瘢痕子宫孕妇选择阴道分娩的预测分析及对分娩结局的影响

目的探讨瘢痕子宫孕妇选择阴道分娩的客观影响因素预测分析模型及对分娩结局的影响。方法对2018年在南京大学医学院附属鼓楼医院因瘢痕子宫选择再次剖宫产分娩的165例产妇和97例选择阴道分娩产妇的相关因素进行比较,对影响因素采用Logistics回归方法构建选择阴道分娩的预测模型,并研究阴道分娩对分娩结局的影响。结果剖宫产及阴道分娩组在产妇年龄、孕周、两次妊娠间隔时间、接受瘢痕子宫相关知识和课程培训方面比较,差异有统计学意义(P<0.05);产妇体重、学历、户籍地、妊娠次数、瘢痕厚度及新生儿体重方面比较,差异无统计学意义(P>0.05)。进一步采用Logistic回归分析显示,产妇年龄和接受产前培训次数是影响瘢痕子宫孕妇选择分娩方式的因素。ROC曲线分析显示接受产前培训次数单个因素和混合因素(产妇年龄和接受产前培训次数)对产妇分娩方式的选择具有较好的预测价值。剖宫产与阴道分娩组产后失血量(323.03±147.18)mL vs(269.85±223.16)mL]、住院天数(5.65±1.36)d vs(4.12±1.54)d]、住院费用(3 997.29±2 269.57)元vs(3 301.02±1 807.08)元]比较,差异均有统计学意义(P<0.05)。结论多种因素都能影响瘢痕子宫孕妇选择阴道分娩的决定,尤其以产妇年龄和接受产前培训次数较为重要,对分娩方式的选择具有一定的预测作用。与再次剖宫产相比,阴道分娩对母婴并未产生不良分娩结局,且可减少产后失血量、住院天数和住院费用。

Predictive analysis of vaginal delivery in pregnant women with scar uterus and its effect on delivery outcome

Objective To explore the predictive analysis model of influencing factors of vaginal delivery in pregnant women with scar uterus and the effect on the outcome of delivery.Methods 165 cases of cesarean delivery due to scar uterus and 97 cases of vaginal delivery after cesarean(VBAC)at Drum Tower Hospital Affiliated of Nanjing University Medical College in 2018 were retrospectively analyzed,correlation factors between two groups were compared, and the influencing factors were used to construct a predictive model for vaginal delivery using the logistic regression method, and the effect of vaginal delivery on the outcome of delivery was studied.Results There was a significant difference in maternal age, gestational week, interval between two gestation, the knowledge and the training curriculum of the scar uterus between cesarean section group and VBAC group(P < 0.05), and there was no significant difference in maternal weight, education, household registration, pregnancy frequency, scar thickness and neonatal weight(P>0.05).Further logistic regression analysis showed that the maternal age and the number of prenatal training were factors that influence the choice of delivery methods for pregnant women with scar uterus.ROC curve analysis showed that the single factor prenatal training times and mixed factors(maternal age and number of antenatal training) had a good predictive value for maternal delivery.There were significant differences in haemorrhage during delivery (323.03±147.18)mL vs(269.85±223.16)mL], hospitalization days (5.65±1.36)d vs(4.12±1.54)d], and hospitalization costs (3 997.29±2 269.57) yuan vs(3 301.02±1 807.08)yuan]between cesarean section group and VBAC group(P<0.05).Conclusion Various factors could influence the choice of VBAC, especially maternal age and the number of prenatal training,has a certain predictive effect on the choice of mode of delivery.Compared with the second cesarean section, VBAC parturient could get more delivery benefits including reducing postpartum haemorrhage, hospitalization days and hospitalization costs.