剖宫产术后再次妊娠阴道分娩与初产妇阴道分娩产程特征的比较分析  

Comparative analysis of labor pattern of vaginal delivery after cesarean section and vaginal delivery of nulliparas

作　　者：贾月改 吴晓[1] 柴利强[1] 康苏娅[1] JIA Yue-gai;WU Xiao;CHAI Li-qiang;KANG Su-ya(Department of Obstetrics and Gynecology,Suzhou Hospital Affiliated to Nanjing Medical University,Headquarter of Suzhou Municipal Hospital,Jiangsu Province,Suzhou 215000,China)

机构地区：[1]南京医科大学附属苏州医院苏州市立医院本部妇产科,江苏苏州215000

出　　处：《中国当代医药》2020年第35期20-24,共5页China Modern Medicine

基　　金：江苏省苏州市科技发展计划项目(SYSD2018210)。

摘　　要：目的比较分析新生儿结局良好的剖宫产术后再次妊娠阴道分娩(VBAC)与初产妇阴道分娩的产程特征。方法回顾性分析2017年1~12月于苏州市立医院本部成功阴道分娩并且新生儿结局良好(5 min Apgar评分≥8分)的单胎足月产妇的临床资料,包括290例无阴道分娩史的VBAC产妇,作为VBAC组;抽取同期经阴道分娩的311例初产妇,作为初产组。比较两组间总产程、不同阶段产程以及采取干预措施时的产程差异。结果VBAC组的总产程、第一产程宫口扩张2~10 cm阶段和第二产程均短于初产组[455.0(340.0,652.5)vs.530.0(380.0,733.0)min;100.0(60.0,190.0)vs.130.0(80.0,220.0)min;31.0(20.0,47.0)vs.43.0(28.0,69.0)min],差异有统计学意义(P<0.05)。两组的第三产程比较,差异无统计学意义(P>0.05)。VBAC组中自然分娩产妇的总产程、第一产程宫口扩张<2 cm阶段、宫口扩张2~10 cm阶段以及第二产程均短于初产妇自然分娩产妇[420.0(315.0,560.0)vs.487.5(371.3,646.3)min;300.0(180.0,408.8)vs.337.5(210.0,480.0)min;80.0(50.0,116.3)vs.109.0(60.0,150.0)min;28.0(18.0,45.0)vs.37.5(28.0,54.3)min],差异有统计学意义(P<0.05)。VBAC组与初产组中采取缩宫素、人工破膜和镇痛等干预措施产妇的总产程比较,差异无统计学意义(P>0.05)。结论与初产妇相比,自然分娩的VBAC产妇产程更短。因此,对剖宫产术后再次妊娠的孕妇,条件许可者可推荐尝试VBAC。Objective To compare and analyze the labor characteristics of vaginal delivery after cesarean section(VBAC)and vaginal delivery of nulliparas with good outcome.Methods The clinical data of single-term full-term maternal women who had successful vaginal delivery and normal neonatal outcomes(5-minute Apgar score≥7 points)from January to December 2017 in Headquarter of Suzhou Municipal Hospital were retrospectively analyzed,including 290 women undergoing VBAC as VBAC group,and 311 women with vaginal delivery at the same time were selected as the nulliparas group.Comparison of total labor duration and labor duration at different stages between two groups with or without interventions were performed.Results The total labor duration,the 2-10 cm period of the uterine dilation in the first labor stage,and the second labor stage in the VBAC group were shorter than those in the nulliparas group(455.0[340.0,652.5]vs.530.0[380.0,733.0]min;100.0[60.0,190.0]vs.130.0[80.0,220.0]min;31.0[20.0,47.0]vs.43.0[28.0,69.0]min),the differences were statistically significant(P<0.05).There was no statistically significant difference in the third stage of labor between the two groups(P>0.05).The total labor duration,<2 cm and 2-10 cm period of the uterine dilation in the first stage of labor,and the second stage of labor in the VBAC group with natural delivery were shorter than those in the nulliparas group with natural delivery(420.0[315.0,560.0]vs.487.5[371.3,646.3]min;300.0[180.0,408.8]vs.337.5[210.0,480.0]min;80.0[50.0,116.3]vs.109.0[60.0,150.0]min;28.0[18.0,45.0]vs.37.5[28.0,54.3]min),the differences were statistically significant(P<0.05).For women who took interventions such as Oxytocin,artificial rupture of membranes,and epidual analgesia,the total labor duration of the VBAC group was similar to that of the nulliparas group(P>0.05).Conclusion Compared with nulliparas,VBAC women with natural delivery has a shorter labor duration.Therefore,for pregnant women who are pregnant again after cesarean section,VBAC can be recommended to th

关 键 词：剖宫产术后再次妊娠阴道分娩 产程 初产妇 回顾性分析 

分 类 号：R714[医药卫生—妇产科学]