剖宫产后阴道试产失败的影响因素分析  

Factors Associated with the Failure of Trial of Labor after Cesarean Delivery

作　　者：陈永康 郑秀丽 刘静芳 王永军 CHEN Yongkang;ZHENG Xiuli;LIU Jingfang(Department of Obstetrics and Gynecology,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China)

机构地区：[1]首都医科大学附属北京积水潭医院妇产科,北京100035

出　　处：《实用妇产科杂志》2023年第8期621-625,共5页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:探讨剖宫产后阴道试产(TOLAC)失败的影响因素。方法:回顾性分析2017年1月至2020年12月在首都医科大学附属北京积水潭医院妇产科住院分娩的TOLAC患者的病例资料共174例。根据此次分娩结局分为剖宫产后阴道分娩(VBAC)组(122例)和TOLAC失败组(52例),对两组的一般资料进行单因素分析,对TOLAC失败的影响因素进行Logistic回归分析;再根据此次分娩是否自然临产,分为自然临产组(124例)和引产组(50例),比较两组在TOLAC失败率上是否有差异;分析引产组中VBAC(26例)和TOLAC失败者(24例)一般资料的差异性;分析TOLAC失败组中自然临产(28例)和引产者(24例)的再次剖宫产指征构成比有无差异。结果:VBAC组与TOLAC失败组在分娩孕周[39^(+3)(38^(+5),40^(+1))周vs.40^(+1)(39^(+2),40^(+4))周,P=0.002]、新生儿出生体质量(3308.44±451.57 g vs.3469.23±334.04 g,P=0.022)、自然临产率(78.69%vs.53.85%,P=0.001)差异有统计学意义;在年龄、2次分娩间隔时间、前次分娩是否临产差异均无统计学意义(P>0.05)。经Logistic回归分析自然临产是TOLAC失败的保护因素(OR 0.395,95%CI 0.186~0.838,P=0.015)。引产组的TOLAC失败率高于自然临产组(48.00%vs.22.58%,P=0.001),但两组在年龄(P=0.612)、分娩孕周(P=0.704)、子宫颈评分(P=0.120)、新生儿出生体质量(P=0.688)差异均无统计学意义。TOLAC失败组中自然临产和引产者再次剖宫产指征的构成比差异无统计学意义(P=0.924)。结论:自然临产降低TOLAC失败的风险,需引产者TOLAC失败率升高。但对于有引产指征的TOLAC孕妇,引产仍然是一种可行的选择。仅孕周>40周不应排除TOLAC。Objective:To study factors associated with the failure of trial of labor after cesarean delivery(TOLAC).Methods:174 cases of TOLAC who delivered in the Department of Obstetrics and Gynecology of Beijing Jishuitan Hospital,Capital Medical University,from January 2017 to December 2020 were retrospectively analyzed.According to the outcome of the delivery,174 cases were divided into vaginal birth after cesarean(VBAC)group(122 cases)and TOLAC failure group(52 cases).The general data of the two groups were analyzed by univariate analysis,and the influencing factors of failed TOLAC were analyzed by Logistic regression.The rate of TOLAC failure was compared between spontaneous labor group(n=124)and induced labor group(n=50).We analyzed the differences of general data between VBAC group(n=26)and TOLAC failure group(n=24)in women undergoing induction of labor,as well as the difference in the composition ratio of repeat cesarean section indications between spontaneous labor(n=28)and induced labor(n=24)in TOLAC failure group.Results:There were significant differences in gestational week of delivery[39^(+3)(38^(+5),40^(+1))weeks vs.40+1(39^(+2),40^(+4))weeks,P=0.002],birth weight(3308.44±451.57 g vs.3469.23±334.04 g,P=0.022)and spontaneous birth rate(78.69%vs.53.85%,P=0.001)between VBAC group and TOLAC failure group,but no significant differences in age,interpregnancy interval or whether the previous birth was in labor or not(P>0.05).Logistic regression analysis revealed that spontaneous labor was a protective factor for TOLAC failure(OR 0.395,95%CI 0.186-0.838,P=0.015).The failure rate of TOLAC in induced labor group was 48.00%,which was significantly higher than the rate(22.58%)in spontaneous labor group(P=0.001).In the induction group,differences in age(P=0.612),gestational age(P=0.704),cervical ripening(P=0.120)and birth weight(P=0.688)were not statistically significant between VBAC and TOLAC failure women.The difference in the composition ratio of repeat cesarean section indications was not statistically significant b

关 键 词：剖宫产后阴道试产 剖宫产后阴道分娩 选择性重复剖宫产 剖宫产 

分 类 号：R714.3[医药卫生—妇产科学]