| 缪嘉燕,李婵娟,吴莉莉,等.瘢痕子宫再次妊娠阴道试产的影响因素及结局分析[J].安徽医药,2021,25(11):2182-2186. |
| 瘢痕子宫再次妊娠阴道试产的影响因素及结局分析 |
| Analysis of influencing factors and outcome of vaginal trial delivery in scar uterus pregnancy |
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| DOI：10.3969/j.issn.1009-6469.2021.11.014 |
| 中文关键词: 妊娠，高危 剖宫产后阴道分娩 产式 妊娠结局 瘢痕子宫再次妊娠 影响因素 血性羊水 |
| 英文关键词: Pregnancy,high-risk Vaginal birth after cesarean Labor presentation Pregnancy outcome Scar uterus pregnancy Influencing factors Bloody amniotic fluid |
| 基金项目:国家自然科学基金青年项目( 81801470) |
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| 中文摘要: |
| 目的探讨瘢痕子宫再次妊娠阴道试产的影响因素，并对产后产妇和新生儿的状况进行分析。方法收集 2019年 1 ―12月南京市妇幼保健医院收治的瘢痕子宫再次妊娠阴道试产孕妇 213例，根据妊娠结局分为试产成功组 188例和试产失败组 25例(转行剖宫产)多因素 logistic回归分析影响试产结局的因素，同时分析两组产妇产后及新生儿情况。结果 213例瘢痕子宫再次妊娠阴道试产，孕产妇中试产成功 188例，试产成功率为 88.3%，发生 1例子宫破裂，发生率为 0.47%。年龄、孕前体质指数( BMI)及羊水是否污染是影响瘢痕子宫再次妊娠阴道试产成功的独立影响因素；试产成功组产妇 24 h出血量低于试产失败组［(422.43±149.29)mL比( 625.45±169.88)mL，P<0.05］；试产成功组新生儿体质量低于试产失败组［( 3 147.30±677.59)g比( 3 412.80±383.74)g，P<0.05］，而两组新生儿 Apgar评分比较差异无统计学意义［( 9.89±0.48)分比( 9.88±0.44)分， P>0.05］。血性羊水病例试产成功组新生儿体质量低于血性病例试产失败组［(2390±785.56)g比( 3252.5±380.03)g，P<0.05］。结论瘢痕子宫再次妊娠阴道试产孕产妇年龄 ≥ 30岁、 BMI ≥ 30 kg/m2及血性羊水污染均可增加阴道试产失败的风险，试产成功组的新生儿体质量较低。产科需加强孕期体质量管理，控制胎儿体质量，并严格把控瘢痕子宫再次妊娠阴道试产适应证，降低子宫破裂的发生率，保障孕产妇的安全性。 |
| 英文摘要: |
| Objective To investigate the influencing factors of vaginal trial delivery in scar uterus pregnancy, and to analyze thepostpartum maternal and newborn status.Methods Two hundred and thirteen cases of pregnant women of vaginal trial delivery withscar uterus in Nanjing Maternity and Child Health Care Hospital from January to December 2019 were collected. According to the pregnancy outcome, they were assigned into 188 cases of the success group and 25 cases of the failure group (cesarean section). Multivariatelogistic regression was used to analyze the factors affecting the outcome of trial delivery, and the postpartum and neonatal conditions ofthe two groups at the same time.Results 188 cases were successful in vaginal trial delivery among 213 cases of pregnant women withscar uterus, and the success rate was 88.3%. Uterine rupture occurred in 1 case, and the incidence rate was 0.47%. Age, body mass index (BMI) and normal amniotic fluid were independent factors affecting the success of vaginal trial delivery in scar uterus pregnancy.The amount of postpartum hemorrhage in the successful group was significantly lower than that in the failed group [(422.43±149.29) mL vs. (625.45±169.88) mL, P<0.05]. The neonatal weight in the success group was significantly lower than that in the failure group [(3 147.30±677.59) g vs. (3 412.80±383.74)g, P<0.05], and there was no significant difference in Apgar score between the two groups [(9.89±0.48) vs. (9.88±0.44), P>0.05]. The weight of newborns in the bloody amniotic fluid group was significantly lower than that in thebloody amniotic fluid group [(2390±785.56) g vs. (3252.5±380.03) g, P<0.05].Conclusion The age≥30 years, BMI≥30 kg/m2 and bloody amniotic fluid pollution of pregnant women with scar uterus can increase the risk of vaginal trial failure. The weight of newbornsin successful trial births is lower. The obstetrics department need to strengthen weight management during pregnancy, control theweight of the fetus, and strictly control the indications of vaginal trial production during the re-pregnancy of scarred uterus, reduce the incidence of uterine rupture, and ensure the safety of pregnant women. |
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