瘢痕子宫阴道试产成功情况及其相关影响因素分析

Analysis of the success of vaginal trial delivery of scar uterus and its related influencing factors

目的探究瘢痕子宫阴道试产成功情况及其相关影响因素。方法回顾性选取本院收治的剖宫产后瘢痕子宫再次妊娠产妇100例,选例时间为2018年3月-2021年1月。将符合剖宫产后阴道试产指征且具有瘢痕子宫阴道试产意愿并阴道试产成功的产妇分为阴道试产成功组(70例)和阴道试产失败及自愿选择性重复剖宫产术的产妇分为阴道试产失败组(30例)。对两组临床基本资料进行分析与整理,比较两组基础资料、产后出血情况和胎儿窘迫情况,对影响剖宫产后阴道试产成功的单因素进行分析,并对影响瘢痕子宫剖宫产后阴道试产成功的相关影响因素进行多因素非条件Logistic回归分析。结果阴道试产成功组年龄小于阴道试产失败组;阴道试产成功组产后24h出血量少于阴道试产失败组;单因素结果分析显示,阴道试产成功组中年龄27岁-32岁、孕周<36周、新生儿体重<2500 g的产妇占比高于阴道试产失败组;多因素非条件Logistic回归分析结果显示,年龄27岁-32岁、孕周<36周、新生儿体重<2500 g均为剖宫产后阴道试产成功的保护因素(OR=0.641、0.314、0.807,P<0.05)。结论年龄27岁-32岁、孕周<36周、新生儿体重<2500g均为瘢痕子宫剖宫产后阴道试产成功的保护因素,临床可通过在产前严格把控瘢痕子宫剖宫产后产妇阴道试产的适应症,并结合剖宫产后阴道试产成功的保护因素,对具备阴道试产条件且有意向的产妇可提倡其进行剖宫产后阴道试产,进而减少产后出血和胎儿窘迫情况的发生,获得最佳的母婴分娩结局。

Objective To explore the success of vaginal trial delivery with scarred uterus and related influencing factors.Methods A retrospective selection of 100 re-pregnancy women with scarred uterus after cesarean section admitted to our hospital was retrospectively selected from March 2018 to January 2021.The parturients who met the indications for vaginal trial delivery after cesarean section and had the willingness to try vaginal delivery with scarred uterus and succeeded in vaginal trial delivery were divided into the successful vaginal trial delivery group(70 cases),and the failure of vaginal trial delivery and voluntary and selective repeated cesarean section,the pregnant women were divided into vaginal trial labor failure group(30 cases).The basic clinical data of the two groups were analyzed and sorted.The basic data,postpartum hemorrhage and fetal distress of the two groups were compared.The single factors that affected the success of the vaginal trial after cesarean section were analyzed,and multi-factor unconditional Logistic regression analysis was conducted on the related factors affecting the success of vaginal trial delivery after cesarean section in scarred uterus.Results The success of vaginal trial production group was younger than the vaginal trial production failed group;the vaginal trial production group had less blood loss at 24 hours after delivery than the vaginal trial production failed group.The univariate analysis showed that the vaginal trial production group was 27 to 32 years old;the proportion of pregnant women with a gestational age of<36 weeks and a newborn weight of<2500 g was higher than that of the vaginal trial labor failure group.The results of multivariate unconditional logistic regression analysis showed that the age was 27 to 32 years,the gestational age was<36 weeks,and the newborn weight was<2500 g were all protective factors for successful vaginal trial delivery after cesarean section(OR=0.641,0.314,0.807,P<0.05).Conclusion Age 27-32 years,gestational age<36 weeks,and newborn weight<2500g are all protective factors for successful vaginal trial delivery after cesarean section in scarred uterus.Clinically,it is possible to strictly control vaginal trial delivery after cesarean section indications with scarred uterus and combined with the protective factors for successful vaginal trial delivery after cesarean section,women who have the conditions for vaginal trial delivery and are interested can be encouraged to have vaginal trial delivery after cesarean section to reduce postpartum hemorrhage and fetal distress.Occurs,and obtain the best maternal and infant delivery outcome.