摘要
目的探讨孕妇剖宫产术后再次妊娠阴道分娩(vaginal birth after cesarean section,VBAC)的影响因素。方法选取2018-01/2019-10月在华中科技大学附属湖北妇幼保健院住院的剖宫产术后妊娠阴道试产(trial of labor after cesarean,TOLAC)孕妇163例,按分娩结局分为VBAC组和紧急剖宫产(emergency cesarean section,ECS)组。比较分析两组孕妇的一般情况及母儿结局。结果VBAC成功率为80.37%(131/163),产后出血发生率3.68%(6/163),新生儿窒息发生率2.45%(4/163)。TOLAC孕妇的引产率为16.56%(27/163),其中引产成功19例(70.37%),引产失败8例(29.63%)。无子宫破裂、孕产妇及新生儿死亡。VBAC组分娩时体质量指数(body mass index,BMI)、年龄低于ECS组,既往有自然分娩史的孕妇比例高于ECS组(P<0.05)。VBAC组分娩孕周、引产率低于ECS组,分娩镇痛率高于ECS组(P<0.05)。结论在严密监测下行TOLAC是安全可行的,分娩时BMI、年龄、孕周、既往产次、既往阴道分娩史、分娩镇痛、引产与VBAC成功率有关。
Objective To investigate the factors that affect vaginal birth after cesarean section(VBAC).Methods The analysis was conducted on 163 cases of pregnant women who had trial of labor after cesarean(TOLAC)history in authors′hospital from January 2018 to August 2018.Based on the delivery outcome,they were divided into two groups:VBAC group and emergency cesarean section(ECS)group.The two groups were then compared and analyzed in terms of the general situation of the mother as well as the prognosis of both mother and fetus.Results The success rate of VBCA was 80.37%(131/163),the incidence of postpartum hemorrhage was 3.68%(6/163),and the incidence of neonatal asphyxia was 2.45%(4/163).The induction rate of TOLAC pregnant women was 16.56%(27/163).Among them,19 cases(70.37%)succeeded,and 8 cases(29.63%)failed.There were no situations such as complete rupture of uterus,maternal or neonatal death.In terms of the body mass index(BMI)during the period of childbirth and the age,the VBAC group were significantly lower than those of the ECS group,and the proportion of pregnant women with natural delivery history was higher than that in the ECS group(P<0.05).As for the gestational weeks,the rate of inducing labor,the VBAC group were significantly lower than those of the ECS group,and the rate of labor analgesia was higher than that of the ECS group(P<0.05).Conclusion It is safe and feasible to have TOLAC under close monitoring.BMI,age,gestational week,the parity,vaginal birth history,labor analgesia,labor induction can affect the success rate of VBAC.
作者
袁璐
彭景
李若冰
赵云
YUAN Lu;PENG Jing;LI Ruobing;ZHAO Yun(Department of Obstetrics,Maternal and Child Health Hospital of Hubei Province,Tongji Medical College,Huazhong University of Science and Technology,Wuhan Huberi 430070,China)
出处
《华南国防医学杂志》
CAS
2021年第3期171-175,共5页
Military Medical Journal of South China
基金
湖北省卫计委基金项目(2019CFA033,WJ2018H0133)。
