剖宫产后再次妊娠阴道分娩

剖宫产术后再次妊娠阴道分娩的人数逐渐增加。Obara等回顾性分析 310例剖宫产术后再次妊娠者 ,其中 96例 (31% )行再次剖宫产术 ,2 14例 (6 9% )阴道试产 ,132例 (4 3% )试产成功 ,两组均未发现孕妇或围生儿死亡。我院近 2年 4 80例剖宫产术后再次妊娠者中 370例 (77.1% )行再次剖宫产术 ,110例(2 2 .9% )行阴道试产 ,87例 (79.1% )试产成功 ,74例 (85 .1% )自然分娩 ,13例 (14 .9% )阴道助产。当然 ,并非所有剖宫产术后再次妊娠者都可以选择阴道分娩 ,合理选择对象 ,加强产程观察 ,谨慎使用缩宫素 ,可以提高试产成功率。同时鼓励了更多的…     

剖宫产后再次妊娠的阴道分娩

近年来剖宫产率在我国不断升高,有些城市已从20年前的9%上升到45%.造成剖宫产率升高的原因很多,例如惧怕分娩、胎儿电子监护的广泛使用、对臀位产缺乏训练和经验、阴道手术产的减少以及再次剖宫产的增多等.减少过高的剖宫产率的办法之一就是剖宫产史孕妇经阴道试产.     

剖宫产术后再次妊娠阴道分娩

随着剖宫产率的上升，剖宫产后再次妊娠率也随之增加，剖官产术后再次妊娠阴道分娩的人数也逐渐增加。我院近两年有182例剖宫产术后再次妊娠，其中有37例阴道分娩，2例阴道助产，其余行再次剖官产术。     

剖宫产后再次妊娠的分娩方式-阴道分娩

近年来，随着剖宫产率的升高，剖宫产后再次妊娠的人数增加。为了解决剖宫产后再次妊娠的阴道分娩问题，降低剖宫产率，国内外学者进行了大量的研究。本文查阅大量资料结合自己的临床实践就这一问题谈一下自己的观点与体会。     

剖宫产后再次阴道分娩

随着医疗水平的提高和社会各方面的因素,剖宫产率呈现逐年增高的趋势,剖宫产后再次妊娠的分娩方式,尚存争议。本文综合分析剖宫产后再次妊娠阴道分娩(vaginal birth after cesarean,VBAC)的发展趋势、病例选择及相关处理方法,以进一步降低剖宫产率,提高产科质量。     

剖宫产术后再次妊娠阴道分娩的研究

随着剖宫产率的逐年上升,剖宫产术后再次妊娠率也随之增加.术后再次妊娠能否经阴道分娩已成为产科医生重视的问题.近年越来越多的研究从剖官产术后阴道分娩的适应证、禁忌证、高危因素、注意事项、缩宫素的应用、影响因素、优越性及危险性等方面探讨阴道试产的可行性.研究证实,剖宫产史并非再次妊娠剖宫产的绝对指征,剖宫产术后阴道分娩与再次剖宫产相比利多弊少,选择合适的病例进行阴道试产是安全可行的.     

剖宫产术后再次妊娠阴道分娩的研究

随着剖宫产率的逐年上升．剖宫产术后再次妊娠率也随之增加。术后再次妊娠能否经阴道分娩已成为产科医生重视的问题。近年越来越多的研究从剖宫产术后阴道分娩的适应证、禁忌证、高危因素、注意事项、缩宫素的应用、影响因素、优越性及危险性等方面探讨阴道试产的可行性。研究证实，剖宫产史并非再次妊娠剖宫产的绝对指征．剖宫产术后阴道分娩与再次剖宫产相比利多弊少．选择合适的病例进行阴道试产是安全可行的。     

剖宫产术后再次妊娠阴道分娩的可行性研究进展

“一次剖宫产，永远剖宫产”是美国Graigin在1916年提出的，而今这个信条在美国主导了将近70年后逐渐开始改变。自1978年，Merrill和Gibbs提出高达83％的剖宫产术后阴道分娩（Vaginal Birth After Cesarean，VBAC）成功率，尝试VBAC的人数逐渐增加，在美国短短20年内，VBAC由2％上升了14倍至28％。许多大型病例系列研究证实VBAC相对安全。     

剖宫产术后再次妊娠阴道分娩的临床分析

目的：探讨剖宫产术后再次妊娠阴道分娩（VBAC）患者的试产成功率、产程及母婴并发症。方法：选取2012年1至2013年3月在我院行阴道分娩的剖宫产术后再次妊娠的153例产妇为研究组,同期选取行阴道分娩的200例孕足月初产妇为对照组。分析两组的阴道试产成功率、产程、母婴并发症。结果：研究组153例,试产成功130例（84.97%）;对照组200例,试产成功183例（91.50%）。两组的阴道试产成功率、第一产程、第二产程及总产程、新生儿窒息率、巨大儿发生率均无显著差异（P〉0.05）;而第三产程时间、手取胎盘率、会阴侧切率及产后出血率均显著高于对照组（P〈0.05）。结论：对有1次子宫下段横切口剖宫产史的孕妇,应给予充分的阴道试产机会,同时应积极处理第三产程,预防产后出血。     

Variables associated with successful vaginal birth after one cesarean section: a proposed vaginal birth after cesarean section score

The objective of this study was to define the variables associated with vaginal birth after cesarean section (VBAC) and to develop a scoring system for the prediction of successful VBAC. We searched our computerized database for parturients with a history of one low-transverse cesarean section (CS) who were delivered during the year 2000. Variables were categorized according to the time period in which they were obtained: (1) first prenatal visit, (2) at the onset of labor, and (3) during labor. Univariate and multiple stepwise logistic regression models were fitted to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Of the 475 parturients with a history of one previous CS, 136 underwent elective CS and 339 underwent a trial of VBAC, of whom 82% were successful. Of the variables that can be obtained at the onset of labor, five were significantly associated with successful VBAC: abnormal presentation as the indication for the primary CS (OR, 7.4; 95% CI 2.8 to 19.2), a previous VBAC (OR, 7.2; 95% CI, 2.1 to 24.8), cervical dilation (OR, 2.5; 95% CI, 1.3 to 4.9), gestational age < or = 41 weeks (OR, 2.8; 95% CI, 1.1 to 7.1), and lower gestational age at the primary CS (OR, 1.2; 95% CI, 1.02 to 1.4). In the proposed VBAC score, each of the four most significant variables was assigned a score ranging between 0 and 3 based on the probability for VBAC. A score < or = 2 was associated with a success rate of 42%, a score between 3 and 6 was associated with a rate of 81%, and a score between 7 and 10 was associated with a 98% successful VBAC rate (p < 0001). The proposed VBAC score may help obstetricians when counseling their patients regarding the individual likelihood of a successful VBAC.     

剖宫产后阴道分娩预测评分模型的初建

目的:建立适合中国人群的剖宫产后阴道分娩预测评分模型,有助于剖宫产后再次妊娠的妇女进行分娩方式的选择。方法:收集2014年1月1日至2016年6月30日于复旦大学附属妇产科医院分娩的有1次剖宫产史的阴道试产病例239例,回顾分析影响阴道试产成功的相关因素,将有统计学差异的有利因素纳入预测评分模型,应用受试者工作特性曲线评价该模型的准确度。结果:将距前次剖宫产间隔、前次剖宫产指征、流产及阴道分娩史、自然临产、宫口扩张、宫颈容受、新生儿出生体重作为评分指标建立剖宫产后阴道分娩预测评分模型。根据预测评分值分为0～2分、3～4分、5～8分3组。0～2分组的阴道试产成功率较低,为10.0%,5～8分者成功率最高为92.5%,3组比较差异有统计学意义(P0.001)。将评分结果绘制受试者工作特性曲线,曲线下面积为0.793,以5分为临界点,该模型的灵敏度为74.6%。结论:建立针对中国人群的剖宫产后阴道分娩预测评分模型,该模型计算简便,易于应用在临床工作中。     

规范化剖宫产后阴道试产478例临床分析

目的:探讨规范化剖宫产后阴道试产(VBAC)诊疗对分娩结局的影响。方法:回顾分析同济大学附属第一妇婴保健院2014年1月至2016年8月接受规范化VBAC诊疗的478例孕妇的分娩结局。结果:478例孕妇的VBAC成功率为95.4%,其中引产率为33.4%。根据发动方式分为自然发动组(318例)和引产组(160例),引产组的第一产程、总产程显著延长,VBAC成功率显著下降。引产组和自然发动组的子宫破裂、产后出血无显著差异。引产组的双球囊应用率为72.5%,催产素应用率为78.8%,分娩镇痛率为80.1%。结论:规范化VBAC诊疗有利于提高VBAC成功率和引产成功率。引产显著降低VBAC成功率。双球囊和催产素应用于VBAC引产具有安全性和较好的临床疗效。充分开展分娩镇痛可能有助于提高VBAC成功率。     

Umbilical glutathione levels are higher after vaginal birth than after cesarean section

Glutathione plays an important role in quenching reactive oxygen species, resulting in oxidation of glutathione, which in times of prolonged oxidative stress may be excreted from the erythrocyte. We investigated arterial and venous umbilical cord levels of glutathione in neonates born by vaginal delivery (n = 140) or cesarean section (n = 38). In a subset of neonates who were delivered vaginally maternal levels were assessed in parallel (n = 14). Median (5th-95th percentile) glutathione levels in venous and arterial umbilical samples were higher after vaginal delivery as compared to cesarean section, 2.7 (0.9-7.3) versus 2.0 (0.6-11.5; P < 0.03) and 3.5 (0.6-22.7) versus 2.3 (0.7-24.3) micromol/L (P < 0.02), respectively. Maternal glutathione levels were higher, 7.8 (4.3-10.6) micromol/L, than corresponding venous (P < 0.001) or arterial (P < 0.02) umbilical levels. These results suggest that vaginal delivery is associated with more oxidative stress than delivery by cesarean section.     

Management of vaginal birth after cesarean

OBJECTIVE: To raise the success rate of vaginal birth after cesarean (VBAC) without increasing maternal or perinatal morbidity and mortality rates. METHODS: Of 468 women with a prior scar, 365 gave valid informed consent for our management of VBAC at Akashi Municipal Hospital during 1986-1999. Trials of labor (TOL) were attempted in 322 cases principally by waiting for spontaneous labor onset and teaching the patients a breathing method to avoid straining until expulsion by vacuum extraction become possible, controlling the intrauterine pressure. Our selection criteria for TOL changed during the trial; from 1991-1999 patients with a prior scar extending into fundus were excluded. RESULTS: Of the 322 TOL, 88.2% were successful, and VBAC was successful in 77.8% (284 of the 365 patients). Uterine rupture was observed in 2 cases (0.62%). Fetal death occurred in 1 case. Three women gave birth to neonates with a 1-minute Apgar score < or = 6. CONCLUSION: The rate of VBAC was 77.8% in all women with a prior scar. During our management of VBAC, maternal or perinatal morbidity and mortality rates did not increase significantly.