瘢痕子宫产妇再次分娩方式选择及阴道试产影响因素分析

Choice of mode of delivery for scar pregnancy and the influence factors of vaginal trial delivery

目的分析瘢痕子宫妊娠产妇再次分娩方式选择及阴道试产影响因素。方法选择2016年7月至2017年7月在广州医科大学附属第六医院(清远市人民医院)进行分娩的瘢痕子宫再次妊娠的118例产妇为研究对象。其中,45例产妇行阴道试产成功,将37例设为观察组;8例转剖宫产,即剖宫产81例产妇中随机抽取37人设为对照组。搜集观察组和对照组患者临床资料,采用单因素和Logistic回归分析瘢痕子宫产妇再次妊娠后成功阴道试产相关因素。比较两组产妇产褥感染、产时宫缩乏力、产后出血、胎儿窘迫、新生儿窒息、子宫破裂、胎儿1 min Agpar评分和出血体重等。结果两组产妇在孕周、平均年龄、产前BMI、宫口扩张、孕期胎儿体重管理、临产入院和自然分娩史方面比较,其差异均具有统计学意义(均P<0.05);入院宫口扩张、年龄、临产入院、孕期胎儿体重管理、产前BMI和有自然分娩史为成功阴道试产独立影响因素(均P<0.05);观察组产妇分娩时宫缩乏力比例高于对照组产妇,其差异具有统计学意义(P<0.05);观察组新生儿1min Apgar评分高于对照组,新生儿出生体重低于对照组,其差异均具有统计学意义(均P<0.05)。结论有自然分娩史、产前BMI和年龄等为瘢痕子宫再次妊娠产妇成功阴道试产影响因素,与再次剖宫产产妇相比,阴道试产产妇子宫破裂和胎儿窘迫等相关并发症几率不会升高。

Objective To analyze the choice of delivery mode and the factors affecting vaginal trial delivery in scar pregnancy. Methods 118 women with scar pregnancy in our hospital from July 2016 to July 2017 were enrolled. Among them, 45 women underwent vaginal trial delivery, where 37 ones succeed(observation group) and 8 ones were transferred to cesarean section. Of all the 81 women underwent cesarean section, 37 ones were randomly selected as control group. The clinical data of observation group and control group were collected, and using single factors and Logistic regression analysis, was analyzed to study the factors related to successful vaginal trial delivery. The incidences of maternal puerperal infection, uterine contraction fatigue, postpartum hemorrhage, fetal distress, neonatal asphyxia and uterine rupture, fetal 1 min Agpar score and bleeding weight were observed in the two groups. Results There were statistically significant differences in the gestational age, mean age, prenatal BMI, uterine dilatation, fetal weight management during pregnancy, admission to hospital before delivery and natural childbirth between the two groups(all P<0.05). Admission of uterine cervix, age, admission to hospital before delivery, fetal weight management during pregnancy, prenatal BMI, and history of spontaneous delivery were all independent factors influencing successful vaginal trials(all P<0.05). The proportion of uterine contraction during delivery in the observation group was higher than that in the control group, with statistically significant difference(P<0.05). The 1 min Apgar score of neonates in the observation group was higher than that of the control group, and the birth weight was lower than that of the control group, all with statistically significant differences(all P<0.05). Conclusions A history of natural childbirth, prenatal BMI and age are all influencing factors of successful vaginal trial delivery for scar pregnancy. Compared with cesarean section, vaginal trial delivery does not increase the incidence of uterine rupture and fetal distress and other complications.