影响剖宫产术后阴道试产成功的临床因素

目的探讨影响剖宫产术后阴道试产成功的临床因素。方法对石泉县医院2008年1月至2009年12月住院的剖宫产术后阴道试产62例孕妇的住院病历资料进行回顾性分析，按照其不同分娩结局分组：试产成功经阴道分娩者为阴道分娩组（VL组），试产失败剖宫产者为阴道分娩失败组（FVL组），对以上两组的人口统计学、产科特征及母儿并发症等进行分析。结果FVL组孕妇年龄、身体质量指数及孕周显著高于VL组（t值分别为7．681、11．532和2．959，均P〈0．05）。F、几组孕妇有阴道分娩史、入院时有宫缩及宫颈成熟度评分≥6分者百分率均显著低于VL组（，值分别为5．362、4．719及5．343，均P〈0．05）；两组孕妇前次剖宫产指征分布不同，以产程异常或头盆不称及引产失败为前次剖宫产指征的百分率FVL组明显高于VL组（X^2值分别为8．420、5．858，均P〈0．05）以胎儿窘迫为前次剖宫产指征的百分率FVL组明显低于vL组（X^2=4．930，P〈0．05）；两组发生母儿并发症共10例，VL组1例，FVL组9例，母儿并发症．90％发生在FVL组，两组比较有显著性差异（X^2=7．305，P〈0．05），母儿结局良好。结论孕妇的年龄、体重、孕周、前次剖宫产指征、剖宫产术后阴道分娩史、宫颈成熟度及入院时宫缩情况等因素可影响剖宫产术后阴道试产成功。

Clinical factors of influencing success of trial vaginal birth after cesarean

Objective To explore the clinical factors that influence the success of trim vaginal birth after cesarean. Methods Retrospective analysis of medical records of 62 pregnant women who were pregnant after cesarean and hospitalized in Hospital of Shiquan County during the period from January 2008 to December 2009 were conducted. The pregnant women were divided into two groups according to different results of trial of labor： successful vaginal labor group （ VL group） and failed vaginal labor group （ FVL group）. The demographic and obstetric characteristics and maternal and perinatal complications of two groups were analyzed. Results Maternal age, body mass index （BMI） and gestational age in FVL group were significantly higher than those in VL group （t value was 7. 681, 11. 532 and 2. 959, respectively, all P 〈 0.05）. The percent of pregnant women with labor history, uterine contraction and cervical favorability score ≥ 6 in FVL group was significantly lower than that in VL group （X2 value was 5. 362, 4. 719 and 5. 343, respectively, all P 〈 0.05 ）. The distribution of previous cesarean section indication in two groups was different, and the percent of cases whose previous cesarean section indications were abnormal stage of labor, cephalopelvic disproportion and failure induction in FVL group was significantly higher than that in VL group （X^2 value was 8. 420 and 5. 858, respectively, both P 〈 0.05）. The percent of cases whose indication of previous cesarean section was fetal distress in FVL group was significantly lower than that in VL group （X^2 = 4. 930, P 〈 0.05 ）. There were ten cases of complications of mother and infant, 1 in VL group and 9 in FVL group. Ninety percent of maternal and perinatal complications occurred in FVL group, and there was significant difference between two groups （X^2 = 7. 035, P 〈 0.05 ）. All had good outcomes. Conclusion There are many factors affecting the successful rate of trial of labor for pregnant women after cesarean, such as maternal age, body weight, gestational age, indications of previous cesarean, history of vaginal birth after cesarean, cervical favorability and uterine contraction.