剖宫产妇女再次妊娠行TOLAC结局的相关因素研究  

STUDY ON THE RELATED FACTORS OF OUTCOME OF TOLAC IN WOMEN UNDERGOING CESAREAN SECTION

作　　者：胡馨予[1] 钟霖 江梅[1] 刘国秀 周丹[1] HU Xinyu;ZHONG Lin;JIANG Mei;LIU Guoxiu;ZHOU Dan(The First Peopled Hospital of NeijiangCity,Neijiang 641000,China)

机构地区：[1]四川省内江市第一人民医院,641000

出　　处：《中国煤炭工业医学杂志》2021年第4期445-448,共4页Chinese Journal of Coal Industry Medicine

基　　金：四川省科技厅重点科研项目(编号:2019YFS0444)。

摘　　要：目的探讨剖宫产后阴道试产(TOLAC)结局的相关因素,为临床阴道试产提供指导建议。方法采用回顾性研究方法,选取该院2018年3月—2020年3月有1次子宫下段横切口剖宫产术史再次妊娠且进行阴道试产的妇女作为研究对象,其中TOLAC成功200例(成功组)、TOLAC失败50例(失败组),分析二组妊娠妇女的年龄、孕次、孕周、胎儿出生体重等基线数据,采用Logistic回归分析法探讨TOLAC结局的相关影响因素。结果成功组和失败组的年龄、受教育年限、孕次、孕周、瘢痕肌层厚度差异均无统计学意义(均P>0.05);成功组孕妇分娩时BMI、剖宫产瘢痕年限、胎儿出生体重均低于失败组,差异均有统计学意义(均P<0.05);成功组临产时bishop评分、临产入院率、镇痛分娩率均高于失败组,差异均有统计学意义(均P<0.05);Logistic回归分析结果显示分娩时BMI越大、剖宫产瘢痕年限越长、胎儿出生体重、临产时bishop评分越低,TOLAC失败率越高,非临产入院是TOLAC失败的独立危险因素(P<0.05)。结论TOLAC前进行相关评估及干预,对提高TOLAC的成功率具有一定的意义。Objective To explore the related factors of the outcome of TOLAC after cesarean section,to guide clinical vaginal labor and to provide guidance and suggestions.Methods Using retrospective research methods,we selected women who had a history of a lower uterine cesarean section from March 2018 to March 2020 and were pregnant again and underwent vaginal trial delivery as the research objects.Among them,two hundred successful cases of TOLAC(success group),50 cases of TOLAC failure(failure group),the baseline data of the two groups of pregnant women,such as age,gestation times,gestational age,and fetal birth weight,were analyzed,and logistic regression analysis was used to explore the relevant factors affecting the TOLAC outcome.Results There was no significant difference in age,years of education,gestation,gestational age,and scar muscle thickness between the success group and the failure group(P>0.05);the pregnant women in the success group had no significant differences in BMI,cesarean section scar years,and fetal birth weight.It was lower than the failure group,the difference was statistically significant(P<0.05);the bishop score during labor,the admission rate during labor,and the analgesic delivery rate of the successful group were higher than those of the failure group,the difference was statistically significant(P<0.05);Logistic Regression model,the results showed that the larger the BMI during delivery,the longer the cesarean section scar,the lower the fetal birth weight,and the lower the bishop score during labor,the higher the TOLAC failure rate.Non-labor admission is an independent risk factor for TOLAC failure(P<0.05).Conclusion Relevant assessment and intervention before TOLAC is of certain significance for improving the success rate of TOLAC.

关 键 词：剖宫产 阴道试产 LOGISTIC回归 

分 类 号：R719.8[医药卫生—妇产科学]