剖宫产术后再次妊娠经阴道分娩的母婴结局及影响因素分析

Factors affecting maternal and neonatal outcomes of vaginal birth after cesarean

目的探讨剖宫产术后再次妊娠经阴道分娩(vaginal birth after cesarean,VBAC)的母婴结局,并分析分娩结局的相关影响因素。方法 132例剖宫产术后再次妊娠经阴道试产的产妇中试产成功组(A组)83例,试产失败组(B组)49例,另选取同期住院的无剖宫产史产妇160例,其中阴道分娩组(C组)80例,首次剖宫产组(D组)80例。对A、B组产妇采用单因素分析与多因素Logistic回归分析,研究影响两组产妇分娩结局的相关因素,同时比较各组的母婴结局。结果产妇宫颈Bishop评分较高、瘢痕厚度较大、有阴道分娩史及胎儿体重较小为VBAC成功的独立影响因素(均P<0.05)。A组产妇产时出血量、产褥感染及住院天数均少于B组,差异有统计学意义(P<0.05)。A组和C组,B组和D组的各项母婴结局间的差异均无统计学意义(均P>0.05)。结论 VBAC的成功与否与产妇宫颈Bishop评分、瘢痕厚度、阴道分娩史及胎儿体重有关,且成功的VBAC可有效提高母婴安全性,缩短产妇产后康复时间,有利于改善母婴预后。

Objective To investigate the maternal and neonatal outcomes of vaginal birth after cesarean(VBAC) as well as the factors that affect the outcomes. Methods Firstly, out of 132 puerperae of vaginal birth after cesarean, 83 successful cases were chosen to be the group A of the study and 49 unsuccessful cases were chosen as the group B;Meanwhile, out of 160 hospitalized puerperae having had no cesarean section before admission, 80 were subjected to vaginal birth and designated to be the group C of study, and the other 80 were subjected to cesarean delivery and designated to be the group D of study. Secondly, univariate analysis and multivariate logistic regression were utilized to identify the possible factors affecting the maternal outcomes of the puerperae in group A and group B. Lastly, the maternal and infant outcomes of group A and group B, those of group A and group C, and those of group B and group D were compared. Results Higher maternal cervical Bishop score, thicker scar thickness, having vaginal delivery history and lighter fetal weight are independent success factors of VBAC(all P<0.05). The maternal bleeding volume, puer infection rate and the length of hospitalization of group A were significantly less than those of group B. The differences were statistically significant(P<0.05). No significant differences were found between group A and group C, or group B and group D, in terms of maternal and infant outcomes(P>0.05). Conclusions The success of VBAC is correlated to maternal cervical Bishop score, scar thickness, vaginal delivery history and fetal weight. Successful VBAC can effectively improve maternal and infant safety, shorten the length of time for postpartum recovery time, and improve maternal and infant prognosis.