剖宫产后再次妊娠不同分娩方式及分娩结局分析
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摘要
目的:调查剖宫产后再次妊娠分娩方式、临产情况及其对分娩结局的影响。方法:回顾性分析2015年1月至2017年12月我院剖宫产后再次妊娠产妇630例临床资料,记录630例产妇择期再次剖宫产(elective cesarean section,ERCS)及再次妊娠阴道试产(trial of labor after cesarean section,TOLAC)分娩方式选择情况,将选择ERCS分娩的产妇纳入ERCS组,并根据TOLAC分娩方式分为经阴道分娩(vaginal birth after cesarean section,VBAC)组(A组)及阴道试产失败转为剖宫产组(B组)。记录A组、B组、ERCS组一般资料(年龄、分娩前体质指数、孕周、孕次、产次),并分析TOLAC组不同临产方式阴道试产失败原因,比较3组母儿结局差异。结果:630例产妇中选择ERCS分娩465例(73.81%),纳入ERCS组;选择TOLAC分娩165例(26.19%),其中成功124例(75.15%),纳入A组;失败41例(24.85%),纳入B组。3组年龄、孕周、孕次、产次比较,差异无统计学意义(P>0.05);B组与ERCS组分娩前BMI比较,差异无统计学意义(P>0.05),但均高于A组(P<0.05)。165例TOLAC分娩中,自然临产98例(59.39%),缩宫素引产18例(10.91%),双球囊引产49例(29.70%);其中自然临产失败10例(10.20%),缩宫素引产失败8例(44.44%),双球囊引产失败23例(46.94%),且失败主要原因均为要求剖宫产。3组子宫破裂、新生儿呼吸窘迫综合征发生率比较,差异无统计学意义(P>0.05);A组与ERCS组先兆子宫破裂、新生儿入住重症监护室发生率比较,差异无统计学意义(P>0.05),但均低于B组(P<0.05);B组与ERCS组产后发热发生率比较,差异无统计学意义(P>0.05),但均高于A组(P<0.05);3组新生儿体质量比较,A组 Objective:To investigate the delivery modes,parturition,and outcomes of re-pregnancy after cesarean section. Methods:The clinical data of 630 puerperae of re-pregnancy after cesarean section were retrospectively analyzed,who were admitted to our hospital from January 2015 to December 2017. All the cases were recorded regarding their selections of delivery modes,either elective repeat cesarean section(ERCS)or trial of labor after cesarean section(TOLAC). The women who chose ERCS delivery were classified as ERCS group,while the women choosing TOLAC were further divided into vaginal birth after cesarean section(VBAC)group(group A)and cesarean section group after failure of vaginal delivery(group B). The general information(age,body mass index before delivery,gestational weeks,gravidity and parity)was recorded for group A,group B,and the ERCS group. The causes of delivery failure in different modes were analyzed for the TOLAC group,and maternal-infant outcomes were also compared between group A,group B,and the ERCS group. Results:Of the 630 cases,465(73.81%)choosing ERCS were enrolled in the ERCS group,and the remaining165(26.19%)selected TOLAC,of which 124(75.15%)were enrolled in group A,and 41(24.85%)in group B. There were no significant differences in age,gestational weeks,gravidity,and parity between the three groups(P>0.05). The BMI before delivery in group B was not significantly different from that in the ERCS group(P>0.05),but the BMIs in group B and the ERCS group were significantly higher than that in group A(P<0.05). In 165 cases of TOLAC,98(59.39%)underwent spontaneous labor,18(10.91%)received oxytocin induction,and 49(29.70%)were treated with double balloon induction. Among these TOLAC cases,10(10.20%)failed in spontaneous labor,8(44.44%)in oxytocin induction,and 23(46.94%)in double balloon induction. The main reason for failure was that cesarean section was required by the puerperae. There were no significant differences in the incidence rates of uterine rupture and neonatal respiratory distress syndrome among the three groups( P >0.05). There were no significant differences in the incidence rates of threatened uterine rupture and neonatal admission to intensive care unit between group A and ERCS group(P>0.05),and they were lower than those in group B(P<0.05). There was no significant difference in the incidence rate of postpartum fever between group B and the ERCS group(P>0.05),but the rates in the two groups were both significantly higher than that in group A(P<0.05). The body mass of neonates was lowest in group A and highest in group B(P<0.05). Conclusion:ERCS is preferred for re-pregnancy after cesarean section,but TOLAC is more beneficial to maternal-infant health care in China.
引文
[1]屈在卿,马润玫,肖虹,等.剖宫产术后再次妊娠阴道试产孕妇的妊娠结局分析[J].中华妇产科杂志,2016,51(10):748-753.
[2]伍绍文,卢颖州,王珊珊,等.剖宫产术后再次妊娠阴道分娩的相关影响因素分析[J].中华妇产科杂志,2016,51(8):576-580.
[3]杨慧霞,李博雅.剖宫产后时代面临的挑战剖宫产术后再次妊娠阴道分娩相关问题[J].中华妇产科杂志,2016,51(8):573-575.
[4]严倩,刘荣慧,王丽娟,等.剖宫产术后再次妊娠阴道分娩的安全性探讨[J].实用妇产科杂志,2016,32(12):933-936.
[5]段冬梅,牛建民,林小红,等.剖宫产术后再次妊娠阴道试产孕妇的临床研究[J].广东医学,2018,39(S1):117-120.
[6]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.
[7]魏素梅,金莹,熊雯,等.前次剖宫产术对再次妊娠影响的临床评价[J].实用妇产科杂志,2017,33(8):619-622.
[8]廖晗甦,杨钦灵.瘢痕子宫再次妊娠分娩方式选择的分析[J].广东医学,2016,37(z2):93-95.
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[10]余琳,苏春宏,王晓怡,等.剖宫产术后再次妊娠阴道试产的多中心临床研究[J].中华妇产科杂志,2016,51(8):581-585.
[11] Sarreau M,Leufflen L,Monceau E,et al. Balloon catheter for cervical ripening on scarred uterus with unfavorable cervix:multicenter retrospective study of 151 patients[J]. J Gynecol Obstet Biol Reprod(Paris),2014,43(1):46-55.
[12]何镭,陈锰,何国琳,等.剖宫产术后再次妊娠阴道分娩孕妇的妊娠结局分析[J].中华妇产科杂志,2016,51(8):586-591.
[13]杨斌,郝一昌,邱敏,等.输尿管软镜与经皮肾镜碎石术治疗孤立肾肾结石的对比研究[J].重庆医科大学学报,2018,43(4):52-56.
[14]魏素梅,杨霄,金莹,等.剖宫产术对妊娠并发胎盘植入程度的影响[J].中国计划生育和妇产科,2017,9(8):61-64.
[15]陈雅颂,袁力,钟沅月.新产程标准对瘢痕子宫孕妇再次阴道分娩结局的影响[J].广东医学,2017,38(22):3473-3474.
[16]袁欢.瘢痕子宫再次妊娠阴道试产临床分析及护理对策[J].中国全科医学,2017,20(S2):297-298.
[17]高晓艳,张玲,张鹏.阴道三维超声对剖宫产术后子宫切口憩室导致的子宫异常出血的诊断价值[J].实用医学杂志,2016,32(10):1598-1601.
[18] Sudhof LS,Has P,Rouse DJ,et al. Choice of trial of labor after cesarean and association with likelihood of success[J]. Am J Perinatol,2018,35(9):892-897.
[2]伍绍文,卢颖州,王珊珊,等.剖宫产术后再次妊娠阴道分娩的相关影响因素分析[J].中华妇产科杂志,2016,51(8):576-580.
[3]杨慧霞,李博雅.剖宫产后时代面临的挑战剖宫产术后再次妊娠阴道分娩相关问题[J].中华妇产科杂志,2016,51(8):573-575.
[4]严倩,刘荣慧,王丽娟,等.剖宫产术后再次妊娠阴道分娩的安全性探讨[J].实用妇产科杂志,2016,32(12):933-936.
[5]段冬梅,牛建民,林小红,等.剖宫产术后再次妊娠阴道试产孕妇的临床研究[J].广东医学,2018,39(S1):117-120.
[6]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.
[7]魏素梅,金莹,熊雯,等.前次剖宫产术对再次妊娠影响的临床评价[J].实用妇产科杂志,2017,33(8):619-622.
[8]廖晗甦,杨钦灵.瘢痕子宫再次妊娠分娩方式选择的分析[J].广东医学,2016,37(z2):93-95.
[9] Brock CO,Govindappagari S,Gyamfi-Bannerman C. Outcomes of operative vaginal delivery during trial of labor after cesarean delivery[J]. Am J Perinatol,2017,34(8):765-773.
[10]余琳,苏春宏,王晓怡,等.剖宫产术后再次妊娠阴道试产的多中心临床研究[J].中华妇产科杂志,2016,51(8):581-585.
[11] Sarreau M,Leufflen L,Monceau E,et al. Balloon catheter for cervical ripening on scarred uterus with unfavorable cervix:multicenter retrospective study of 151 patients[J]. J Gynecol Obstet Biol Reprod(Paris),2014,43(1):46-55.
[12]何镭,陈锰,何国琳,等.剖宫产术后再次妊娠阴道分娩孕妇的妊娠结局分析[J].中华妇产科杂志,2016,51(8):586-591.
[13]杨斌,郝一昌,邱敏,等.输尿管软镜与经皮肾镜碎石术治疗孤立肾肾结石的对比研究[J].重庆医科大学学报,2018,43(4):52-56.
[14]魏素梅,杨霄,金莹,等.剖宫产术对妊娠并发胎盘植入程度的影响[J].中国计划生育和妇产科,2017,9(8):61-64.
[15]陈雅颂,袁力,钟沅月.新产程标准对瘢痕子宫孕妇再次阴道分娩结局的影响[J].广东医学,2017,38(22):3473-3474.
[16]袁欢.瘢痕子宫再次妊娠阴道试产临床分析及护理对策[J].中国全科医学,2017,20(S2):297-298.
[17]高晓艳,张玲,张鹏.阴道三维超声对剖宫产术后子宫切口憩室导致的子宫异常出血的诊断价值[J].实用医学杂志,2016,32(10):1598-1601.
[18] Sudhof LS,Has P,Rouse DJ,et al. Choice of trial of labor after cesarean and association with likelihood of success[J]. Am J Perinatol,2018,35(9):892-897.