剖宫产术后阴道分娩的产程特点及试产失败危险因素分析  

The characteristics of labor of women with vaginal delivery after cesarean and the risk factors of trial delivery failure

作　　者：辛昕[1] 许智 XIN Xin;XU Zhi(The First Affiliated Hospital of Shandong First Medical University (Shandong Qianfoshan Hospital), Jinan, Shandong Province, 250014)

机构地区：[1]山东第一医科大学第一附属医院(山东省千佛山医院),济南250014

出　　处：《中国计划生育学杂志》2020年第8期1316-1320,共5页Chinese Journal of Family Planning

摘　　要：目的:分析剖宫产术后阴道分娩(VBAC)的产程时间特点,探讨经阴道试产失败的高危因素。方法:回顾性收集2018年1月—2020年1月本院经阴道试产(TOLAC)产妇168例、经阴道分娩初产妇及经产妇各120例临床资料,按最终分娩方式将TOLAC产妇分为VBAC组与TOLAC失败组,比较VBAC组产程时间差异,分析试产失败的高危因素。结果:VBAC组产妇活跃期时间大于经产妇组但小于初产妇组,第二产程时间VBAC组及初产妇组无差异但均大于经产妇组(P<0.001),VBAC组、初产妇组、经产妇组在潜伏期时间及第三产程时间比较无差异(P>0.05)。年龄≥35岁、生育间隔≥5年的产妇TOLAC失败的比例高于年龄<35岁、生育间隔<5年者,文化程度为高中的产妇TOLAC失败的比例高于初中及以下、大专、本科及以上者(均P<0.001)。分娩孕周≥39周与分娩孕周<39周,前次剖宫产为未临产剖宫产与产程中转剖宫产,其TOLAC失败的比例未见差异(P>0.05)。年龄≥35岁是TOLAC失败的独立危险因素(P<0.05),生育间隔≥5年及文化程度等不是TOLAC失败的独立危险因素(P>0.05)。结论:VBAC的产妇产程时间不能完全等同于初产妇或经产妇,高龄会增加TOLAC失败的风险,临床应有所注意。Objective:To analyze the characteristics of labor of women with vaginal delivery after cesarean(VBAC),and to explore the high risk factors of the trial delivery failure.Methods:The clinical data of 168 women who had experienced the try of labor after cesarean(TOLAC)in group A,120 primipara after vaginal delivery in group B,and 120 multiparous in group C from January 2018 to January 2020 were collected retrospectively.And in group A,the women were divided into group A1(women with VBAC success)and A1(women with VBAC failure).The difference of labor time of women labor in group A1 was compared,and the risk factors of failure of vaginal delivery were analyzed.Results:The time of active stage of labor of women in group A1 was significant longer than that of women in group C,but was significant less than that of women in group B.The time of the second stage of labor of women in group A1 and group B was significant longer than that of women in group C(P<0.001),but there was no significant difference between group A1 and group B.There were no significant difference in the time of latency stage and the third stage of labor among group A1,group B and group C(P>0.05).The proportion of TOLAC failure of women with age≥35 years old or birth interval≥5 years was significant higher,the proportion of TOLAC failure of women with high school education level was significant higher than that of women with middle school or less,college,or undergraduate or above education level(all P<0.001).There was no statistical significant difference in the proportion of TOLAC failure between the women with≥39 gestational weeks when delivery and the women with<39 gestational weeks when delivery,and between the women with cesarean section before near the time of labor and the women with previous transfer to cesarean section(P>0.05).The women with≥35 years old was an independent risk factor of TOLAC failure(P<0.05),but birth interval≥5 years and education level were not independent risk factors of TOLAC failure(P>0.05).Conclusion:The labor

关 键 词：剖宫产术后 阴道分娩 产程时间 影响因素 

分 类 号：R714.4[医药卫生—妇产科学]