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  

Discussion on the Risk Factors Affecting the Vaginal Delivery of the Scarred Uterus and Its Influence on Pregnancy Outcome

作　　者：陈美娜[1] CHEN Meina(Department of Obstetrics,Xiamen Third Hospital,Xiamen,Fujian Province,361100 China)

机构地区：[1]厦门市第三医院产科,福建厦门361100

出　　处：《中外医疗》2021年第30期76-79,共4页China & Foreign Medical Treatment

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的影响。方法回顾性分析2019年1月—2020年12月该院86例疤痕子宫再次妊娠拟接受阴道试产孕妇的临床资料,根据试产结局,分为成功组(n=64)与失败组(n=22),比较两组基线资料,总结影响疤痕子宫再次经阴道分娩的危险因素,并对两组妊娠结局进行比较。结果86例疤痕子宫再次妊娠拟接受阴道试产的孕妇中试产成功64例,失败22例;成功组年龄<35岁、产前BMI<30 kg/m^(2)、距上次剖宫产时间≥3年、有阴道分娩史、子宫瘢痕厚度≥2 mm、胎儿体质量<3500 g、宫颈成熟度≥3分、未合并妊娠期糖尿病、无焦虑抑郁情绪率均高于失败组,差异有统计学意义(χ^(2)=17.086、18.758、5.760、6.509、5.305、8.513、44.035、11.306、12.366,P<0.05);多因素分析显示,产前BMI、距上次剖宫产时间、宫颈成熟度、子宫瘢痕厚度、胎儿体质量、焦虑抑郁情绪为影响疤痕子宫再次经阴道分娩的危险因素(P<0.05);成功组产后出血与发热率均低于失败组,产后住院时间短于失败组,差异有统计学意义(P<0.05)。结论影响疤痕子宫再次经阴道分娩的危险因素为产前BMI、距上次剖宫产时间、子宫瘢痕厚度、宫颈成熟度、胎儿体质量、焦虑抑郁情绪,阴道分娩成功有利于改善产妇妊娠结局。Objective To explore the risk factors that affect the vaginal delivery of the scarred uterus and its influence on pregnancy outcome.Methods A retrospective analysis of the clinical data of 86 pregnant women with scarred uterus who were to undergo vaginal trial delivery in the hospital from January 2019 to December 2020,they was divided into the success group(n=64)and the failure group(n=22)according to the outcome of the trial delivery.The baseline data of the two groups were compared,the risk factors affecting the vaginal delivery of the scarred uterus were summarized,and the pregnancy outcomes of the two groups were compared.Results Among the 86 cases of scar uterus pregnant women who planned to receive vaginal trial labor,64 cases succeeded in trial labor,22 cases failed.In the successful group,age<35 years,prenatal BMI<30 kg/m^(2),≥3 years since last cesarean section,history of vaginal delivery,uterine scar thickness≥2mm,fetal body weight<3500 g,cervical maturity≥3 points,no gestational diabetes mellitus,no anxiety and depression mood rate were higher than those in the failure group,the difference were statistically significant(χ^(2)=17.086,18.758,5.760,6.509,5.305,8.513,44.035,11.306,12.366,P<0.05).Multivariate analysis showed that,prenatal BMI,time since last cesarean section,cervical maturity,uterine scar thickness,fetal body mass,anxiety and depression were the risk factors affecting the second vaginal delivery of scar uterus(P<0.05);the rates of postpartum hemorrhage and fever in the successful group were lower than those in the failed group,and the length of postpartum hospitalization was shorter than that in the failed group,the difference were statistically significant(P<0.05).Conclusion The risk factors that affect the vaginal delivery of the scarred uterus are prenatal BMI,time since the last cesarean section,uterine scar thickness,cervical maturity,fetal body weight,anxiety and depression.The successful vaginal delivery is beneficial to improve the pregnancy outcome of the parturient.

关 键 词：疤痕子宫 经阴道分娩 试产结局 危险因素 妊娠结局 负性情绪 

分 类 号：R5[医药卫生—内科学]