高龄产妇剖宫产术后再次妊娠阴道试产成功因素分析  

Analysis of the factors related to successful vaginal trial of labor after cesarean of advanced women

作　　者：时姗姗 郭茹 杨大平[2] 石荟莲[1] SHI Shanshan;GUO Ru;YANG Daping;SHI Huilian(Sixian People's Hospital,Anhui Province,234300;Suzhou Municipal Hospital,Anhui Province)

机构地区：[1]安徽省泗县人民医院,234300 [2]安徽省宿州市立医院

出　　处：《中国计划生育学杂志》2023年第10期2491-2494,2498,共5页Chinese Journal of Family Planning

摘　　要：目的:探究高龄产妇剖宫产术后再次妊娠阴道试产(TOLAC)成功的相关因素。方法:将本院2020年1月-2023年1月剖宫产且分娩年龄≥35岁产妇200例临床资料,根据TOLAC成功与否分为成功组与失败组,比较两组相关临床资料,单因素及多因素logistic回归分析影响TOLAC成功的相关因素并统计母婴结局。结果:TOLAC成功155例(77.5%),失败45例(22.5%)。成功组年龄、距上次剖宫产时间、产前体质指数、羊水分度、新生儿体质量均小于失败组,临产子宫颈Bishop评分、无焦虑症与无抑郁症比例均大于失败组(均P<0.05)。logistic回归分析显示,临床前子宫颈Bishop评分高是促TOLAC成功因素(P<0.05),而距离上次剖宫产时间长、羊水分度高、有焦虑症、抑郁症是影响TOLAC成功的危险因素(P<0.05)。成功组产后出血比例(3.9%)低于失败组(26.7%)(P<0.05)。结论:高龄产妇距离上次剖宫产时间、羊水分度、宫颈成熟度及心理状态均会影响TOLAC成功与否,需多方面兼顾、针对性干预以提高TOLAC成功率,减少产后出血。Objective:To explore the factors related to successful vaginal trial of labor after cesarean(TOLAC)of ad-vanced women.Methods:According to TOLAC success or not,200 advanced women with≥35 years old who hadbeen given cesarean section from January 2020 to January 2023 were divided into group A(women with TOLAC suc-ceeded)and group B(women with TOLAC failure).The clinical data of the women were compared between the twogroups.Univariate and multivariate Logistic regression analysis were conducted to analyze the related factors affectingTOLAC success of the women.The maternal and infant outcomes in the two groups were counted.Results:Therewere 155(77.5%)women with TOLAC succeeded and 45(22.5%)women with TOLAC failure.The age,the timesince the last cesarean section,the prenatal body mass index value,and the amniotic fluid situation of the women,andthe newborn body mass in group A were all significantly lower than those in group B,and the Bishop score of cervix atdelivery of the women and the proportions of the women without anxiety disorder or depression in group A were all sig-nificantly higher than those in group B(all P<o.05).Logistic regression analysis showed that the high preclinical cer-vical Bishop score of the women was the factor promoting their TOLAC success(P<0.05),while the long time sincethe last cesarean section,and the amniotic fluid abnormality,the anxiety and depression status of the women were therisk factors affecting their TOLAC success(P<0.05).The proportion of postpartum hemorrhage(3.9%)of thewomen in group A was significantly lower than that(26.7%)of the women in group B(P<0.05).Conclusion:Thetime since the last cesarean section,the amniotic fluid situation,the cervical ripeness,and the psychological states ofthe women can all affect their success of TOLAC,so many aspects of which should be need to consider,targeted inter-vention should be conducted to improve the success rate of TOLAC and to reduce the postpartum hemorrhage of thewomen.

关 键 词：高龄产妇 剖宫产 再次妊娠 阴道试产 影响因素 

分 类 号：R714.22[医药卫生—妇产科学]