摘要
目的探讨剖宫产术后再次妊娠阴道分娩(VBAC)的影响因素,为临床管理提供依据。方法回顾性分析2015年10月至2017年5月于上海健康医学院附属嘉定区中心医院分娩的63例剖宫产术后再次妊娠阴道成功分娩(VBAC),60例选择性重复剖宫产(ERCS),49例剖宫产术后再次妊娠阴道试产失败急诊剖宫产(Unsuccessful Vaginal Birth After Cesarean,UVBAC),60例阴道分娩的初产孕妇的临床资料,并对VBAC的影响因素进行多因素回归分析。结果VBAC、ERCS和UVBAC组产妇在分娩前与孕前BMI差值、子宫下段厚度,新生儿体质量、临产前/术前住院日数、宫颈Bishop评分、住院时间、住院费用、产后出血量、并发症、输血、新生儿窒息率,差异有统计学意义(P<0.05),VBAC与非瘢痕子宫初次阴道分娩组比较,总产程、产程干预率差异有统计学意义(P<0.05)。剖宫产原因分析发现,UVBAC组主要为产程停滞(91.8%),ERCS组主要是既往剖宫产史为指征(95.0%),两组比较,差异有统计学意义(P<0.05)。多因素logistic回归分析发现,胎儿体质量、自然临产、Bishop评分、分娩前与孕前BMI差值、临产前/术前住院日数可能是VBAC影响因素。结论VBAC的成功实施与胎儿体质量、自然临产、宫颈Bishop评分、分娩前与孕前BMI差值、临产前/术前住院天数有关;正常分娩组较VBAC的总产程长,VBAC因医者各种顾虑则产程干预率明显较正常分娩组低,提示应重视对VBAC的孕早期甚至孕前管理,重视人文关爱,及时产程干预,提高VBAC成功率。
Objective To explore the influencing factors of vaginal birth after cesarean(VBAC),and to provide the evidence for clinical management.Methods A retrospectively study was performed 63 cases of vaginal birth after cesarean section(VBAC),60 cases of elective repeat cesarean section(ERCS),49 cases of unsuccessful vaginal birth after cesarean(UVBAC),and 60 cases of primiparas with vaginal delivery in Jiading District Central Hospital Affiliated Shanghai University of Medicine&Health Sciences from October 2015 to May 2017.The influencing factors VBAC were analyzed by multivariable logistic regression.Results There were statistical differences between antepartum and progestation of VBAC,UVBAC and ERCS groups in the body mass index,lower uterine segment thickness,Infant weight,predelivery in hospital day,cervical Bishop score,hospitalized days,expenditure,postpar tum hemorrhage,complications,blood transfusion,neonatal asphyxia(P<0.05).There were statistical differences in total stage of la bor and interference between and non scar uterus group and VBAC group(P<0.05).The analysis of the causes of cesarean section showed that the main cause of UVBAC group was stagnation of labor(91.8%),that the main cause of ERCS group was previous history of cesarean section(95.0%),and the difference was statistically significant(P<0.05).Multivariate logistic regression analy sis showed that fetal weight,natural labor,Bishop score,BMI difference between pre delivery and pre pregnancy,and the number of hospital days before labor/operation might be the influencing factors of VBAC.Conclusion The factors,such as fetus weight,spon taneous in labor,cervical Bishop score,BMI difference between prenatal and predelivery,have contributed to the successful imple ment of VBAC.The total duration of labor in the normal labor group was longer than that in the VBAC group,and the intervention rate of labor in the VBAC group was significantly lower than that in the normal labor group due to various concerns of the doctors,suggesting that more attention should be paid at the first trimester even early at prenatal period,humanity care is advocated,timely labor intervention,and the success rate of VBAC should be improved.
作者
赵婷
谢滟
杨欢
叶琴芬
叶薇
ZHAO Ting;XIE Yan;YANG Huan;YE Qinfen;YE Wei(Department of Obstetrics and Gynecology,Jiading District Central Hospital Affiliated to Shanghai Medical College,Shanghai 201800,China)
出处
《安徽医药》
CAS
2020年第4期719-723,共5页
Anhui Medical and Pharmaceutical Journal
基金
上海市嘉定区卫计委面上项目(2016 KY 05)。
关键词
剖宫产后阴道分娩
剖宫产术
再
接生
产科
胎儿体质量
分娩发动
瘢痕子宫
试产
Vaginal birth after cesarean
Cesarean section
repeat
Delivery
obstetric
Fetal weight
Labor onset
Scar uterus
Trial labor
作者简介
通信作者:谢滟,女,主任医师,研究方向为围产医学,E mail:1458410536@qq.com。
