规范化剖宫产后阴道试产478例临床分析

Clinical analysis of 478 cases of vaginal birth after cesarean section

目的:探讨规范化剖宫产后阴道试产(VBAC)诊疗对分娩结局的影响。方法:回顾分析同济大学附属第一妇婴保健院2014年1月至2016年8月接受规范化VBAC诊疗的478例孕妇的分娩结局。结果:478例孕妇的VBAC成功率为95.4%,其中引产率为33.4%。根据发动方式分为自然发动组(318例)和引产组(160例),引产组的第一产程、总产程显著延长,VBAC成功率显著下降。引产组和自然发动组的子宫破裂、产后出血无显著差异。引产组的双球囊应用率为72.5%,催产素应用率为78.8%,分娩镇痛率为80.1%。结论:规范化VBAC诊疗有利于提高VBAC成功率和引产成功率。引产显著降低VBAC成功率。双球囊和催产素应用于VBAC引产具有安全性和较好的临床疗效。充分开展分娩镇痛可能有助于提高VBAC成功率。

Objective： To investigate the delivery outcome of vaginal birth after cesarean section（ VBAC）. Methods： Totally 478 pregnant women who received standardized VBAC clinics and treatment in First Maternity and Infant Hospital,Tongji University between Jan.2014 and Aug.2016 were reviewed retrospectively.Results： The success rate of VBAC was 95.4%,among which the rate of induced labor was 33.4%.The spontaneous labor group contains 313 cases and the induction group contains 143 cases.The induction group had extended first stage of labor,extended total course of labor and the decreased success rate of VBAC notably compared to the induction labour group. Induction of labor didn ＇ t increase uterine rupture,postpartum hemorrhage,or adverse events remarkably in mother and fetus.Conclusion： Standardized VBAC diagnosis and treatment can improve the success rate of VBAC and the success rate of induced labor significantly.Induction labor reduced the success rate of VBAC notably.The application of double balloon and oxytocin in VBAC induction of labor is safe and effective.The employment of labor analgesia may help to improve the success rate of VBAC.