剖宫产术后再次妊娠阴道试产评分表的建立及应用  

Establish and application of scoring scale for trial of labor after cesarean section

作　　者：张冬梅 王雅莉 刘文枝 徐浏阳 陈淑梅 Zhang Dongmei;Wang Yali;Liu Wenzhi;Xu Liuyang;Chen Shumei(Department of Obstetrics and Gynecology,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学附属郑州中心医院妇产科,郑州450052

出　　处：《中华妇产科杂志》2022年第5期339-345,共7页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的建立剖宫产术后再次妊娠阴道试产(TOLAC)评分表,探讨此评分表对剖宫产术后再次妊娠阴道分娩(VBAC)的评估能力,提高TOLAC的成功率。方法回顾性分析2014年至2017年郑州大学附属郑州中心医院收治的661例TOLAC孕妇的分娩相关信息并参照相关文献建立本院的TOLAC评分表。对2018年1月至2019年12月本院TOLAC孕妇进行前瞻性队列研究,排除试产禁忌后440例孕妇纳入本研究。依据本院TOLAC评分表分为3组,0~6分组(94例),7~9分组(234例),10~15分组(112例),比较3组孕妇的阴道试产成功率、失败原因及母儿并发症发生率。结果(1)440例孕妇TOLAC的总体成功率为75.0%(330/440)。其中,0~6分组、7~9分组、10~15分组的成功率分别为53.2%(50/94)、76.9%(180/234)、89.3%(100/112),10~15分组的TOLAC成功率显著高于0~6分组和7~9分组(P均<0.05)。(2)阴道试产失败原因中,先兆子宫破裂和孕妇放弃的发生率分别在3组中比较,差异有统计学意义(P均<0.05)。进一步两两比较显示,0~6分组先兆子宫破裂和孕妇放弃的发生率均低于7~9分组和10~15分组,差异均有统计学意义(P均<0.05)。(3)母儿并发症主要包括产后出血和新生儿窒息,其发生率分别在3组TOLAC成功或失败孕妇中比较,差异均无统计学意义(P均>0.05)。各组均无子宫破裂的发生。(4)影响3组孕妇TOLAC评分的主要因素包括自然临产、本次胎儿估计体重、入院子宫颈Bishop评分和孕周,以上指标在10~15分组中的评分均显著高于0~6分组和7~9分组(P均<0.05)。结论TOLAC评分表对VBAC具有较准确的评估能力,能够提高TOLAC的成功率和母儿安全性。评分为0~6分者不推荐阴道试产,7~9分者建议阴道试产,10~15分强烈推荐阴道试产。Objective To establish a scoring scale for trial of labor after cesarean section(TOLAC),to explore the evaluation ability of this scoring scale for vaginal delivery after cesarean section(VBAC),and to improve the success rate of TOLAC.Methods The delivery information of 661 TOLAC pregnant women admitted to Zhengzhou Central Hospital Affiliated to Zhengzhou University from 2014 to 2017 was retrospectively analyzed,and the TOLAC scoring scale was established by referring to relevant literatures.A prospective cohort study of pregnant women with TOLAC from January 2018 to December 2019 in Zhengzhou Central Hospital was conducted,including 440 pregnant women who were excluded from contraindications in trial labor.According to TOLAC scoring scale,pregnant women were divided into 3 groups,0-6 group(94 cases),7-9 group(234 cases)and 10-15 group(112 cases).The success rate of trial labor,failure reasons and incidence of maternal and neonatal complications were compared among the three groups.Results(1)The overall success rate of TOLAC in 440 pregnant women was 75.0%(330/440).The success rates of 0-6,7-9 and 10-15 groups were 53.2%(50/94),76.9%(180/234)and 89.3%(100/112),respectively.The success rate of 10-15 group were significantly higher than those of 0-6 and 7-9 groups(all P<0.05).(2)Among the causes of trial labor failure,there were statistically significant differences between the three groups in terms of threatened uterine rupture and maternal abandonment(all P<0.05).Pairings showed that the incidences of threatened uterine rupture and maternal abandonment in 0-6 group was lower than those in 7-9 and 10-15 groups,and the differences were statistically significant(all P<0.05).(3)Maternal and neonatal complications mainly included postpartum hemorrhage and neonatal asphyxia,but there were no significant difference in the incidence of TOLAC success or failure among the three groups(all P>0.05).There was no uterine rupture in all groups.(4)The main factors affecting TOLAC score of pregnant women in the three groups incl

关 键 词：剖宫产后阴道分娩 试分娩 危险性评估 

分 类 号：R714.4[医药卫生—妇产科学]