银川市瘢痕子宫孕妇分娩方式选择意愿及其影响因素分析

A survey on the choice of delivery mode among pregnant women with scar uterus and it’s analysis of influence factors in Yinchuan City

目的了解银川市瘢痕子宫孕妇再次分娩方式的选择意愿,并分析影响其分娩选择的相关因素,以期为社区及医院相关部门针对瘢痕子宫孕妇健康教育提供依据。方法选取2019-11-01-2020-02-28银川市2个社区(凯尔富邸社区和丽景雅居社区)及1所三甲医院(宁夏人民医院)门诊的118名瘢痕子宫孕妇作为研究对象。采用自行设计的调查问卷进行调查收集相关资料,通过单因素及多因素Logistic回归分析影响瘢痕子宫孕妇选择分娩方式的因素。结果共回收124份电子问卷,其中有效问卷118份。瘢痕子宫孕妇愿意剖宫产的占总例数73.6%。单因素分析结果显示,年龄(χ2=604.397,P<0.001)、身体质量指数(body mass index,BMI)(χ2=127.051,P<0.001)、学历(χ2=140.413,P<0.001)、年收入(χ2=539.295,P<0.001)、第1次与第2次妊娠时间间隔(χ2=542.917,P<0.001)、是否合并疾病(χ2=115.637,P<0.001)、剖宫产后是否可以顺产(χ2=275.950,P<0.001)、主动查阅分娩相关知识(χ2=9.107,P=0.003)、剖宫产后瘢痕的影响(χ2=188.385,P<0.001)及分娩决定因素(χ2=23.956,P<0.001)均为瘢痕子宫孕妇分娩方式选择的相关影响因素。多因素Logistic回归分析结果显示,年龄(OR=1.387,95%CI为1.088~1.062,P=0.001)、间隔时间(OR=0.868,95%CI为0.857~1.135,P=0.031)、学历(OR=1.147,95%CI为1.145~1.395,P=0.015)、BMI(OR=0.610,95%CI为0.282~0.481,P<0.001)、是否合并疾病(OR=0.259,95%CI为34.171~214.668,P<0.001)、剖宫产后可否顺产(OR=17.114,95%CI为35.621~89.035,P<0.001)、第1次剖宫产后的影响(OR=2.429,95%CI为4.262~6.697,P<0.001)及分娩决定因素(OR=0.180,95%CI为0.119~0.272,P<0.001)是瘢痕子宫孕妇选择分娩方式的影响因素。结论影响瘢痕子宫孕妇分娩方式的相关因素较多,应加强对瘢痕子宫孕妇的分娩相关知识健康教育,提高其对分娩方式的认知能力,鼓励其选择合适的分娩方式,从而降低剖宫产率,进一步提高产科质量。

Objective To understand the willingness of pregnant women with scar uterus in choosing the mode of delivery again in Yinchuan City,and to analyze the related factors in influencing choice of delivery,so as to provide the basis for health education of pregnant women with scar uterus in the community and relevant departments of hospitals.Methods This study was a cross-sectional study,from November 2019 to February,2020118 scar uterus pregnant women with scarred utervus from 2 communities in Yinchuan City and an outpatient clinic of a tertiary hospital were selected as the research objects,adopted the self-designed questionnaire combined with chi-square test and Logistic regression to analysis of factors influencing the scar uterus pregnant women choose way of delivcery.Results A total of 124 electronic questionnaires were recovered,118 of which were valid.Pregnant women with scar uterus were willing to deliver cesarean section,accounting for 73.6%of the total number of cases.Univariate analysis showed that age(χ2=604.397,P<0.001),body mass index(BMI)(χ2=127.051,P<0.001),educational background(χ2=140.413,P<0.001),annual income(χ2=539.295,P<0.001),time interval between the first and second pregnancy(χ2=542.917,P<0.001),comorbidity(χ2=115.637,P<0.001),and natural labor after cesarean section(χ2=275.950,P<0.001),active access to delivery related knowledge(χ2=9.107,P=0.003),the influence of scar after cesarean section(χ2=188.385,P<0.001)and the determinants of delivery(χ2=23.956,P<0.001)were the related influencing factors of delivery mode selection of pregnant women with scar uterus.The differences were statistically significant.Logistic regression analysis showed that age(OR=1.387,95%CI:1.088-1.062,P=0.001),time interval(OR=0.868,95%CI:0.857-1.135,P=0.031),educational background(OR=1.147,95%CI:1.145-1.395,P=0.015),BMI(OR=0.610,95%CI:0.282-0.481,P<0.001),complications(OR=0.259,95%CI:34.171-214.668,P<0.001),vaginal delivery after cesarean section(OR=17.114,95%CI:35.621-89.035,P<0.001).The influence after the first cesarean section(OR=2.429,95%CI:4.262-6.697,P<0.001)and the determinants of delivery(OR=0.180,95%CI:0.119-0.272,P<0.001)were the influencing factors of the choice of delivery mode for pregnant women with scar uterus,and the differences were statistically significant.Conclusions The related factors influencing childbirth way of the scar uterus pregnant are more.Medical personnel shouldstrengthen health education of related childbirth knowledge to scar uterus pregnant woman,in order to improve the cognitive ability of the manner of childbirth,encouraging them to choose the right means of delivery,to reduce cesarean section rate and improve the quality of obstetrics.