剖宫产术后瘢痕子宫患者再次妊娠阴道分娩发生子宫破裂的影响因素分析  

Influencing factors of uterine rupture during vaginal delivery in patients with scarred uterus after cesarean section

作　　者：居晓庆[1] 金蕴洁 王晓燕 Ju Xiaoqing;Jin Yunjie;Wang Xiaoyan(Department of Obstetrics and Gynecology,Suzhou Municipal Hospital,Suzhou 215000,Jiangsu Province,China)

机构地区：[1]苏州市立医院妇产科,苏州215000

出　　处：《中华妇幼临床医学杂志（电子版）》2023年第5期575-581,共7页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：江苏省自然科学基金项目(BK20190190)。

摘　　要：目的探讨剖宫产术后瘢痕子宫(SUAC)患者再次妊娠选择阴道分娩时发生子宫破裂的影响因素。方法选取2015年1月至2022年12月在苏州市立医院妇产科再次妊娠选择阴道分娩的105例SUAC患者为研究对象。根据SUAC患者再次妊娠选择阴道分娩时是否发生子宫破裂,将其分别纳入子宫破裂组(n=26)与非子宫破裂组(n=79)。2组孕妇分娩年龄及孕龄、孕次、本次妊娠距离前次剖宫产术分娩间隔时间,以及产前人体质量指数(BMI)、子宫瘢痕厚度、前次剖宫产术切口缝合方式构成比及妊娠并发症、母婴不良妊娠结局发生率等比较,采用成组t检验或χ^(2)检验。结合既往研究结果与临床经验,进一步采用多因素非条件logistic回归分析SUAC患者再次妊娠选择阴道分娩发生子宫破裂的独立影响因素。本研究遵循的程序符合苏州市立医院医学伦理委员会要求,通过该伦理委员会批准(审批文号:南医伦审2022326号)。结果①105例再次妊娠选择阴道分娩的SUAC患者中,子宫破裂发生率为24.8%(26/105)。子宫破裂组患者分娩年龄、孕次、产前BMI≥30 kg/m 2者占比、子宫瘢痕厚度<3 mm者占比及前次剖宫产术切口缝合方式为单层者占比,均显著高于非子宫破裂组,而本次妊娠距离前次剖宫产术分娩间隔时间,则显著短于非子宫破裂组,并且差异均有统计学意义(t=4.19、P<0.001,t=3.16、P=0.002,χ^(2)=7.07、P=0.008,χ^(2)=13.56、P<0.001,χ^(2)=12.69、P<0.001,t=7.60、P<0.001)。②多因素非条件logistic回归分析结果显示,子宫瘢痕厚度<3 mm、前次剖宫产术切口缝合方式为单层,均为影响SUAC患者再次妊娠选择阴道分娩时发生子宫破裂的独立危险因素(OR=2.343,95%CI:1.361~4.032,P=0.002;OR=1.857,95%CI:1.124~3.067,P=0.015),本次妊娠距离前次剖宫产术分娩间隔时间长,则是其独立保护因素(OR=0.243,95%CI:0.097~0.607,P=0.002)。③子宫破裂组患者母婴不良妊娠结局总发生�Objective To investigate the influencing factors of uterine rupture during vaginal delivery in patients with cesarean scar uterus(SUAC).Methods A total of 105 patients with SUAC who underwent vaginal delivery in the Department of Obstetrics and Gynecology of Suzhou Municipal Hospital from January 2015 to December 2022 were selected as research subjects.According to whether SUAC patients experienced uterine rupture during vaginal delivery,they were divided into uterine rupture group(n=26)and non-uterine rupture group(n=79).Independent-samples t test or chi-square test was used to compare the age,gestational age,gravidity,interval between current pregnancy and previous cesarean section,prenatal body mass index(BMI),uterine scar thickness,proportion of suture method of previous cesarean section incision,incidence of pregnancy complications,and incidence of adverse pregnancy outcomes of mother and infant between two groups.Combined with previous research results and clinical experience,multivariate unconditional logistic regression analysis was further performed to analyze the independent influencing factors of uterine rupture in SUAC patients undergoing vaginal delivery.The procedures followed in this study were in accordance with the regulations of the Ethics Committee of Suzhou Municipal Hospital and were reviewed and approved by this Ethics Committee(Approval No.2022326).Results①Among 105 SUAC patients who underwent vaginal delivery,the incidence of uterine rupture was 24.8%(26/105).The age,gravidity,proportion of prenatal BMI≥30 kg/m 2,proportion of uterine scar thickness<3 mm,and proportion of single layer suture of previous cesarean section incision in uterine rupture group were significantly higher than those in non-uterine rupture group,and interval between current pregnancy and previous cesarean section was significantly shorter than that in non-uterine rupture group,and all the differences were statistically significant(t=4.19,P<0.001;t=3.16,P=0.002;χ^(2)=7.07,P=0.008;χ^(2)=13.56,P<0.001;χ^(2)=12.69

关 键 词：剖宫产术 剖宫产后阴道分娩 子宫破裂 瘢痕子宫 生育间隔 妊娠结局 危险因素 孕妇 

分 类 号：R714.4[医药卫生—妇产科学]