山063000 [2]首都医科大学附属北京妇产医院产科,北京100026

出　　处：《中国医药导报》2019年第3期75-79,共5页China Medical Herald

基　　金：首都临床特色应用研究与成果推广项目(Z151100004015182);首都医科大学附属北京妇产医院中青年学科骨干培养专项(fcyy201511)

摘　　要：目的探讨影响剖宫产术后再次妊娠阴道试产成功率的因素。方法选取首都医科大学附属北京妇产医院2016年1月～2017年6月期间,符合阴道试产条件,并自愿阴道试产的151例剖宫产术后再次妊娠孕妇为研究对象。按分娩结局分成剖宫产术后阴道试产(TOLAC)成功组和失败组,比较分析两组孕妇的一般情况及母儿预后。结果 151例TOLAC孕妇中,成功分娩125例(成功组),失败后中转剖宫产26例(失败组),成功率为82.78%,子宫破裂1例,子宫破裂率为0.66%。两组孕妇的一般情况比较:孕前体重指数(BMI)、分娩前BMI、孕次、产次、子宫下段厚度、前次剖宫产距本次分娩间隔差异均无统计学意义(P> 0.05);TOLAC成功组分娩年龄高于失败组,差异有高度统计学意义(P <0.01)。剔除早产病例后,孕足月TOLAC成功组分娩年龄与失败组比较差异无统计学意义(P> 0.05)。成功组引产率明显低于失败组(P <0.01)。两组孕妇产后2 h出血量、新生儿体重比较差异无统计学意义(P> 0.05);成功组新生儿1 min Apgar评分高于失败组(P <0.05)。结论 TOLAC是否成功,与孕妇的年龄、孕次、产次、孕前BMI、分娩前BMI、分娩前子宫下段厚度、前次剖宫产距本次分娩间隔等均无关,而不能自然临产、引产干预可能与分娩成功率下降有关。Objective To explore the factors influencing the success rate of vaginal delivery after cesarean section. Methods One hundred and fifty-one pregnant women after cesarean section and voluntary vaginal delivery, who did their prenatal care in Beijing Obstetrics and Gynecology Hospital, Capital Medical University from January 2016 to June 2017, were involved. They were divided into the success group and the failure group according to the outcome of trial of labor after cesarean (TOLAC). The general situation and prognosis of two groups were compared and analyzed. Results In 151 cases of TOLAC, 125 cases were successfully delivered (success group) and 26 cases were transferred to cesarean section after failure (failure group). The success rate was 82.78%. There was 1 uterine rupture and the uterine rupture rate was 0.66%. There was no significant difference in the pre-pregnancy body mass index (BMI), ante partum BMI, the gravidity, the parity, thickness of the lower uterine segment and the interval time of the previous cesarean section between two groups (P > 0.05). The age of success group was highly significantly higher than that of failure group (P < 0.01). After removing preterm birth cases, there was no statistically significant difference in the age between two groups (P > 0.05). The induction rate of success group was lower than that of failure group (P < 0.01). There was no significant difference in postpartum 2 h blood loss and neonatal body weight between the two groups (P > 0.05). The 1 min Apgar score of the success group was significantly higher than that of the failure group (P < 0.05). Conclusion Age, the gravidity, the parity, pre-pregnancy BMI, ante partum BMI, thickness of lower uterine segment before delivery and the interval time of previous cesarean section do not affect the outcome of TOLAC. The inability to spontaneous labor and the intervention of induced labor may be related to the decrease of the success rate of vaginal delivery.

关 键 词：剖宫产术后再次妊娠 阴道试产 分娩结局 影响因素 

分 类 号：R719[医药卫生—妇产科学]