瘢痕子宫再次妊娠分娩时机和分娩方式选择的影响因素分析

目的：探讨瘢痕子宫再次妊娠分娩时机和分娩方式选择的影响因素。方法：选取2015年1月-2017年12月于深圳市龙华区人民医院妇产科待产并选择阴道试产的瘢痕子宫再次妊娠孕妇228例为研究对象，根据最终分娩方式分为再次剖宫产组（121例）及阴道分娩组（107例），收集并比较2组孕妇的临床资料。结果：228例孕妇中，107例顺利完成阴道分娩，成功率为46.93%，且所有孕妇均无子宫破裂发生；单因素分析发现，2组孕妇在年龄、文化程度、产前体质量指数（BMI）、距离上次剖宫产时间、阴道分娩史、定期产前检查、使用催产素、瘢痕厚度、现孕周、新生儿体质量等因素间差异有统计学意义（P＜0.05）；多因素分析发现，年龄、产前BMI、距离上次剖宫产时间、阴道分娩史、定期产前检查、瘢痕厚度、新生儿体质量是分娩方式选择的影响因素。结论：瘢痕子宫再次妊娠阴道分娩较为安全，对于35岁以下、BMI＜30 kg/m2、距离上次剖宫产时间超过2年、瘢痕厚度≥3 mm、预计新生儿体质量＜2 500 g且行定期产前检查的瘢痕子宫再次妊娠孕妇可选择阴道分娩。

Analysis of Influencing Factors of Delivery Time and Delivery Mode Selection in Pregnant Women with Scarred Uterus

Objective：To explore the influencing factors of delivery time and delivery mode of scarred uterus. Methods：228 cases of pregnant women with uterine cicatricial pregnancy were selected as the subjects in the department of Obstetrics and Gynecology in the People′s Hospital of Longhua District from January 2015 to December 2017, and were divided into the second cesarean section group and the vaginal delivery group according to the difference of the final delivery mode. The clinical data of two groups of pregnant women were collected and compared. Results：107 cases of pregnant women successfully completed vaginal delivery, the success rate was 46.93%, and all pregnant women had no uterine rupture. Single factor analysis showed that there were significant differences between the two groups of pregnant women in age, educational level, prenatal BMI, the time of the last cesarean section, the history of vaginal delivery, the regular antenatal examination, the use of oxytocin, the thickness of scar, the present pregnancy week and the weight of the newborn (P＜0.05). Multiple factors analysis showed that age, prenatal BMI, the distance from the last cesarean section, the history of vaginal delivery, the periodic antenatal examination, the thickness of the scar and the weight of the newborn were the influencing factors of the choice of delivery mode. Conclusions：Vaginal delivery of scar uterus is safe. Pregnant women under 35 years of age, BMI＜30 kg/m2, more than 2 years from the last cesarean section, the cicatricial thickness≥3 mm, the estimated newborn weight ＜ 2 500 g and the regular antenatal examination of the uterine cicatricial uterus should be given vaginal delivery.