剖宫产术后阴道分娩成功因素及母婴结局的临床研究

目的探讨影响剖宫产术后阴道分娩成功的因素以及母婴结局。方法回顾性分析2013~2016年深圳市龙华新区人民医院收治的1 638名剖宫产术后阴道试产孕妇,根据阴道试产成功与否分为阴道分娩成功组(1 038名)和阴道试产失败组(600名)。对比两组的产后出血率、子宫破裂率以及新生儿窒息率,总结影响剖宫产术后阴道分娩相关因素,影响母婴结局的相关因子。结果孕妇剖宫产术后阴道分娩情况与年龄、产前体质量指数(body mass index,BMI)、入院宫口的扩张情况、上次剖宫产手术时间、是否紧急入院及有无阴道分娩史之间有关联;两组孕妇的产后出血率、子宫破裂率及新生儿窒息率比较差异均有统计学意义(P0.05)。结论剖宫产术后阴道分娩成功与孕妇年龄≤35岁、产前BMI30 kg/m~2、距离上次剖宫产手术时间10年、有阴道分娩史、紧急入院以及入院时宫口扩张≥6 cm密切相关。

Clinical study on success factors and maternal - fetal outcomes of vaginal delivery after cesarean section

Objective To explore the success factors and maternal- fetal outcomes of vaginal delivery after cesarean section. Methods Retrospective analyzed 1 638 vaginal trial production of pregnant women in Shenzhen Longhua New District People's Hospital from January 2013 to December 2016, including 1 038 cases of successfull vaginal delivery after cesarean section group and 600 cases of vaginal trial failure group.Compared the deferences between the two groups to summarize the factors that affect the success of vaginal delivery after cesarean section. Compared the two groups of postpartum hemorrhage rate, uterine rupture rate and neonatal asphyxia rate,to sum up factors affecting maternal and child outcomes of vaginal delivery after cesarean section. Results Vaginal delivery situations have correlations with the maternal age,prenatal BMI,expansion of the cervix,last cesarean section time,the last time of cesarean section,whether it is an emergency admission and whether or not vaginal birth history(P <0.05). There were significant differences in postpartum hemorrhage rate, uterine rupture rate and neonatal asphyxia rate between the two groups of pregnant women(P<0.05). Conclusion Age≤35,prenatal BMI<30 kg/m2,<10 years from the last cesarean section operation, history of vaginal delivery,emergency admission and expansion of the cervix≥6 cm are correlated with successfull vaginal delivery after cesarean section.