| 赵婷,谢滟,杨欢,等.剖宫产术后再次妊娠阴道分娩的临床分析[J].安徽医药,2020,24(4):719-723. |
| 剖宫产术后再次妊娠阴道分娩的临床分析 |
| Clinical analysis of vaginal birth after cesarean section |
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| DOI：10.3969/j.issn.1009?6469.2020.04.021 |
| 中文关键词: 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 |
| 英文关键词: Vaginal birth after cesarean Cesarean section,repeat Delivery,obstetric Fetal weight Labor onset Scar |
| 基金项目:上海市嘉定区卫计委面上项目( 2016?KY?05) |
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| 中文摘要: |
| 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，U，VBAC)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。 |
| 英文摘要: |
| 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 primiparaswithvaginaldeliveryinJiadingDistrict，Central Hospital Affiliated Shanghai University of Medicine & Health Sciencesfrom 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，timelylabor intervention，and the success rate of VBAC should be improved. |
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