疤痕子宫再次经阴道分娩危险因素及对妊娠结局影响  

Risk factors of vaginal delivery of women with scarred uterus and its effect on pregnancy outcomes

作　　者：曹春珠 陈兵[1] 郑云英[1] CAO Chunzhu;CHEN Bing;ZHENG Yunying(Xinglin Branch Hospital of the First Hospital Affiliated to Xiamen University, Fujian Province, 361022)

机构地区：[1]厦门大学附属第一医院杏林分院,361022

出　　处：《中国计划生育学杂志》2020年第8期1292-1295,共4页Chinese Journal of Family Planning

摘　　要：目的:探讨影响疤痕子宫再次经阴道分娩的危险因素及对妊娠结局影响。方法:回顾性收集2017年1月—2019年1月本院妇产科收治的疤痕子宫再次妊娠拟行阴道试产孕妇300例临床资料,根据是否试产成功分为阴道分娩组和剖宫产组。logistic回归分析影响疤痕子宫再次经阴道分娩因素,观察不同分娩方式妊娠结局。结果:经阴道分娩成功225例(75.0%),阴道分娩组产后出血(1.3%)、产后发热(0.4%)、产后住院时间(3.0±0.5d)均小于剖宫产组(P<0.05)。产前BMI≥30 kg/m^2、无阴道分娩史、入院时胎膜早破、距上次剖宫产时间<3年、产前评估胎儿体重≥3500g、子宫瘢痕厚度<2mm、孕妇情绪紧张等是影响瘢痕妊娠经阴道分娩方式的主要危险因素。结论:疤痕子宫再次经阴道分娩有一定可行性,可降低产后出血、感染机率,缩短住院时间。产前体质量过高、无阴道分娩史、入院时胎膜早破、距上次剖宫产时间过短、胎儿体重偏大、子宫瘢痕较薄孕妇经阴分娩成功率低,孕妇情绪对分娩方式也有一定影响。Objective:To explore the risk factors of vaginal delivery of women with scarred uterus,and to analyze its effect on pregnancy outcomes.Methods:The clinical data of 300 pregnant women with scarred uterus who wanted vaginal delivery from January 2017 to January 2019 were collected retrospectively.And they were divided into group A(women with vaginal delivery successfully)and group B(women with turned to cesarean section).Logistic regression analysis was used to analyze the affect factors of vaginal delivery of women with scarred uterus.The pregnancy outcomes of women in both groups were observed.Results:225 women(75.0%)had vaginal delivery successfully.The rate of postpartum hemorrhage,postpartum fever,and postpartum hospital stay of women in group A were 1.3%,0.4%,and 3.0±0.5d,respectively,which were significant lower than those of women in group B(P<0.05).The prenatal BMI≥30kg/m^2,no history of vaginal delivery,premature rupture of membranes at admission,less than 3 years from the last cesarean section,the prenatal evaluated fetal weight≥3500g,uterine scar thickness<2 mm,and emotional stress of pregnant women were the main risk factors affected success vaginal delivery of women with scar pregnancy.Conclusion:It is feasible to success vaginal delivery of women with scarred uterus,which can reduce postpartum haemorrhage and infection,and can shorten hospital stay.The women with high weight during pregnancy,no history of vaginal delivery,premature rupture of the fetal membrane at admission,short time from the last cesarean section,excessive fetal weight,and the uterine scar thin have lower success rate of vaginal delivery,and mood of pregnant women also has some influence on delivery mode.

关 键 词：疤痕子宫再次分娩 经阴道分娩 妊娠结局 危险因素 

分 类 号：R714.4[医药卫生—妇产科学]