剖宫产后阴道分娩的临床观察

Clinical Results of Vaginal Birth after Cesarean

目的研究影响剖宫产后阴道分娩成败的因素。方法回顾性分析2012年10月-2013年7月间80例自愿要求经阴道试产的既往有剖宫产手术史的单胎孕妇资料,按照最终阴道分娩成败分为剖宫产后阴道分娩(VBAC)组(n=40)和重复剖宫产(RCS)组(n=40),对其一般资料进行比较,并作多因素相关分析。同时随机选取同时期40例既往有阴道分娩史,此次再行阴道分娩的患者作为对照组,记录VBAC组与对照组产后出血量、总产程的时间、会阴情况。结果既往前次剖宫产指征为产程停滞[OR=1.601,95%CI(1.025,2.469),P=0.04]、宫颈Bishop评分<7分[OR=3.757,95%CI(1.437,8.772),P=0.01]及新生儿体质量大[OR=1.391,95%CI(1.124,2.583),P=0.03]与VBAC失败有关。VBAC组总产程时间为(6.71±2.94)h,对照组为(5.88±2.47)h,差异无统计学意义(P=0.176);VBAC组产后出血量为(259.13±75.31)m L,对照组为(230.36±67.44)m L,差异无统计学意义(P=0.076)。结论 VBAC术后恢复快,住院时间短,但需把握合适的指征以保证母婴安全。

Objective To investigate the factors affecting the results of vaginal birth after cesarean （VBAC）. Methods We retrospectively analyzed the data from 80 pregnant women of prior cesarean section with intention of vaginal delivery between October 2012 and July 2013. According to the final way of delivery, the 80 women were divided into two groups, the VBAC group （40 cases） and repeated cesarean section （RCS） group （40 eases）. The clinical characteristics of the two groups were compared and further multi-variant analysis was conducted. Besides, 40 women with successful repeated vaginal delivery were included as controls. The delivery time and bleeding volume were compared between the VBAC group and the control group. Results The three determinant factors associated with the present VBAC were： Arrested labor as the indication of prior cesarean section [OR=l.601, 95%CI （1.025, 2.469）, P=0.04], Bishop Score [OR=3.757, 95%CI （1.437, 8.772）, P=0.01] and infant weight [OR=1.391, 95%CI （1.124, 2.583）, P=0.03]. The VBAC group presented a higher Episiotomy rate than the RCS group. No significant difference was found between the VBAC and the control group regarding the delivery time [（6.71 ± 2.94） vs. （5.88 ± 2.47） hours, P=0.176] and bleeding volume [（259.13 ± 75.31） vs. （230.36 ± 67.44） mL, P=0.076]. Conclusions VBAC presents a better and faster recovery with a shorter hospital stay. But the indication of VBAC should be strictly followed to ensure the safety of both mothers and babies.