阴道助产对剖宫产术后阴道分娩母婴结局的影响  

The effect of operative vaginal delivery on women with previous cesarean delivery

作　　者：彭静[1] 陈雅颂[1] 梁月梅 张丽[1] 陈丹玲[1] 刘国成[1] Peng Jing;Chen Yasong;Liang Yuemei;Zhang Li;Chen Danling;Liu Guocheng(Department of Obestetrics,Guangdong Women and Children Hospital,Guangzhou,510000,China)

机构地区：[1]广东省妇幼保健院产科,广州510000

出　　处：《中华产科急救电子杂志》2020年第3期180-185,共6页Chinese Journal of Obstetric Emergency（Electronic Edition）

摘　　要：目的探讨阴道助产对于剖宫产术后再次妊娠阴道分娩母婴结局的影响。方法回顾性分析2014年1月1日至2018年12月31日广东省妇幼保健院收治的剖宫产术后再次妊娠阴道分娩的567例产妇的临床资料,将成功阴道分娩者纳入顺产组475例,将阴道分娩过程中接受助产手术者纳入助产组92例(产钳助产59例、胎头吸引助产33例),比较两组母婴结局和并发症情况,以及不同助产方式母婴结局和并发症情况。结果(1)助产组高龄产妇29例(31.52%),顺产组89例(18.74%),两组相比差异有统计学意义(χ2=7.64,P<0.001);助产组住院时间(2.80±0.73)d,顺产组(2.04±0.24)d,差异有统计学意义(t=-18.13,P<0.001)。(2)助产组产后出血量(316.16±483.67)ml,产后出血率5.43%,顺产组产后出血量(201.38±144.43)ml,产后出血率1.26%,差异有统计学意义(t=-4.29,P<0.001;χ2=7.05,P=0.008);两组其他分娩并发症及新生儿并发症发生率均无统计学差异(P>0.05)。(3)两种助产方式之间相比,产钳组出胎时间(10.36±1.75)min,胎吸引产组出胎时间(12.12±2.36)min,差异有统计学意义(t=-4.09,P<0.001)。产钳组住院时间为(2.95±0.71)d,胎吸引产组为(2.55±0.71)d,差异有统计学意义(t=2.63,P=0.010);两种助产方式分娩并发症及新生儿并发症发生率无统计学差异(P>0.05)。结论阴道助产可能会增加剖宫产术后再次妊娠阴道试产产妇产后出血的风险,但未增加新生儿并发症的发生风险,产程中应根据母胎情况选择恰当的助产方式。Objective To investigate the effect of Operative Vaginal Delivery on women with one previous low transverse cesarean.Methods This a retrospective study.The clinical data of patients underwent a VBAC(vaginal birth after cesarean section,VBAC)were collected who were admitted to Department of Obstetrics of our hospital from January1,2014 to December 31,2018.The patients successfully underwent VBAC were included in the vaginal delivery group,patients who underwent forceps-assisted delivery or vacuum-assisted delivery were included in operative vaginal delivery group.The results and complications of the different groups were compared.Results(1)567 patients were enrolled.475 in vaginal delivery group.92 in operative vaginal delivery group,including 59 forceps-assisted vaginal delivery(62.58%),and 33 vacuum-assisted vaginal delivery(37.42%).(2)There were 29(31.52%)advanced maternal age cases in operative vaginal delivery group and 89 cases(18.74%)in vaginal delivery group.The difference between the two groups was statistically significant(χ2=7.64,P<0.001);The mean hospitalization time of patients in operative vaginal delivery group was 2.80±0.73 d,and that in vaginal delivery group was 2.04±0.24 d,the difference was statistically significant(t=-18.13,P<0.001).(3)The average amount and incidence of postpartum hemorrhage in operative vaginal delivery group was 316.16±483.67 ml and 5.43%,and that in vaginal delivery group was 201.38±144.43 ml and 1.26%,the differences were statistically significant(t=-4.29,P<0.001;χ2=7.05,P=0.008).there were no statistical difference in the incidence of other delivery complications and neonatal complications between the two groups.(4)Analysis between forceps-assisted group and vacuum-assisted group showed that the determine-to-delivery time interval was shorter in forceps-assisted group(10.36±1.75 min vs 12.12±2.36 min,t=-4.09,P<0.001),but the average hospitalization time was longer(2.95±0.71 d vs 2.55±0.71 d,t=2.63,P=0.010).There were no significant difference in other delivery

关 键 词：剖宫产术后阴道分娩 阴道助产术 子宫破裂 产钳助产术 胎头吸引术 

分 类 号：R714.2[医药卫生—妇产科学]