前次剖宫产后再次妊娠经阴道分娩成功的影响因素分析

Factors affecting the successful vaginal delivery after previous cesarean section

目的探讨影响前次剖宫产术后再次妊娠经阴道分娩成功的相关因素。方法回顾性分析2014年1月—2017年12月在上海交通大学医学院附属国际和平妇幼保健院产科进行分娩的325例前次剖宫产再次分娩孕妇的资料(妊娠≥28周),比较剖宫产术后阴道试产(trial of labor after cesarean section,TOLAC)成功组和TOLAC失败组年龄、孕前BMI、孕期体质量增长、孕周、新生儿体质量、阴道分娩史、剖宫产次数、距前次剖宫产时间间隔、新生儿Apgar评分等情况。结果325例孕妇全面评估后进行阴道试产,其中阴道分娩成功210例(TOLAC成功组64.62%),中转剖宫产115例(TOLAC失败组35.38%)。单因素分析两组孕妇孕前BMI、孕期体质量增长、孕周、新生儿体质量、阴道分娩史差异均有统计学意义(P<0.05),而两组的剖宫产次数、距前次剖宫产时间间隔、孕妇年龄、新生儿Apgar评分比较,差异均无统计学意义(P>0.05)。多元Logistic回归分析,孕妇孕期体质量增长、孕周、新生儿体质量是前次剖宫产后影响阴道试产成功的独立因素(P<0.05)。结论孕妇孕期体质量增长、孕周、新生儿体质量是前次剖宫产后影响阴道试产成功的独立因素。

Objective To analyze the affecting factors of successful vaginal delivery after previous cesarean section.Methods The clinical data of 325 repregnant women with previous cesarean section admitted in Shanghai Jiaotong University School of Medicine Affiliated International Peace Maternity&Child Health Hospital from January 2014 to December 2017 were retrospectively analyzed(pregnancy≥28 weeks).The age,BMI before pregnancy,weight gain during pregnancy,gestational week,birth weight of the newborn,history of vaginal delivery,number of cesarean section,interval from previous cesarean section,and the Apgar score of the newborn were compared between the success group and the failure group of trial of labor after cesarean section(TOLAC).Results A total of 325 pregnant women were evaluated before their vaginal trial.There were 210 cases of successful vaginal delivery(64.62%,TOLAC success group)and 115 cases of intermediate cesarean delivery(35.38%,TOLAC failure group).Univariate analysis showed that there were significant differences in BMI before pregnancy,weight gain during pregnancy,gestational week,neonatal weight and vaginal delivery history between the two groups(P<0.05),but no significant differences in the number of cesarean sections,the interval from the previous cesarean section,age of pregnant woman,and the Apgar score of the newborn between the two groups(P>0.05).Multivariate logistic regression analysis showed that weight gain during pregnancy,gestational weeks and neonatal weight were independent factors influencing the success of vaginal delivery after previous cesarean section(P<0.05).Conclusion The weight gain during pregnancy,gestational weeks of pregnant women and the neonatal weight would affect the success of vaginal delivery after previous cesarean section.