剖宫产后再妊娠阴道试产成功的相关影响因素分析  

Analysis of the factors affecting the successful vaginal birth after cesarean section

作　　者：林文静 温高静 郑小冬 LIN Wenjing;WEN Gaojing;ZHENG Xiaodong(Wenzhou People's Hospital,Wenzhou,Zhejiang Province,325000)

机构地区：[1]浙江省温州市人民医院,325000

出　　处：《中国计划生育学杂志》2025年第3期741-745,共5页Chinese Journal of Family Planning

基　　金：温州市科技项目(Y20210346)。

摘　　要：目的:分析剖宫产后再妊娠阴道分娩(VBAC)试产成功影响因素及其预测。方法:收集2018年6月-2024年3月在本院剖宫产后再次妊娠阴道试产(TOLAC)孕产妇299例临床资料,根据试产是否成功分为剖宫产后阴道分娩组(VBAC组,239例)和剖宫产后阴道试产失败组(F-TOL组,60例)。比较VBAC组和F-TOL组临床资料和母婴结局,分析TOLAC成功率相关因素;采用受试者工作特征(ROC)曲线和二元logistic回归分析影响因素预测VBAC价值。结果:VBAC组与F-TOL组距上次剖宫产间隔时间、孕晚期子宫下段厚度、宫颈Bishop评分、自然临产占比和阴道分娩史占比均有差异(P<0.05);ROC分析,子宫下段厚度、宫颈Bishop评分预测VBAC的曲线下面积分别为0.618和0.779,截断值分别为2.05 mm和5.5分。多因素logistic分析,年龄<35岁、分娩前体质指数<30 kg/m^(2)、宫颈Bishop评分≥6分、阴道分娩史及自然临产是TOLAC成功有利因素,优势比分别为2.812、3.255、8.298、8.567和3.614(P<0.05)。结论:宫颈Bishop评分、分娩前BMI、阴道分娩史和自然临产与TOLAC试产结局有关,其中宫颈Bishop评分≥6分和有阴道分娩史是TOLAC成功可能性较大的有利影响因素,其中宫颈Bishop评分预测VBAC价值较高。Objective:To analyze the factors influencing the maternal and infant outcomes of pregnant women with vaginal birth after cesarean section(VBAC),and to explore the predictive value of these influencing factors for their successful VBAC.Methods:The clinical data of 299 pregnant women who underwent VBAC after cesarean section in the hospital from June 2018 to March 2024 were collected in this study.These women were divided into 239 cases with successful VBAC in group A and 6o cases with failure VBAC in group B according to the successful VBAC or not.The clinical data and the maternal-infant outcomes of the women were compared between the two groups.The factors related to the success rate of VBAC of the women were analyzed.Receiver operating characteristic(ROC)curve and binary logistic regression analysis were used to analyzed the predictive value of these influence factors of the women for their successful VBAC.Results:There were significant differences in the interval from the last cesarean section,the thickness of the lower uterine segment during the third trimester of pregnancy,the cervical Bishop score,the proportion of natural delivery and the proportion of the vaginal delivery history of the women between group A and group B(P<O.05).ROC analysis showed that the area under the curve of the lower uterine thickness and the cervical Bishop score of the women for predicting their successful VBAC were 0.618 and 0.779,and the cut-off values of which were 2.05 mm and 5.5.Multivariate logistic analysis showed that the age<35 years old,the body mass index<30 kg/m^(2)before delivery,the cervical Bishop score≥6 points,the history of vaginal delivery and the natural delivery of the women were the favorable factors of their successful VBAC,with the odds ratios of 2.812,3.255,8.298,8.567 and 3.614,respectively(P<o.o5).Conclusion:The cervical Bishop score,the pre-delivery BMI,the history of vaginal delivery and the nature near to give birth of the pregnant women are associated with their outcomes of VBAC,and among them,the

关 键 词：剖宫产后再妊娠 阴道试产 分娩方式 影响因素 

分 类 号：R71[医药卫生—妇产科学]