基于Robson分类系统分析不同类型的阴道试产失败中转剖宫产的构成及母儿结局

Ratio of transfer cesarean section after trial of labor and maternal-fetal adverse outcomes based on Robson classifications

目的探讨基于Robson分类系统的不同类型阴道试产失败中转剖宫产的构成及母儿结局。方法回顾性分析2009年1月1日至2015年12月31日于广州医科大学附属第三医院行剖宫产术分娩的13 742例产妇(分娩孕周≥28周且新生儿出生体重>1 000 g)的资料,根据Robson分类法分析不同类型的产妇阴道试产失败中转剖宫产的构成及母儿结局。结果(1)911例阴道试产失败中转剖宫产孕妇的构成中,R9类(除臀位外的其他胎位单胎妊娠产妇,包括既往有剖宫产术史者)最高(47.31%,431/911),R2类(单胎头位初产妇,分娩孕周≥37周,引产)次高为(44.90%,409/911)。(2)阴道试产失败中转剖宫产产妇的不良母儿结局的指标,根据加权不良结局评分显著增加的,依次为R10类(单胎头位,分娩孕周<37周,包括既往有剖宫产术史者)24.55分,R5类(单胎头位经产妇,既往至少有1次剖宫产术史,分娩孕周≥37周)为3.64分。结论应重点关注足月头位引产初产妇与剖宫产术后阴道试产产妇的分娩期管理,慎重评估分娩方式对减少阴道试产失败中转剖宫产后的不良母儿结局具有重要意义。

Objective To investigate the ratio of transfer cesarean section after trial of labor and maternal-fetal outcomes based on Robson classifications. Methods The delivery data by cesarean section in Third Affiliated Hospital of Guangzhou Medical University from January 1st, 2009 to December 31st, 2015 (gestational age ≥28 weeks and newborn birth weight >1 000 g) were retrospectively collected. The ratio of transfer cesarean section after trial of labor and maternal-fetal adverse outcomes were analyzed by weighted adverse outcome score in different Robson classifications. Results (1) The highest ratio of transfer cesarean section after trial of labor was classification 9 (all abnormal lies, including previous cesarean section and breech were excluded) reached 47.31%(431/911), followed by classification 2 (nulliparous women with a single cephalic pregnancy,≥37 weeks gestation who had labour induced) accounted for 44.90%(409/911).(2)The tops of weighted adverse outcome score of transfer cesarean section after trial of labor were classification 10 (single cephalic pregnancy at <37 weeks gestation, including women with previous cesarean delivery) 24.55, classification 5 (single cephalic pregnancy multiparous women, with at least one previous cesarean delivery,≥37weeks gestation) 3.64. Conclusion Carefully evaluating the delivery mode and emphasizing the intrapartum management in nulliparous women with a single cephalic pregnancy, at ≥37 weeks gestation who had labour induced and trial of labor after cesarean section is essential to reduce the risk of adverse outcomes in transfer cesarean section after trial of labor.