既往分娩史对剖宫产后阴道试产结局的影响

目的:探讨既往分娩史对剖宫产后阴道试产(TOLAC)患者成功率的影响。方法:回顾性分析2013年7月至2016年3月尝试TOLAC的瘢痕子宫孕妇的资料(妊娠≥28周),共506例,其中阴道分娩成功414例(TOLAC成功组),中转剖宫产92例(TOLAC中转剖宫产组)。比较两组前次剖宫产时间、剖宫产指征、阴道分娩史、新生儿存活情况等。结果:TOLAC中转剖宫产组的孕前体质量指数(BMI)及新生儿出生体质量大于TOLAC成功组(P0.05),两组平均妊娠间隔时间比较差异无统计学意义(P0.05),两组在妊娠间隔1年、1~2年、2~3年、3年的比例分别比较,差异无统计学意义(P0.05)。两组的前次剖宫产指征分别比较,差异均无统计学意义(P0.05)。TOLAC成功组有阴道分娩史患者比例明显高于TOLAC中转剖宫产组(P0.05),新生儿未存活的比较差异无统计学意义(P0.05)。结论:既往有阴道分娩史是TOLAC成功的有利因素,而既往分娩史的其他因素对TOLAC的成功率影响较小。

The Influence of Previous Delivery History on TOLAC

Objective:To explore the impact of childbirth history on trial of labor after cesarean section(TOLAC).Methods:A total of 506 patients with scarred uterus who tried TOLAC since July 2013 to March 2016 were recruited in this study.Results:Among the 506 patients,there were 414 patients with successful vaginal delivery (successful TOLAC group) and 92 patients with repeated cesarean section(CS) after failed TOLAC(failed TO-LAC group).The previous CS time and CS indications,vaginal delivery history and neonatal survival condition were compared between the two groups.The outcomes were as followes:The pre-pregnancy BMI and neonatal birth weight of failed TOLAC group were significantly higher than those of successful TOLAC group (P ＜ 0.05).The averaged pregnant interval time and the rates of the pregnant interval time (＜ 1 year,1 ～ 2 years,2 ～ 3 years,＞3 years) in two groups had no significant difference(P ＞0.05).The previous CS indications of two groups including cephalopelvic disproportion had no significant differences(P ＞ 0.05).The proportion of patients with vaginal birth history in successful TOLAC group was significantly higher than that of failed TOLAC group(P ＜ 0.05),and the comparison of the other factors had no significant difference(P ＞ 0.05).Conclusions:Previous vaginal childbirth history is a favorable factor for the success of TOLAC.The other factors about previous delivery history had few influence on success of TOLAC.