阴道分娩对疤痕子宫再妊娠孕妇围产期应激反应和免疫功能的影响

Effect of vaginal delivery on perinatal stress response and immune function in pregnant women with uterine scar pregnancy

目的探讨阴道分娩对疤痕子宫再妊娠孕妇围产期应激反应和免疫功能的影响。方法选取2013年5月至2017年5来佛山市南海区第四人民医院孕检并分娩的疤痕子宫再妊娠孕妇60例作为研究对象,根据分娩方式将其分为两组,26例成功剖宫产术后经阴道分娩孕妇作为VBAC组,34例择期重复剖宫产孕妇作为ERCS组,分析VBAC成功率,比较两组产前及产后12h、48h外周血皮质醇(Cor)、去甲肾上腺素(NE)、T淋巴细胞水平(CD4^+、CD8^+、CD4^+/CD8^+),并比较两组分娩结果。结果 36例孕妇符合VBAC条件,其中26例(72.22%)按计划顺利完成VBAC。两组产后12h、48 h Cor、NE水平较产前降低,差异具有统计学意义(P<0.05),但两组间比较差异无统计学意义(P>0.05);两组产后12h、48h CD4^+、CD4^+/CD8^+水平均较产前降低,CD8^+水平较产前升高,差异具有统计学意义(P<0.05),且VBAC组产后12h、48 h CD4^+、CD4^+/CD8^+水平略高于ERCS组,CD8^+水平略低于ERCS组,差异具有统计学意义(P<0.05);两组新生儿体重及新生儿Apgar评分为8分～10分、产后出血、产褥感染、新生儿窒息、子宫破裂发生几率比较,差异无统计学意义(P>0.05);VBAC组24h出血量、住院费用少于ERCS组,住院时间短于ERCS组,差异具有统计学意义(P<0.05)。结论与ERCS相比,符合VBAC适应证的疤痕子宫再次妊娠孕妇行VBAC,可减轻产后免疫抑制,显著减少术后出血量、住院费用,缩短住院时间,且对新生儿健康、围产期应激反应无明显影响。

Objective To investigate the effect of vaginal delivery on perinatal stress response and immune function in pregnant women with uterine scar pregnancy.Methods The medical data of 60 pregnant women with uterine scar pregnancy who took pregnancy test and delivered in our hospital during the period of May 2013 to May 2017 were retrospectively analyzed.According to the delivery mode,the pregnant women were divided into two groups.26 women undergoing vaginal birth after cesarean(VBAC)were included into VBAC group and 34 women undergoing elective repeat cesarean section(ERCS)were included into ERCS group.The success rate of VBAC was analyzed.Levels of peripheral blood cortisol(Cor),norepinephrine(NE)and T lymphocytes(CD4+,CD8+,CD4+/CD8+)were compared between the two groups before delivery and at 12h and 48h after delivery,and the delivery outcomes were also compared between the two groups.Results There were 36 pregnant women meeting the criteria of VBAC,and 26 patients(72.22%)completed the VBAC successfully as planned.Levels of Cor and NE in the two groups at 12h and 48h after delivery were lower than those before delivery(P<0.05),but there was no significant difference between the two groups(P>0.05).Levels of CD4+,CD4+/CD8+in the two groups at 12h and 48h after delivery were lower than those before delivery,CD8+in the two groups at 12h and 48h after delivery were higher than those before delivery(P<0.05).However,levels of CD4+and CD4+/CD8+in VBAC group at 12h and 48h after delivery were slightly higher than those in ERCS group,and the level of CD8+was slightly lower than that in ERCS group(P<0.05).There was no significant difference in probabilities of neonatal weight and neonatal Apgar score of 8~10 points,postpartum hemorrhage,puerperal infection,neonatal asphyxia and uterine rupture(P>0.05).The 24h bleeding volume and hospitalization expenses of VBAC group were less than those of ERCS group,and the hospitalization time was shorter than that of ERCS group(P<0.05).Conclusions Compared with ERCS,the use of VBAC in women with uterine scar pregnancy meeting indications of VBAC can alleviate immune suppression,significantly reduce postoperative blood loss and hospitalization expenses,and shorten hospitalization time.It has no significant effect on neonatal health and perinatal stress response.