剖宫产术后瘢痕子宫妊娠阴道试产失败的危险因素及妊娠结局

Risk factors and pregnancy outcomes of the failure of vaginal trial delivery in scar uterus pregnancy after cesarean section

目的分析剖宫产术后瘢痕子宫妊娠阴道试产失败的危险因素及妊娠结局。方法回顾性分析125例阴道试产的剖宫产术后瘢痕子宫妊娠孕妇的临床资料,根据阴道试产是否成功分为两组。使用单因素和多因素Logistic回归分析影响阴道试产失败的危险因素,并对比两组的妊娠结局。结果 125例孕妇有95例(76.00%)经阴道试产成功,为成功组;30例(24.00%)未成功,为失败组。单因素分析结果显示,两组的年龄、产前BMI、子宫下段厚度比较,差异有统计学意义(P<0.05)。Logistic回归分析结果显示,年龄≥35岁、产前BMI≥30 kg/m^2、子宫下段厚度<3.9 mm是导致阴道试产失败的独立危险因素(P<0.05);两组的胎儿窘迫、新生儿窒息、产后出血、胎盘前置发生率比较,差异不显著(P>0.05)。结论年龄≥35岁、产前BMI≥30 kg/m^2、子宫下段厚度<3.9 mm是导致剖宫产术后瘢痕子宫妊娠经阴道试产失败的独立危险因素,阴道试产不会显著增加不良妊娠结局的发生率。

Objective To analyze the risk factors and pregnancy outcomes of the failure of vaginal trial delivery in scar urterus pregnancy after cesarean section. Methods The clinical data of 125 pregnant women undergoing vaginal trial delivery with scar urterus pregnancy after cesarean section were analyzed retrospectively, who were divided into two groups according to the success of vaginal trial delivery. The univariate analysis and multiple factor Logistic regression analysis were used to analyze the risk factors for the failure of vaginal trial delivery, and the pregnancy outcomes of the two groups were compared. Results Ninety-five cases（76.00%） of 125 cases of pregnant women were successfully in vaginal trial delivery, which were as successful group; and 30 cases（24.00%） failed, which were as failure group. The univariate analysis showed that there were significant differences in the age, prenatal BMI and the thickness of lower uterine segment between the two groups（P〈0.05）. The Logistic regression analysis showed that age≥35, prenatal BMI≥30 kg/m^2, thickness of lower uterine segment 3.9 mm were the independent risk factors of vaginal delivery failure（P〈0.05）. There were no significant differences in the incidence of fetal distress, neonatal asphyxia, postpartum hemorrhage and placenta previa in the two groups（P〈0.05）. Conclusion The age≥35, prenatal BMI≥30 kg/m^2, thickness of lower uterine segment3.9 mm were the independent risk factors for the failure of vaginal trial delivery after cesarean section. Vaginal trial delivery doesn＇t significantly increase the incidence of adverse pregnancy outcomes.