疤痕子宫再次妊娠分娩方式的危险因素分析

Risk factors of delivery mode in women with scarred uterus

目的观察瘢痕子宫再次妊娠分娩方式的相关影响因素。方法 120例有剖宫产史的瘢痕子宫孕妇的相关临床资料,鼓励患者进行自然阴道分娩,孕妇规律宫缩开始16 h宫口尚未开全则进行剖宫产。记录所有孕妇的年龄、体重指数、孕周、剖宫产次数、上次剖宫产距本次引产间隔时间、子宫瘢痕厚度、胎位、有无子宫破裂、产后出血量、宫腔残留率及子宫切除术等情况。结果 120例产妇中,96例孕妇最终成功阴道分娩,分娩率为80.00%,另24例中途转为剖宫产,占20.00%。对影响孕妇阴道分娩的相关因素进行多因素非条件Logistic回归分析结果显示:影响成功阴道试产的主要危险因素包括孕妇体重指数和上次剖宫产距离时间。阴道分娩及剖宫产的孕妇的产后出血量分别为(394.39±64.11),(432.66±59.12)mL;产后住院时间分别为(5.69±4.29),(4.94±2.31)d,产后产褥病患病率分别为1.04%、12.50%,差异均有统计学意义(均P<0.05)。结论瘢痕子宫孕妇用经阴道分娩也是一种较为安全方式,对于体重指数>30 kg·m^(-2)、距离上次剖宫产时间小于2年的瘢痕子宫孕妇谨慎选择经阴道分娩。

Objective To investigate the risk factors of delivery mode in women with scarred uterus. Methods Clinical data of 120 pregnant women with a scarred uterus,who were encouraged to have a natural vaginal delivery in our hospital were retrospectively analyzed. The pregnant women with regular contractions begin 16 h but cervix not yet open,will have cesarean section. Age,body mass index,gestational age,number of cesarean section,cesarean section from this last interval induction,uterine scar thickness,fetal position,with or without uterine rupture,postpartum hemorrhage,uterine residual rate and uterine surgery were documented. Results The successful rate of vaginal delivery rate was 80. 00%（ 96/120 cases） and the unsuccessful rate was 20. 00%（ 24/120cases）. Multivariate unconditional Logistic regression analysis of the factors influencing maternal vaginal delivery showed that： the main risk factors affecting the success of vaginal trial production of pregnant women included the body mass index and the last cross house production from the time. Vaginal delivery and cesarean section in pregnant women postpartum haemorrhage amount had significant statistical differences（ P〈0. 05）,which were（ 394. 39 ± 64. 11）,（ 432. 66 ± 59. 12） m L,and hospitalization after childbirth was statistically different（ P〈0. 05）,which were（ 5. 69 ± 4. 29）,（ 4. 94 ± 2. 31） d. Rates of puerperal diseasewere statistically difference（ P〈0. 05）,which were 1. 04% and 12. 50%. Conclusion The vaginal delivery would be a feasible secure way for pregnant women with uterine. However,for the pregnant women with cesarean uterine scar,body mass index 30 kg·cm^（-2）,and less than 2 years from the last cesarean section,the vaginal deliver would be prudent.