剖宫产再次妊娠不同分娩方式的临床结局及影响因素

Clinical outcomes and influencing factors of different delivery ways in pregnant women with scar uterus

目的分析疤痕子宫再次妊娠分娩时不同分娩方式的临床结局及影响阴道顺利分娩的因素。方法回顾性分析2015年1月至2017年1月期间在临海市第二人民医院分娩的177例疤痕子宫孕妇的临床资料,比较阴道分娩和剖宫产孕妇的一般情况、妊娠结局,并分析影响阴道分娩顺利进行的因素。结果通过阴道试产,最终阴道分娩54例,剖宫产123例,分娩后产妇均确认无子宫破裂。阴道分娩组孕妇的年龄、BMI及胎儿体重均显著低于剖宫产组(t值分别为3.458、3.731、2.263,均P<0.05),距上次剖宫产时间显著长于剖宫产组(t=4.975,P<0.05),而两组孕周和剖宫产次数比较无显著性差异(t值分别为0.737、0.242,均P>0.05)。阴道分娩组孕妇产时出血量、产后24h出血量及住院天数均明显低于剖宫产组(t值分别为18.718、33.396、26.121,均P<0.05),且产后发热发生率显著低于剖宫产组(χ~2=5.436,P<0.05)。两组新生儿出生1分钟Apgar评分比较无显著性差异(t=0.658,P>0.05),新生儿窒息发生率比较无显著性差异(χ~2=0.365,P>0.05)。多因素Logistic回归分析显示,孕妇BMI大、距上次剖宫产时间短、胎儿体重大是影响孕妇阴道顺利分娩的独立危险因素(OR值分别为3.583、2.638、2.354,均P<0.05)。结论经阴道分娩对剖宫产瘢痕子宫再次妊娠孕妇损伤小,较安全,但须严格掌握指征。

Objective To analyze the clinical outcomes and influencing factors of different delivery ways of women with scar uterus. Methods The clinical data of 177 pregnant women with scar uterus admitted in the Second People＇s Hospital of City from January 2015 to January 2017 was retrospectively analyzed to compare the general situations of pregnant women and pregnancy outcomes of vaginal delivery and cesarean section, and the risk factors influencing vaginal delivery were analyzed. Results Through vaginal trial production, 54 cases performed vaginal delivery and 123 cases received cesarean section without uterus rupture. The age, BMI and fetal weight of pregnant women in vaginal delivery group were significantly lower than those in cesarean sections group（t value was 3.458, 3.731 and 2.263, respectively, all P〈0.05）, and the interval was significantly longer than that in cesarean section group （t=4.975, P〈0.05）. There was no significant difference in gestational age and the number of cesarean delivery between two groups （t value was 0.737 and 0.242, respectively, both P〉0.05）. The blood loss at birth, postpartum 24h blood loss and hospital stay in vaginal delivery group were significantly lower than in cesarean sections group（t value was 18. 718, 33. 396 and 26.121, respectively, all P〈0.05）, and the incidence of postpartum fever was significantly lower （χ^2= 5.436, P〈0.05）. There was no significant difference in I rain Apgar score between two groups （t = 0.658, P〉0.05）, and no significant difference in neonatal asphyxia （χ^2= 0. 365, P ~0.05）. Multivariate Logistic regression analysis showed that pregnant women with large BMI, short interval of delivery and large fetal weight were independent risk factors influencing vaginal delivery of pregnant women （OR value was 3.583, 2.638 and 2.354, respectively, all P〈0.05）.Conclusion Vaginal delivery after scar uterus pregnancy leads mild injury with safety, but it must be strictly controlled.