剖宫产术后再次妊娠阴道试产151例临床分析
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摘要
目的探讨影响剖宫产术后再次妊娠阴道试产成功率的因素。方法选取首都医科大学附属北京妇产医院2016年1月～2017年6月期间,符合阴道试产条件,并自愿阴道试产的151例剖宫产术后再次妊娠孕妇为研究对象。按分娩结局分成剖宫产术后阴道试产(TOLAC)成功组和失败组,比较分析两组孕妇的一般情况及母儿预后。结果 151例TOLAC孕妇中,成功分娩125例(成功组),失败后中转剖宫产26例(失败组),成功率为82.78%,子宫破裂1例,子宫破裂率为0.66%。两组孕妇的一般情况比较:孕前体重指数(BMI)、分娩前BMI、孕次、产次、子宫下段厚度、前次剖宫产距本次分娩间隔差异均无统计学意义(P> 0.05);TOLAC成功组分娩年龄高于失败组,差异有高度统计学意义(P <0.01)。剔除早产病例后,孕足月TOLAC成功组分娩年龄与失败组比较差异无统计学意义(P> 0.05)。成功组引产率明显低于失败组(P <0.01)。两组孕妇产后2 h出血量、新生儿体重比较差异无统计学意义(P> 0.05);成功组新生儿1 min Apgar评分高于失败组(P <0.05)。结论 TOLAC是否成功,与孕妇的年龄、孕次、产次、孕前BMI、分娩前BMI、分娩前子宫下段厚度、前次剖宫产距本次分娩间隔等均无关,而不能自然临产、引产干预可能与分娩成功率下降有关。
Objective To explore the factors influencing the success rate of vaginal delivery after cesarean section.Methods One hundred and fifty-one pregnant women after cesarean section and voluntary vaginal delivery, who did their prenatal care in Beijing Obstetrics and Gynecology Hospital, Capital Medical University from January 2016 to June 2017, were involved. They were divided into the success group and the failure group according to the outcome of trial of labor after cesarean(TOLAC). The general situation and prognosis of two groups were compared and analyzed.Results In 151 cases of TOLAC, 125 cases were successfully delivered(success group) and 26 cases were transferred to cesarean section after failure(failure group). The success rate was 82.78%. There was 1 uterine rupture and the uterine rupture rate was 0.66%. There was no significant difference in the pre-pregnancy body mass index(BMI), ante partum BMI, the gravidity, the parity, thickness of the lower uterine segment and the interval time of the previous cesarean section between two groups(P > 0.05). The age of success group was highly significantly higher than that of failure group(P < 0.01). After removing preterm birth cases, there was no statistically significant difference in the age between two groups(P > 0.05). The induction rate of success group was lower than that of failure group(P < 0.01). There was no significant difference in postpartum 2 h blood loss and neonatal body weight between the two groups(P > 0.05). The1 min Apgar score of the success group was significantly higher than that of the failure group(P < 0.05). Conclusion Age, the gravidity, the parity, pre-pregnancy BMI, ante partum BMI, thickness of lower uterine segment before delivery and the interval time of previous cesarean section do not affect the outcome of TOLAC. The inability to spontaneous labor and the intervention of induced labor may be related to the decrease of the success rate of vaginal delivery.
Objective To explore the factors influencing the success rate of vaginal delivery after cesarean section.Methods One hundred and fifty-one pregnant women after cesarean section and voluntary vaginal delivery, who did their prenatal care in Beijing Obstetrics and Gynecology Hospital, Capital Medical University from January 2016 to June 2017, were involved. They were divided into the success group and the failure group according to the outcome of trial of labor after cesarean(TOLAC). The general situation and prognosis of two groups were compared and analyzed.Results In 151 cases of TOLAC, 125 cases were successfully delivered(success group) and 26 cases were transferred to cesarean section after failure(failure group). The success rate was 82.78%. There was 1 uterine rupture and the uterine rupture rate was 0.66%. There was no significant difference in the pre-pregnancy body mass index(BMI), ante partum BMI, the gravidity, the parity, thickness of the lower uterine segment and the interval time of the previous cesarean section between two groups(P > 0.05). The age of success group was highly significantly higher than that of failure group(P < 0.01). After removing preterm birth cases, there was no statistically significant difference in the age between two groups(P > 0.05). The induction rate of success group was lower than that of failure group(P < 0.01). There was no significant difference in postpartum 2 h blood loss and neonatal body weight between the two groups(P > 0.05). The1 min Apgar score of the success group was significantly higher than that of the failure group(P < 0.05). Conclusion Age, the gravidity, the parity, pre-pregnancy BMI, ante partum BMI, thickness of lower uterine segment before delivery and the interval time of previous cesarean section do not affect the outcome of TOLAC. The inability to spontaneous labor and the intervention of induced labor may be related to the decrease of the success rate of vaginal delivery.
引文
[1]陈志英,陈洁.瘢痕子宫足月妊娠孕妇经阴道分娩的价值研究[J].黑龙江医药科学,2017,40(5):110-113.
[2]Pachori G,Sharma R,Sunaria PK,et al.Scar endometriosis:Diagnosis by fine needle aspiration[J].J Cytol,2015,32(1):65-67.doi:10.4103/0970-9371.155243.
[3]李晓华,权祥菊.瘢痕子宫再次妊娠阴道分娩的安全性及阴道试产的适应证[J].检验医学与临床,2018,15(3):396-398.
[4]Islam A,Ehsan A,Arif S,et al.Evaluating trial of scar in patients with a history of caesarean section[J].N Am JMed Sci,2011,3(4):201-205.
[5]中华医学会妇产科学分会产科学组.剖宫产术后再次妊娠阴道分娩管理的专家共识(2016)[J].中华妇产科杂志,2016,51(8):561-564.
[6]戚越,张剑锋.72例瘢痕子宫再次妊娠结局的分析[J].中医临床研究,2015,7(10):128-130.
[7]王梁萍,李丽洁,王慧.瘢痕子宫再次剖宫产并发症的发生情况分析[J].中国妇幼保健,2017,32(22):5544-5546.
[8]Metz TD,Stoddard GJ,Henry E,et al.How do good candidates for tria1 of labor after cesarean(TOLAC)who undergo e1ective repeat cesarean differ from those who choose TOLAC[J].Am J Obstet Gynecol,2013,208(6):1-6.
[9]陈月花,王志芹,张桂英,等.剖宫产手术指征变迁与剖宫产率的变化分析[J].中国医刊,2015,50(6):90-92.
[10]莫世盼.瘢痕子宫再妊娠孕产妇经阴道分娩的安全性[J]中国实用医药,2017,12(12):180-182.
[11]黄乐,陈琰,彭景.96例瘢痕子宫阴道试产的临床分析[J]当代医学,2016,22(34):98-99.
[12]张颖,杨小风,张国梅.瘢痕子宫再次妊娠孕妇阴道试产的风险分析及措施[J].中国实用医药,2015,10(29):273-274.
[13]杜明钰,李航,马润玫.前次剖宫产史瘢痕子宫阴道分娩的评估及管理[J].实用妇产科杂志,2016,32(3):167-170.
[14]史琳,陈锰,刘兴会.再谈瘢痕子宫阴道分娩[J].中华围产医学杂志,2016,19(9):653-656.
[15]Sentilhes L,Vayssiere C,Beucher G,et al.Delivery for women with a previous cesarean:guideline for clinical practice from the French College of Gynecologists and Obstetricians(CNGOF)[J].Eur J Obstet Gynecol Reprod Biol,2013,170(1):25-32.
[16]吴彩林,陈新,邱伟修,等.瘢痕子宫试产结局与分娩间隔及子宫下段厚度的关系[J].实用妇产科杂志,2013,29(11):826-829.
[17]中华医学会妇产科学分会产科组.早产临床诊断与治疗指南(2014)[J].中华围产医学杂志,2015,18(4):241-245.
[18]张勤建,颜建英.剖宫产瘢痕子宫妊娠期管理[J].实用妇产科杂志,2018,34(1):3-6.
[19]金枝.瘢痕子宫足月妊娠经阴道试产产程特点及临床结局分析[J].中国医药科学,2017,7(24):104-106.
[20]林晶,陈宇清.妊娠晚期瘢痕子宫不全破裂12例临床分析[J].实用妇产科杂志,2017,33(3):226-227.
[21]任卫娟,张玮,荀生丽,等.剖宫产术后阴道分娩的产程分析[J].中国医药导报,2018,15(9):74-77.
[22]Black M,Entwistle VA,Bhattacharya S,et al.Vaginal birth after caesarean section:why is up take so low?In sights from a meta-ethnographic synthesis of women′s accounts of their birth choices[J].BMJ Open,2016,6(1):e008881.
[23]焦颖,付玉静,徐采炎.子宫破裂4例临床分析[J].中国医药导报,2017,14(21):163-166.
[24]赫英东,杨慧霞.瘢痕子宫妊娠期间子宫破裂的早识别与处理[J].中国计划生育和妇产科,2016,8(7):1-2.
[2]Pachori G,Sharma R,Sunaria PK,et al.Scar endometriosis:Diagnosis by fine needle aspiration[J].J Cytol,2015,32(1):65-67.doi:10.4103/0970-9371.155243.
[3]李晓华,权祥菊.瘢痕子宫再次妊娠阴道分娩的安全性及阴道试产的适应证[J].检验医学与临床,2018,15(3):396-398.
[4]Islam A,Ehsan A,Arif S,et al.Evaluating trial of scar in patients with a history of caesarean section[J].N Am JMed Sci,2011,3(4):201-205.
[5]中华医学会妇产科学分会产科学组.剖宫产术后再次妊娠阴道分娩管理的专家共识(2016)[J].中华妇产科杂志,2016,51(8):561-564.
[6]戚越,张剑锋.72例瘢痕子宫再次妊娠结局的分析[J].中医临床研究,2015,7(10):128-130.
[7]王梁萍,李丽洁,王慧.瘢痕子宫再次剖宫产并发症的发生情况分析[J].中国妇幼保健,2017,32(22):5544-5546.
[8]Metz TD,Stoddard GJ,Henry E,et al.How do good candidates for tria1 of labor after cesarean(TOLAC)who undergo e1ective repeat cesarean differ from those who choose TOLAC[J].Am J Obstet Gynecol,2013,208(6):1-6.
[9]陈月花,王志芹,张桂英,等.剖宫产手术指征变迁与剖宫产率的变化分析[J].中国医刊,2015,50(6):90-92.
[10]莫世盼.瘢痕子宫再妊娠孕产妇经阴道分娩的安全性[J]中国实用医药,2017,12(12):180-182.
[11]黄乐,陈琰,彭景.96例瘢痕子宫阴道试产的临床分析[J]当代医学,2016,22(34):98-99.
[12]张颖,杨小风,张国梅.瘢痕子宫再次妊娠孕妇阴道试产的风险分析及措施[J].中国实用医药,2015,10(29):273-274.
[13]杜明钰,李航,马润玫.前次剖宫产史瘢痕子宫阴道分娩的评估及管理[J].实用妇产科杂志,2016,32(3):167-170.
[14]史琳,陈锰,刘兴会.再谈瘢痕子宫阴道分娩[J].中华围产医学杂志,2016,19(9):653-656.
[15]Sentilhes L,Vayssiere C,Beucher G,et al.Delivery for women with a previous cesarean:guideline for clinical practice from the French College of Gynecologists and Obstetricians(CNGOF)[J].Eur J Obstet Gynecol Reprod Biol,2013,170(1):25-32.
[16]吴彩林,陈新,邱伟修,等.瘢痕子宫试产结局与分娩间隔及子宫下段厚度的关系[J].实用妇产科杂志,2013,29(11):826-829.
[17]中华医学会妇产科学分会产科组.早产临床诊断与治疗指南(2014)[J].中华围产医学杂志,2015,18(4):241-245.
[18]张勤建,颜建英.剖宫产瘢痕子宫妊娠期管理[J].实用妇产科杂志,2018,34(1):3-6.
[19]金枝.瘢痕子宫足月妊娠经阴道试产产程特点及临床结局分析[J].中国医药科学,2017,7(24):104-106.
[20]林晶,陈宇清.妊娠晚期瘢痕子宫不全破裂12例临床分析[J].实用妇产科杂志,2017,33(3):226-227.
[21]任卫娟,张玮,荀生丽,等.剖宫产术后阴道分娩的产程分析[J].中国医药导报,2018,15(9):74-77.
[22]Black M,Entwistle VA,Bhattacharya S,et al.Vaginal birth after caesarean section:why is up take so low?In sights from a meta-ethnographic synthesis of women′s accounts of their birth choices[J].BMJ Open,2016,6(1):e008881.
[23]焦颖,付玉静,徐采炎.子宫破裂4例临床分析[J].中国医药导报,2017,14(21):163-166.
[24]赫英东,杨慧霞.瘢痕子宫妊娠期间子宫破裂的早识别与处理[J].中国计划生育和妇产科,2016,8(7):1-2.