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剖宫产术后再次妊娠分娩方式的 Fisher 判别
引用本文:沈素娟,董 云,郑帅英,等.剖宫产术后再次妊娠分娩方式的 Fisher 判别[J].咸宁医学院学报,2014(1):20-23.
作者姓名:沈素娟  董 云  郑帅英  
作者单位:舞阳县中心医院妇产科,河南舞阳462400
摘    要:目的:应用Fisher判别法归类剖宫产术后再次妊娠的分娩方式,为剖宫产史( PCS)孕妇分娩方式的选择提供参考。方法以愿意阴道试产的216例 PCS 孕妇为研究对象,采集年龄、职业、临产前体重指数( BMI)、距前次剖宫产时间、妊娠并发症、超声测量胎儿腹围、胎儿双顶径、子宫下段厚度、胎儿性别,记录分娩中Bishop宫颈成熟评分、宫缩剂应用情况等。结果①分娩方式:阴道自然分娩成功66例,阴道助产分娩成功58例,剖宫产分娩92例。②单因素分析显示:3种分娩方式在职业、临产前BMI、胎儿腹围、双顶径、宫缩剂应用、距前次剖宫产时间、子宫下段厚度和Bishop评分方面差异有统计学有意义,P<0.05。③逐步法Fisher判别入选判别函数的因素是胎儿腹围( X1)、子宫下段厚度( X2)、Bishop评分( X3)和应用宫缩剂( X4)。 Fisher判别函数:Function 1=-0.101X1+2.202X2+0.649X3+0.289X4-9.243;Function 2=0.258X1-0.156X2+0.593X3+0.409X4-14.384。④函数预测阴道顺产、阴道助产和剖宫产的敏感性分别是80.30%、56.90%和78.26%,总体符合率为73.15%。结论胎儿腹围、子宫下段厚度、Bishop评分和应用宫缩剂是影响PCS孕妇阴道分娩成败的重要因素。以此4项指标建立的Fisher判别函数可为PCS孕妇分娩方式的选择提供中等强度诊断效能。

关 键 词:剖宫产  再次妊娠  阴道试产  分娩方式  预测  Fisher判别

The Fisher Discriminant of Pregnancies after Cesarean Section
Institution:( Department of Obstetrics and Gynecology, Wuyang Central Hospital, Wuyang, Henan 462400, China)
Abstract:Objective To classify the pregnancies after cesarean section by using Fisher discriminant in order to provide a reference mode of delivery in pregnant women with the history of cesarean section ( PCS ) . Methods 216 cases of PCS pregnant women with vaginal delivery were applied in this study .Age, occupation , labor before the body mass index ( BMI) , the time from a previous cesarean section , complications of pregnan-cy, fetal abdominal circumference , fetal biparietal diameter , the lower uterine segment thickness , the sex of a fetus, the Bishop cervical ripening score , and the application of contraction agent were collected .Results ①The mode of delivery:Vaginal delivery was successful in 66 cases.Vaginal midwifery delivery was successful in 58 cases.Cesarean section delivery was successful in 92 cases.②Single factor analysis showed:The three kinds of mode of delivery has statistically significantat in occupation , preclinical BMI , fetal abdominal circum-ference , biparietal diameter , application , tocolytic agents from the previous cesarean section time , lower uter-ine segment thickness and Bishop score , P〈0.05.③The selected discriminant factors were the fetal abdomi-nal circumference ( X1 ) , the lower uterine segment thickness ( X2 ) , Bishop score ( X3 ) and the application of of oxytocin ( X4 ) by stepwise Fisher discriminant function .Fisher discriminant function: Function 1 =-0. 101X1+2.202X2 +0.649X3 +0.289X4 -9.243;Function 2=0.258X1 -0.156X2 +0.593X3 +0.409X4 -14 .384 .④The sensitivity of spontaneous vaginal delivery , vaginal delivery and cesarean section is respectively 80.30%, 56.90%and 78.26% by Function prediction.Overall compliance rate was 73.15%.Conclusion Fetal abdominal circumference , the lower uterine segment thickness , Bishop score and application of tocolytic agents are the main factors affecting the success of PCS pregnant women with vaginal delivery .It can provide a moderate diagnostic efficacy for PCS pregnant women with vaginal delivery based on the four indexes of Fisher discriminant function .
Keywords:Cesarean section  Pregnancy  Vaginal delivery  Delivery mode  Prediction  Fisher discriminant
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