剖宫产术后瘢痕子宫患者再次妊娠阴道分娩发生子宫破裂的影响因素分析

目的 探讨剖宫产术后瘢痕子宫(SUAC)患者再次妊娠选择阴道分娩时发生子宫破裂的影响因素。方法 选取2015年1月至2022年12月在苏州市立医院妇产科再次妊娠选择阴道分娩的105例SUAC患者为研究对象。根据SUAC患者再次妊娠选择阴道分娩时是否发生子宫破裂,将其分别纳入子宫破裂组(n=26)与非子宫破裂组(n=79)。2组孕妇分娩年龄及孕龄、孕次、本次妊娠距离前次剖宫产术分娩间隔时间,以及产前人体质量指数(BMI)、子宫瘢痕厚度、前次剖宫产术切口缝合方式构成比及妊娠并发症、母婴不良妊娠结局发生率等比较,采用成组t检验或χ²检验。结合既往研究结果与临床经验,进一步采用多因素非条件logistic回归分析SUAC患者再次妊娠选择阴道分娩发生子宫破裂的独立影响因素。本研究遵循的程序符合苏州市立医院医学伦理委员会要求,通过该伦理委员会批准(审批文号：南医伦审2022326号)。结果 (1)105例再次妊娠选择阴道分娩的SUAC患者中,子宫破裂发生率为24.8%(26/105)。子宫破裂组患者分娩年龄、孕次、产前BMI≥30 kg/m²者占比、子宫...     

妊娠期子宫破裂7例临床分析

目的探讨妊娠子宫破裂的原因、临床特点及预防方法。方法对2014年1月—2016年6月本院收治的妊娠子宫破裂7例的病例资料进行回顾分析。结果 7例子宫破裂的患者中,有剖宫产手术史5例(2次剖宫产史1例),非瘢痕子宫2例。完全性破裂6例,其中4例瘢痕子宫,此次分娩距前次剖宫产时间均≥4年;子宫不完全破裂1例,分娩孕周38周,此次分娩距前次剖宫产时间为5年。7例中5例入院时未足月,3例自发性破裂,4例发生在分娩过程中(2例子宫瘢痕中孕引产)。5例主诉伴有下腹部疼痛,1例产后持续阴道流血,1例产后检查产道时发现。7例均行子宫修补术,痊愈出院。结论剖宫产术后再次妊娠是子宫破裂的高危因素,整个孕期都应严密监护,尽早识别子宫破裂。     

瘢痕子宫孕妇再次分娩方式的选择和危险因素分析

目的探讨瘢痕子宫孕妇再次分娩方式的选择和相关危险因素。方法回顾性分析2016年2月-2017年2月在该院住院分娩、有剖宫产史的156例瘢痕子宫孕妇的临床资料,根据最终分娩方式分为自然分娩组(125例)和剖宫产组(31例),比较两种分娩方式预后,分析相关危险因素。结果 156例瘢痕子宫孕妇,阴道试产成功125例,中途转剖宫产术31例;两组孕妇新生儿出生后5min Apgar评分比较差异无统计学意义(P0.05);自然分娩组孕妇产时出血量明显少于剖宫产组,住院时间明显短于剖宫产组,产后感染及产后出血等并发症发生率明显低于剖宫产组(均P0.05);多元Logistic回归分析,孕妇产前BMI30 kg/m~2、宫颈长度28 mm、距离前次剖宫产时间≤2年是影响阴道试产顺利进行的独立危险因素(P0.05)。结论瘢痕子宫孕妇经阴道分娩安全可行,对孕妇和新生儿影响小,临床应结合相关危险因素指导孕妇选择最佳分娩方式。     

剖宫产术后瘢痕子宫再次妊娠阴道试产失败的危险因素分析

目的探讨剖宫产术后瘢痕子宫再次妊娠阴道试产失败的影响因素。方法回顾分析2013年11月-2016年11月眉山市人民医院收治的剖宫产术后瘢痕子宫再次妊娠进行阴道试产的143例孕妇临床资料,根据阴道试产结局进行分组,对比分析可能影响阴道试产失败的因素。结果 143例孕妇中,阴道试产失败39例,成功104例,成功率为72.73%。试产成功组和试产失败组的年龄、产前BMI、距前次剖宫产时间、阴道分娩史、使用宫缩剂、子宫下段厚度、胎龄、婴儿体重比较,差异均有统计学意义(均P0.05);而两组患者的剖宫产次数、是否临产入院及有无定期体比较,差异均无统计学意义(均P0.05)。多因素Logistic回归分析显示,孕妇年龄、产前BMI值、距离前次剖宫产时间、阴道分娩史、子宫下段厚度及婴儿体重均是造成剖宫产后瘢痕子宫再次妊娠试产失败的独立因素。结论剖宫产术后瘢痕子宫再次妊娠孕妇进行阴道试产具有一定可行性,但导致试产失败的影响因素较多,在产前应对试产对象的体征及手术指征进行正确评估,选择最佳分娩方式。     

瘢痕子宫阴道试产失败的危险因素分析及对妊娠结局的影响

目的分析瘢痕子宫阴道试产失败的危险因素及对妊娠结局的影响,为提高产妇分娩的安全性提供指导。方法回顾性分析2018年1月至2019年6月桂林市妇幼保健院收治的150例瘢痕子宫再次妊娠分娩的产妇,根据阴道试产情况,将其分为阴道试产成功组127例和阴道试产失败组23例,对比两组的年龄、体质量指数(body mass index,BMI)、合并癌症、剖宫产史、子宫破裂史等因素,将其中有统计学差异的指标进行多因素Logistic回归分析,并分析阴道试产失败对妊娠结局的影响。结果单因素分析结果显示:两组在年龄、孕前BMI、胎儿体重、子宫下段瘢痕厚度、子宫破裂史、先兆子宫破裂、宫缩情况、产程停滞、胎儿宫内窘迫方面比较,差异均有统计学意义(P<0.05)。Logistic分析结果显示:孕前BMI、胎儿体重、子宫下段瘢痕厚度、先兆子宫破裂、宫缩乏力、产程停滞、胎儿宫内窘迫是阴道试产失败的独立危险因素,差异有统计学意义(P<0.05)。阴道试产成功组的产程时间、产后出血量、新生儿Apgar评分、产褥病率、子宫破裂率优于阴道试产失败组,差异均有统计学意义(P<0.05)。结论孕前BMI、胎儿体重、子宫下段瘢痕厚度、先兆子宫破裂、宫缩乏力、产程停滞、胎儿宫内窘迫均是导致孕妇阴道试产失败的影响因素,应根据孕妇的身体情况和具体手术指征选择合适的分娩方式,以降低不良妊娠结局。     

影响剖宫产术后再次妊娠阴道分娩成功因素分析

目的分析影响剖宫产术后再次妊娠孕妇阴道分娩成功的因素。方法回顾性分析遂宁市中医院产科2015年10月至2016年10月426例剖宫产后再次妊娠孕妇分娩试产的临床资料,统计试产结果并对影响因素进行单因素和多因素相关性分析。结果 426例孕妇中,阴道试产成功271例,阴道自然/助产分娩,且无子宫破裂;失败155例,试产期间出现剖宫产指征而改行剖宫产。对影响因素进行统计分析,成功组产后出血率3.32%,子宫破裂率1.10%,失败组产后出血率7.10%,子宫破裂率1.29%,产后出血率差异明显(P0.05),而子宫破裂率、新生儿窒息人数比较差异无统计学意义;经单因素分析,两组孕妇产前体质量指数(body mass index,BMI)、孕妇年龄、子宫下段厚度、有阴道分娩史等比较差异有统计学意义(P0.05),而在瘢痕厚度、孕周、入院宫口扩张、距前次剖宫产手术时间、新生儿重量等方面比较差异无统计学意义(P0.05);经多因素分析,孕妇产前BMI、孕妇年龄、子宫下段厚度、有阴道分娩史、是否临产入院均对剖宫产后再次妊娠阴道试产有统计学意义(P0.05),其中有阴道分娩史OR值最高,是影响试产成功的重要因素。结论孕妇产前BMI30 kg/m~2,年龄30岁,子宫下段厚度4 mm,上次术后无发热,临产入院者,有阴道分娩史经历者比较适合阴道试产。     

前次剖宫产后再次妊娠孕期子宫瘢痕变化及妊娠结局分析

目的通过对287例前次剖宫产术后再次妊娠孕妇孕期采用B超动态监测子宫瘢痕厚度变化、术中所见情况及妊娠结局进行分析,探讨影响瘢痕变化和妊娠结局的相关因素。方法选取2016年于北京市丰台区妇幼保健院产科建档,愿意参与研究并完整随访至足月分娩的287例瘢痕子宫再孕、择期剖宫产孕产妇纳入研究。依据孕37～38周瘢痕分类及术中所见情况,分析再孕距离前次剖宫产时间、年龄、妊娠次数、胎盘位置、孕早期瘢痕厚度(孕11～12+6周)、羊水指数及新生儿出生体质量等对孕晚期瘢痕分类、瘢痕变化率及妊娠结局的影响。结果子宫瘢痕厚度在孕中、晚期分别以平均每月0. 64 mm、0. 40 mm的速度递减;观察孕妇距前次剖宫产年限、年龄、妊娠次数、新生儿体质量、羊水指数及胎盘位置对孕晚期子宫瘢痕分类的影响,仅距前次剖宫产不同间隔年限在孕28～30周及孕37～38周的瘢痕厚度差异具有统计学意义(P<0. 05)。孕晚期瘢痕分类与子宫不全破裂之间关系密切(P<0. 05)。结论①子宫瘢痕厚度变化主要受距前次剖宫产间隔时间的影响,剖宫产术后2～5年是子宫瘢痕肌层愈合最佳时期,也是再孕选择的最佳时期。②早孕期瘢痕厚度与孕晚期瘢痕分类、瘢痕变化率关系密切,孕早期瘢痕越厚,孕期瘢痕变化率越小,孕晚期分类越好。③孕晚期瘢痕分类与子宫不全破裂之间关系密切;与产后出血、胎盘异常之间比较,差异未见统计学意义。     

剖宫产后瘢痕子宫再次妊娠孕妇接受阴道试产的影响因素及不同模式分娩的妊娠结局分析

目的分析剖宫产后瘢痕子宫再次妊娠孕妇接受阴道试产成功的影响因素,并比较不同分娩方式妊娠结局。方法回顾性分析该院2015年1月-2016年6月收治的350例剖宫产后瘢痕子宫再次妊娠孕妇相关资料,其中阴道试产115例,试产成功95例(为成功组),试产失败中转剖宫产20例(为失败组)。对两组产妇年龄、产前BMI、瘢痕厚度等资料,单因素及多因素Logistic回归分析阴道试产成功的影响因素。剖宫产产妇255例(包括阴道试产失败者)为剖宫产组,比较不同分娩方式下的妊娠结局。结果 Logistic回归分析显示,年龄30岁、产前BMI30 kg/m~2、有自然分娩史、临产入院、入院宫口扩张≥6 cm为剖宫产后瘢痕子宫再次妊娠阴道试产成功独立影响因素;与剖宫产组比较,阴道试产成功组产时宫缩乏力发生率高,新生儿出生体重低,1 min Apgar评分高,差异均有统计学意义(均P0.05);成功组与剖宫产组在胎儿窘迫、子宫破裂、产后出血、产褥感染及新生儿窒息发生率方面比较差异无统计学意义(P0.05)。结论年龄30岁、产前BMI30 kg/m~2、有自然分娩史等是剖宫产后瘢痕子宫再次妊娠阴道试产成功的重要因素,且相比再次剖宫产,阴道试产不增加胎儿窘迫、子宫破裂等并发症,建议严格把握阴道试产适应证或成功因素,以提高阴道试产率,降低再次剖宫产率。     

胎膜早破孕妇发生宫内感染的影响因素分析

目的探讨胎膜早破孕妇发生宫内感染的影响因素。方法回顾性分析182例胎膜早破孕妇的临床资料,根据是否发生宫内感染分为感染组与未感染组,统计两组的基线资料,分析胎膜早破发生宫内感染的影响因素。结果182例胎膜早破孕妇有69例(37.91%)发生宫内感染。感染组的破膜孕周<33周、破膜至分娩时间≥3 d、破膜后阴道镜检查次数≥5次、瘢痕子宫占比均高于未感染组(P<0.05)。多因素Logistic回归分析显示,破膜孕周<33周、破膜至分娩时间≥3 d、破膜后阴道镜检查次数≥5次、瘢痕子宫是胎膜早破孕妇发生宫内感染的独立危险因素(OR≥1,P<0.05)。结论胎膜早破孕妇的宫内感染发生率较高,破膜孕周<33周、破膜至分娩时间≥3 d、破膜后阴道镜检查次数≥5次、瘢痕子宫是发生宫内感染的独立危险因素。     

胎膜早破孕妇发生宫内感染的影响因素分析

目的探讨胎膜早破孕妇发生宫内感染的影响因素。方法回顾性分析182例胎膜早破孕妇的临床资料,根据是否发生宫内感染分为感染组与未感染组,统计两组的基线资料,分析胎膜早破发生宫内感染的影响因素。结果182例胎膜早破孕妇有69例(37.91%)发生宫内感染。感染组的破膜孕周<33周、破膜至分娩时间≥3 d、破膜后阴道镜检查次数≥5次、瘢痕子宫占比均高于未感染组(P<0.05)。多因素Logistic回归分析显示,破膜孕周<33周、破膜至分娩时间≥3 d、破膜后阴道镜检查次数≥5次、瘢痕子宫是胎膜早破孕妇发生宫内感染的独立危险因素(OR≥1,P<0.05)。结论胎膜早破孕妇的宫内感染发生率较高,破膜孕周<33周、破膜至分娩时间≥3 d、破膜后阴道镜检查次数≥5次、瘢痕子宫是发生宫内感染的独立危险因素。     

Uterine scars and subsequent vaginal birth: follow-up of 73 parturients in the Central Maternity Hospital of Bangui (Central African Republic)

Uterine rupture is a threat during vaginal deliveries of women with uterine scars from previous caesarean deliveries or other surgery. Special prudence among this group has resulted in a rise of cesarean rates in developed countries but also in Africa. The lack of available data in this domain in our country led us to conduct this preliminary study, with the objectives of: determining the frequency of deliveries among these patients and of the complications associated with them; identifying some of the risk factors and assessing maternal and fetal prognosis. This should facilitate further studies to determine the management attitudes most appropriate to the realities of our health system. We conducted a cross-sectional study during the last six months of 1999 at the central maternity hospital in Bangui. We included in this study only women with previous caesarean scars giving birth again during the study period. We followed them from admission to the labour room until discharge, without intervening in their delivery. Structured questionnaires enabled us to collect data on clinical, social and demographic variables. We recorded 74 births, including one set of twins, among the 73 parturient subjects. Vaginal delivery occurred in 45 cases (60.8%), and caesarean in 29. Women with a single uterine scar gave birth by vaginal delivery significantly more often than they had caesareans. We recorded 7 cases of uterine rupture, most often associated with a birth interval less than 2 years. One uterine rupture led to the mother's death. Perinatal mortality was 10.8%: no newborn survived these uterine ruptures. Vaginal delivery remains possible for women with uterine scars when adequate monitoring of a trial of labor is available and on condition that the pelvis is normal and the birth interval exceeds two years.     

38例疤痕子宫妊娠引产分析

目的:探讨终止疤痕子宫(均为子宫下段剖宫产术后)中晚期妊娠的治疗方法。方法:对我院2003年1月~2006年12月年行疤痕子宫中晚期妊娠要求终止妊娠患者38例,分别采用剖宫取胎方法、利凡诺尔羊膜腔内注射法、米非司酮联合米索前列醇法和水囊引产法。选择同期非疤痕子宫引产者208例,将引产方法相同的疤痕子宫与非疤痕子宫进行比较,观察其一般情况、胎儿胎盘娩出时间、产时出血及软产道裂伤情况。结果:7例剖宫产术后半年内妊娠的疤痕子宫引产均采用剖宫取胎的方法。余31例剖宫产术后半年后妊娠的疤痕子宫引产分别采用其余3种方法。无1例子宫破裂发生;同种引产方法比较,疤痕子宫与正常子宫胎儿胎盘排出时间、产时出血及软产道裂伤较无差异显著性(P>0.05)。结论:剖宫产术后半年后疤痕子宫中晚期妊娠引产可以在严密观察下施行常用几种引产方法。     

Advantages and risk of a trial of vaginal delivery in the scarred uterus

We present a retrospective study of 1235 deliveries in scarred uterus. The aim of this study is to analyse the materno-fetal mortality and morbidity after caesarean section and a trial vaginal delivery. Uterine challenge has been tried is 578 cases with success in 12.14%. The global rate of real uterine rupture is 1.3% and of scare opening is 3.16%. The trial vaginal birth was complicated by uterine rupture in 5.9% versus 2.89% in planned caesarean section. (P = 0.00967). The length of hospitalization, the number of blood transfusion and the rate of puerperal infections are lower in the vaginal delivery trial group. The rate of new-born with Apgar < 7 in the 5th minute is in a significative way, lower in the iterative caesarean section group. (2.58% versus 4.67%), (P = 0.048). In the other hand, uterine rupture rate as well as fetal distress rate are higher in case of failure of the vaginal delivery. Maternal and fetal complications are rare and seem to be more frequent in case of failure of the uterine challenge. Accurate analysis of different obstetrical situations is necessary in order to predict the success or the failure of the vaginal delivery trial. It may lessen the maternal and fetal morbidity.     

瘢痕子宫妊娠引产及促宫颈成熟的研究进展

瘢痕子宫患者剖宫产术后阴道分娩(VBAC)引产面临的问题日益严峻,如引产是否安全、何时引产及采用何种方式引产等,常困扰产科医师。对于足月妊娠且胎儿存活的瘢痕子宫患者,VBAC引产可能失败,并增加子宫破裂风险,因此瘢痕子宫患者VBAC引产需要严格把握引产指征,并在具备抢救条件的大型医疗机构进行。对于因胎儿畸形或死胎引产的瘢痕子宫患者,引产的关键是选择个体化引产方式,使对母体的损伤降至最低。笔者拟对中、晚孕期瘢痕子宫患者VBAC引产及促宫颈成熟的国内外指南及近期较重要的临床研究进行综述,旨在为产科医师提供临床指导。     

Outcome of delivery following previous cesarean section

Of 249 women whose last pregnancy was terminated by a caesarean section, 57 (22.9%) were delivered again by a primary caesarean section. The other 192 (77.1%) were allowed to attempt vaginal birth. Of these, 151 (60.6%) were successful, and 41 (16.5%) underwent a repeat caesarean section. The percentage of successful vaginal births was strongly correlated with the indication for the previous caesarean section. There was one case of incomplete uterine rupture. The maternal morbidity was lowest in the group who had a vaginal delivery. One child developed an Erb-Duchenne paralysis in addition to a mechanical birth trauma. In the secondary caesarean section group there were more children with a low one minute Apgar score than in the group delivered vaginally or by a primary caesarean section. It is concluded that there are sufficient arguments against routinely performing a repeat caesarean section after a previous one. The indication for the previous caesarean section can be an important aid in the selection of women to be allowed to try a vaginal delivery.     

Uterine Rupture: A Seven Year Review at a Tertiary Care Hospital in New Delhi,India

Objective:

To identify the obstetric risk factors, incidence, and causes of uterine rupture, management modalities, and the associated maternal and perinatal morbidity and mortality in one of the largest tertiary level women care hospital in Delhi.

Materials and Methods:

A 7-year retrospective analysis of 47 cases of uterine rupture was done. The charts of these patients were analyzed and the data regarding demographic characteristics, clinical presentation, risk factors, management, operative findings, maternal and fetal outcomes, and postoperative complications was studied.

Results:

The incidence of rupture was one in 1,633 deliveries (0.061%). The vast majority of patients had prior low transverse cesarean section (84.8%). The clinical presentation of the patients with rupture of the unscarred uterus was more dramatic with extensive tears compared to rupture with scarred uterus. The estimated blood loss ranged from 1,200 to 1,500 cc. Hemoperitoneum was identified in 95.7% of the patient and 83% of the patient underwent repair of rent with or without simultaneous tubal ligation. Subtotal hysterectomy was performed in five cases. There were no maternal deaths in our series. However, there were 32 cases of intrauterine fetal demise and five cases of stillbirths.

Conclusions:

Uterine rupture is a major contributor to maternal morbidity and neonatal mortality. Four major easily identifiable risk factors including history of prior cesarean section, grand multiparity, obstructed labor, and fetal malpresentations constitute 90% of cases of uterine rupture. Identification of these high risk women, prompt diagnosis, immediate transfer, and optimal management needs to be overemphasized to avoid adverse fetomaternal complications.     

剖宫产术后瘢痕子宫再次妊娠经阴道分娩可行性的预测模型构建

目的 构建剖宫产术后瘢痕子宫再次妊娠经阴道分娩预测模型并探讨其可行性.方法 回顾性分析2020年2月至2021年3月在苏州市第九人民医院和苏州市立医院接受剖宫产术后瘢痕子宫再次妊娠经阴道试产的294例孕妇的临床资料.采用Logistic回归分析筛选瘢痕子宫阴道分娩可行性的影响因素,基于筛选结果建立列线图预测模型.采用R...     

Uterine rupture: report of 41 cases

To establish the epidemiological profile, of patients who presented a uterine rupture, as well as the obstetrical follow up, the neonatal outcome and the prognosis factors. A retrospective study of 41 cases of uterine rupture treated in the maternity center of Tunis during a 5-year period. The frequency of uterine rupture was 1.38%@1000 of births. Rupture in scarred uterus was found in 58.5% of the cases against 41.5% in sain uterus. Three risk factors were statistically significant in our series: cesarian section, multiparity and high fetal weight. Uterine rupture is a medico-surgical emergency causing materno-fetal morbidity and mortality.