剖宫产术后再次妊娠经阴道分娩的妊娠结局及相关因素分析  

Analysis of pregnant outcome and related factors of vaginal birth after cesarean section

作　　者：李认认 朱锦明[1] LI Renren;ZHU Jinming(Department of Obstetrics,Xuzhou Maternal and Children Health Care Hospital in Jiangsu Province,Xuzhou 221000,China)

机构地区：[1]江苏省徐州市妇幼保健院产科,江苏徐州221000

出　　处：《中国现代医生》2020年第19期72-75,共4页China Modern Doctor

摘　　要：目的探讨剖宫产术后再次妊娠经阴道分娩的妊娠结局及影响因素。方法选取2019年1~12月在徐州市妇幼保健院分娩的符合剖宫产后阴道试产(TOLAC)条件的孕妇1024例,其中882例选择重复剖宫产(ERCS)为ERCS组,经阴道分娩(VBAC)者91例为VBAC组,TOLAC失败转剖宫产者51例为TOLAC失败组。比较ERCS与VBAC组新生儿及分娩情况,另探讨影响阴道分娩成功的相关因素。结果VBAC组新生儿窒息率显著高于ERCS组(P<0.05),产后出血率、产褥病率、住院费用和住院时间显著低于ERCS组(P<0.05)。VBAC组与TOLAC失败组阴道分娩史、宫颈评分及胎儿体重有显著差异(P<0.05),多因素Logistic回归分析显示,宫颈评分、胎儿体重是VBAC成功的影响因素。结论严格把握瘢痕子宫再次阴道分娩的适用证的情况下TOLAC是可行的,宫颈评分高及胎儿体重低是VABC成功的有利因素。Objective To explore the pregnancy outcome and influencing factors of re-pregnancy vaginal delivery after cesarean section.Methods 1024 pregnant women meeting the conditions of trial of labor after cesarean(TOLAC)who delivered at Xuzhou Maternity and Child Health Care Hospital from January to December 2019 were selected.Among them,the 882 who chose elective repeat cesarean section(ERCS)were taken as the ERCS group,the 91 who had vaginal birth after cesarean section(VBAC)were taken as the VBAC group,the 51 who suffered the failure of TOLAC and transferred to cesarean section were taken as the TOLAC failure group.The newborn and delivery situation in the ERCS group and the VBAC group were compared,and the related factors affecting the success of vaginal delivery were also explored.Results The neonatal asphyxia rate in the VBAC group was significantly higher than that in the ERCS group(P<0.05),and the postpartum hemorrhage rate,puerperal morbidity,hospitalization expense and time were significantly lower than those in the ERCS group(P<0.05).There were significant differences in vaginal delivery history,cervical scores and fetal weight between the VBAC group and the TOLAC failure group(P<0.05).Multivariate Logistic regression analysis showed that cervical scores and fetal weight were the influencing factors of VBAC success.Conclusion TOLAC is feasible when the indications of vaginal delivery of scarred uterus are strictly grasped.High cervical scores and low fetal weight are favorable factors for VBAC success.

关 键 词：瘢痕子宫 再次妊娠 阴道分娩 妊娠结局 

分 类 号：R714.15[医药卫生—妇产科学]