一次剖宫产术后阴道试产62例病例分析回顾性分析
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摘要
目的为了国家计划生育开放生育政策后,降低现有的超高的剖宫产率现状,为一次剖宫产术后阴道分娩(vaginal birth after cesarean, VBAC)提供一定的临床依据和经验借鉴。方法回顾性分析宜昌市中心人民医院2016年12月-2017年12月间,采用统计学分析一次剖宫产术后阴道试产(trial of labor after cesarean, TOLAC)成功和失败的数据结果。结果 1)有意愿阴道试产的孕妇仅为62例(8.12%),最后阴道试产成功为7例(0.91%);2)7例VBAC孕妇年龄28~43岁,平均34.57±6.241岁,均为自然临产,体重无肥胖患者,6例未进行瘢痕厚度监测;3)7例阴道试产成功的病例中,新生儿体重3200~3900g,平均3400±42.85g,无一例发生窒息,产程中未见羊水异常。结论一次剖宫产术后阴道分娩的成功,其最优势的条件是孕妇能够自然临产,同时孕期控制体重,在孕前体重标准的前提下,孕期增长范围15kg,而孕妇年龄,剖宫产时间,瘢痕厚度仅为参考条件。
Objective To reduce the current high cesarean section rate after the birth control policy for national family planning, provide a certain clinical basis and experience for vaginal delivery after a cesarean section. Methods A retrospective analysis was performed between December 2016 and December 2017 in the People's Hospital of Yichang City. Statistical analysis was used to determine the success and failure of vaginal trial production after cesarean section. Results 1) Only 62(8.12%) were expectant vaginal trials, and 7(0.91%) succeeded in vaginal trial production; 2) Seventeen vaginal birth after cesarean pregnant women aged 28 to 43 years old, with an average of 34.57±6.241. All patients were naturally born with weight without obesity. Six patients had no monitoring of scar thickness. 3) In 7 cases with successful vaginal trials, the neonatal weight was 3200 to 3900 g, with an average of 3400±42.85 g. There was no case of asphyxia. No abnormality in amniotic fluid was seen. Conclusion The most advantageous condition of vaginal birth after cesarean success is that pregnant women are able to spontaneously give birth. At the same time, weight is controlled during pregnancy. Under the premise of weight standard, the range of pregnancy growth is 15 kg. The age of pregnant women, the time of cesarean section and the thickness of scar are only the reference conditions.
Objective To reduce the current high cesarean section rate after the birth control policy for national family planning, provide a certain clinical basis and experience for vaginal delivery after a cesarean section. Methods A retrospective analysis was performed between December 2016 and December 2017 in the People's Hospital of Yichang City. Statistical analysis was used to determine the success and failure of vaginal trial production after cesarean section. Results 1) Only 62(8.12%) were expectant vaginal trials, and 7(0.91%) succeeded in vaginal trial production; 2) Seventeen vaginal birth after cesarean pregnant women aged 28 to 43 years old, with an average of 34.57±6.241. All patients were naturally born with weight without obesity. Six patients had no monitoring of scar thickness. 3) In 7 cases with successful vaginal trials, the neonatal weight was 3200 to 3900 g, with an average of 3400±42.85 g. There was no case of asphyxia. No abnormality in amniotic fluid was seen. Conclusion The most advantageous condition of vaginal birth after cesarean success is that pregnant women are able to spontaneously give birth. At the same time, weight is controlled during pregnancy. Under the premise of weight standard, the range of pregnancy growth is 15 kg. The age of pregnant women, the time of cesarean section and the thickness of scar are only the reference conditions.
引文
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[15]刘玲.产程观察及管理对瘢痕子宫阴道试产情况的影响[J].医疗装备,2018,12:79-80.
[16]叶晓英.瘢痕子宫阴道试产的可行性分析[J].当代医学,2018,17:130-131.
[17]宋敏洁.瘢痕子宫阴道试产研究进展[J].中国民康医学,2012,24:3067.
[18]熊娟,刘世秀.剖宫产术后瘢痕子宫阴道试产73例结局分析[J].吉林医学,2010,22:3775-3776.
[19]谢幸,苟文丽.妇产科学第八版[M].北京:人民卫生出版社, 2013:218.
[20]Hruban L, Janku P, Ventruba P,et al. Incarcerateduterus in pregnancypitfalls of diagnosis, clinical course andtherapy:two case reports[J]. Ceska Gynekol, 2013, 78(5):427-431.
[2]杨素英.瘢痕子宫阴道试产可行性与应用价值分析[J].临床医药文献电子杂志,2015,16:3186.
[3]董小琼,张茜茜,周雪微.瘢痕子宫阴道试产与剖宫产母婴结局比较[J].浙江实用医学,2015,05:355-357.
[4]刘星,刘俊丽.瘢痕子宫再次妊娠分娩方式临床分析[J].陕西医学杂志,2015,12:1639-1641.
[5]张茗,王孝贤,尚丽莉,等.瘢痕子宫与非瘢痕子宫阴道试产的临床结局比较[J].大连医科大学学报,2015,06:589-591.
[6]刘小灿.瘢痕子宫阴道试产失败的影响因素分析[J].实用妇科内分泌杂志(电子版),2016,05:110-111.
[7]张肖怡.瘢痕子宫阴道试产的可行性[J].医疗装备,2016,19:102.
[8]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,2016,34:98-99.
[9]杨秀芳,冯亚斌,韩轶超,等.瘢痕子宫阴道试产的可行性分析[J].中国妇幼保健,2017,03:477-480.
[10]庄莉.瘢痕子宫、非瘢痕子宫阴道试产妊娠结局比较[J].临床医学研究与实践,2017,16:136-137.
[11]苏卫兰,赖宝玲,杨静,等.瘢痕子宫阴道试产的预测因素分析[J].现代诊断与治疗,2017,12:2173-2175.
[12]林雅真,汪燕,陈怡玲.影响瘢痕子宫阴道试产的相关因素分析[J].中国冶金工业医学杂志,2017,06:682-683.
[13]柴丹,周丽.宫颈扩张球囊在瘢痕子宫阴道试产中的应用探讨[J].华西医学,2017,12:1886-1889.
[14]彭萍,滕伟.瘢痕子宫阴道试产的产程管理[J].中国医刊,2018,02:120-125.
[15]刘玲.产程观察及管理对瘢痕子宫阴道试产情况的影响[J].医疗装备,2018,12:79-80.
[16]叶晓英.瘢痕子宫阴道试产的可行性分析[J].当代医学,2018,17:130-131.
[17]宋敏洁.瘢痕子宫阴道试产研究进展[J].中国民康医学,2012,24:3067.
[18]熊娟,刘世秀.剖宫产术后瘢痕子宫阴道试产73例结局分析[J].吉林医学,2010,22:3775-3776.
[19]谢幸,苟文丽.妇产科学第八版[M].北京:人民卫生出版社, 2013:218.
[20]Hruban L, Janku P, Ventruba P,et al. Incarcerateduterus in pregnancypitfalls of diagnosis, clinical course andtherapy:two case reports[J]. Ceska Gynekol, 2013, 78(5):427-431.