| 朱琳,彭贤容.剖宫产再次妊娠阴道试产 40例分析[J].安徽医药,2021,25(1):88-91. |
| 剖宫产再次妊娠阴道试产 40例分析 |
| Analysis of 40 cases of vaginal trial delivery after cesarean section |
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| DOI：10.3969/j.issn.1009?6469.2021.01.022. |
| 中文关键词: 剖宫产 再次妊娠 阴道试产 妊娠结局 分娩方式 |
| 英文关键词: Cesarean section Second pregnancy Vaginal trial delivery Pregnancy outcome Mode of delivery |
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| 中文摘要: |
| 目的探讨剖宫产再次妊娠孕妇阴道试产及妊娠结局。方法回顾性分析内江市妇幼保健院于 2017年 6月至 2018年 6月接收的剖宫产再次妊娠阴道试产(TOLAC)的孕妇 40例的临床资料，将剖宫产再次妊娠经阴道分娩(VBAC)的孕妇归为甲组，阴道试产失败的孕妇归为乙组。分析阴道试产失败原因，比较分析两组病人产前各项指标以及影响 VBAC成功率的因素，比较两组妊娠结局。结果 40例 TOLAC孕妇中 VBAC共有 30例，成功率为 75.00%，10例孕妇 TOLAC失败从而中途转剖宫产，其中包括胎儿窘迫 3例、宫缩乏力 1例、病人意愿 3例、产程异常 2例以及先兆子宫破裂 1例。甲组与乙组产前各项指标相比，甲组的宫颈成熟度(Bishop)评分为(6.59±1.78)分，明显高于乙组的(5.12±1.34)分，甲组的分娩孕周较短，产前体质量指数(BMI)较小，入院宫口扩张较大，差异有统计学意义(P＜0.05)年龄、孕次之间的比较差异无统计学意义(P＞0.05)。甲组与乙组妊娠结局相比，产褥期感染率低，甲组的产后住院天数为(3.2，2±1.14)d，明显短于乙组的(5.22±2.01)d，甲组的出血量为(100.33±24.34)mL，明显少于乙组的(298.32±88.11)mL(P＜0.05)新生儿感染肺炎、新生儿窒息以及爱普格新生儿(Apgar)评分的比较差异无统计学意义(P＞0.05)。结论宫颈 Bishop评分娩孕周、产前 BMI、入院宫口扩张大小均是影响 VBAC成功率的因素，并且选择阴道试产的孕妇产褥期感染率低，产后住院天数短、出血量少。因此，对于剖宫产术后再次妊娠的孕妇而言，阴道试产是一个可选择的分娩方式。 |
| 英文摘要: |
| Objective To investigate the vaginal trial and pregnancy outcome of pregnant women with cesarean section.Methods Retrospective analysis was made on the clinical data of 40 pregnant women trialoflaboraftercesareansection(TOLAC)from June 2017 to June 2018 in Neijiang Maternal and Child Health Care Hospital The pregnant women with vaginal delivery after cesareansection(VBAC)were classified as group A，and those who failed in vaginal trial delivery were classified as group B.The deliverysituation of 40 cases of TOLAC pregnant women，the causes of failure of vaginal trial delivery in group B，the prenatal indicatorsand the factors influencing the success rate of VBAC between group A and group B were compared and analyzed.Results Amongthe 40 TOLAC pregnant women，there were 30 cases of VBAC，with a success rate of 75.00%.10 cases of pregnant women with TO? LAC failure were transferred to cesarean section，including 3 cases of fetal distress，1 case of uterine atony，3 cases of patient’s in? tention，2 cases of abnormal labor process，and 1 case of threatened uterine rupture.Compared with prenatal indicators of group B， the cervical maturity(Bishop)score of group A was(6.59±1.78)points，which was significantly higher than that of group B(5.12±1.34)points，the gestational weeks of delivery in group A were shorter，the body mass index(BMI)was smaller，and the uterine mouth dilation was larger in group A than that in group B(P＜0.05).There was no significant difference in age and pregnancy times(P＜0.05).Compared with the pregnancy outcomes in group B，the puerperal infection rate in group A was lower，the length of postpartum hospital stay in group A was(3.22±1.14)d，which was significantly shorter than that in group B(5.22±2.01)d，the blood loss in group A was(100.33±24.34)mL，which was significantly less than that in group B(298.32±88.11)mL，the differ? ence was statistically significant(P＜0.05).There were no significant differences in neonatal pneumonia，neonatal asphyxia，or Ap? gar score(P＞0.05).Conclusions Cervical Bishop score，gestational weeks of delivery，prenatal BMI，and the size of uterine dila? tation are all factors affecting the success rate of VBAC，and the pregnant women who choose vaginal trial delivery have low puer? peral infection rate，short postpartum hospital days and less bleeding.Therefore，vaginal trial delivery is an optional delivery mode for pregnant women who are pregnant again after cesarean section. |
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