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。

Analysis of successful factors of vaginal delivery after cesarean section

Objective To study and analyze the factors influencing the success of vaginal delivery after cesarean section.Methods Clinical data of 426 cases of pregnant women's pregnancy after cesarean section in Suining Traditional Chinese Medicine Hospital from October 2015 to October 2016 were collected.The results were analyzed and the factors influencing were analyzed by single factor and multivariate correlation.Results Among the 426 cases of pregnant women,271 cases succeeded in vaginal natural delivery or midwifery delivery without uterine rupture.155 cases who have cesarean indications during the trial production failed,and changed to cesarean section.Statistical analysis of influencing factors showed the postpartum hemorrhage rate was 3.32 % and the uterine rupture rate was 1.10 % in the successful group,the postpartum hemorrhage rate was 7.10 % and the uterine rupture rate was 1.29 % in the failed group.There were no significant differences in the uterine rupture rate and the number of neonatal asphyxia but the postpartum hemorrhage rate was significantly different.The single factor analysis showed that there were significant differences in prenatal body mass index(BMI),maternal age,lower uterine segment thickness and vaginal delivery history(P<0.05).There were no significant differences in scar thickness,gestational age,hospital cervix dilatation,time from previous cesarean section and neonatal weight(P>0.05).The multiple factor analysis showed that prenatal BMI,maternal age,uterine segment thickness,vaginal delivery history,whether pregnant women have signs of clinical admission all had significant impacts on trial production(P<0.05),and childbirth vaginal trial history was the most important factor to success.Conclusion Pregnant women with BMI less than 30,age less than 30,the lower uterine segment thickness greater than 4 mm,no fever after last operation and having vaginal birth experience are more suitable for vaginal trial production.