前次阴道分娩经产妇二胎剖宫产指征及影响因素分析  

Analysis of Indications and Influencing Factors of Cesarean Section in Second-Pregnancy Multiparas with Previous Vaginal Delivery

作　　者：钱虹[1] 张正宇 袁源 Qian Hong;Zhang Zhengyu;Yuan Yuan(The First Hospital of Lanzhou University,Lanzhou 730030,Gansu Province,China;不详)

机构地区：[1]兰州大学第一医院,甘肃省兰州市730030 [2]浙江大学医学院附属第一医院,浙江省杭州市310006 [3]重庆医科大学附属妇女儿童医院,重庆市401147

出　　处：《中国病案》2025年第3期65-68,共4页Chinese Medical Record

摘　　要：目的通过分析前次阴道分娩的经产妇第二次分娩时行剖宫产手术的影响因素,探讨孕期及分娩的管理改进,降低二胎经产妇剖宫产率的方法。方法回顾性分析2020年1月1日—2023年12月31日期间,某三甲医院分娩的二胎经产妇共5796例。收集产妇基本信息、剖宫产指征和影响剖宫产的因素等数据,分析首位剖宫产指征比例,通过χ^(2)检验,分析产妇、胎儿、胎盘及羊水和产程管理及医疗干预等因素,并利用二元Logistic回归分析建立剖宫产影响因素模型。结果二胎经产妇剖宫产率为24.17%,其中无医学指征剖宫产为12.92%,剖宫产第一指征主要为胎儿窘迫235例、前置胎盘160例、双胎妊娠141例、先露异常139例和妊娠期高血压疾病136例。先露异常、双胎妊娠、前置胎盘和胎儿窘迫是二胎经产妇剖宫产重要影响因素。结论通过分析前次阴道分娩经产妇二胎剖宫产指征及影响因素发现经产妇二胎剖宫产受胎儿因素、产妇因素、胎盘因素及产程管理等多因素影响。产科医疗实践应据此制定个性化孕期管理策略,综合干预和宣教,以降低剖宫产率,保障经产妇安全有效的分娩。Objectives This study aims to explore the management during pregnancy and reduce the cesarean section rate by analyzing the influencing factors of cesarean section during the second delivery of multiparas women with previous vaginal delivery.Methods A total of 5,796 multiparas who gave birth with their second child in a tertiary hospital between January 1,2020 and December 31,2023 were retrospectively analyzed.The basic maternal information,cesarean section indications,and factors affecting cesarean section were collected,and the proportion of the first cesarean section indication was analyzed.The χ^(2) test was used to analyze the factors of mother,fetus,placenta,amniotic fluid,labor management and medical intervention,and binary Logistic regression analysis was used to establish a model of influencing factors of cesarean section.Results The cesarean section rate for second-time multiparous women was 24.17%,of which 12.92% were cesarean sections without medical indications.The primary indications for cesarean sections were mainly fetal distress in 235 cases,placenta previa in 160 cases,twin pregnancy in 141 cases,malpresentation in 139 cases,and hypertensive disorders complicating pregnancy in 136 cases.Abnormal presentation,twin pregnancy,placenta previa and fetal distress were important factors affecting cesarean section in second-time multiparas.Conclusions By analyzing the indications and influencing factors of cesarean section for the second child in multiparas with a previous vaginal delivery,it was found that cesarean section for the second child in multiparas is affected by multiple factors,including fetal factors,maternal factors,placental factors,and labor management.Obstetric medical practice should formulate personalized pregnancy management strategies,comprehensive intervention and education based on this,so as to reduce the cesarean section rate and ensure safe and effective delivery for multiparous women.

关 键 词：剖宫产指征 经产妇 胎儿窘迫 前置胎盘 

分 类 号：R719.8[医药卫生—妇产科学]