影响瘢痕子宫再次妊娠阴道试产的可行性相关因素分析

Factors Influencing Vaginal Trial Labor Feasibility in Re-pregnancy of Scar Uterus

目的探讨影响瘢痕子宫再次妊娠进行阴道试产的可行性相关因素。方法采用病例对照研究方法,收集2015年3月至2019年3月于本院产科待产的剖宫产术后再次妊娠并进行阴道试产失败的产妇80例作为研究对象,按照1∶1选取80例瘢痕子宫再妊娠阴道试成功产妇作为对照组。分析两组分娩前的基础资料,以及分娩情况、心理状态等,并针对可疑影响因素进行回归分析。结果(1)两组基础资料分析中,两组的年龄、孕周、身高、孕前体重、分娩前体重及引产史、宫颈bishop评分等资料比较,差异均无统计学意义(P>0.05);(2)两组分娩情况比较,观察组的第二产程时间、会阴切开率、阴道助产使用率均显著高于对照组(P<0.05);(3)两组心理状态评分比较,观察组的妊娠压力、医院焦虑评分、医院抑郁评分均显著高于对照组,且社会支持评分显著低于对照组(P<0.05);(4)经Logistic分析,第二产程时间、妊娠压力、社会支持度、焦虑等是影响阴道试产可行性的影响因素(P<0.05)。结论瘢痕子宫再次妊娠在进行阴道试产时,孕妇心理状态及分娩进度均是本次阴道试产可行性的影响因素。

Objective To explore related factors influencing vaginal trial labor feasibility in re-pregnancy of scar uterus.Methods A case-control study was conducted to collect 80 pregnant women who underwent re-pregnancy after cesarean section,awaited delivery and underwent vaginal trial labor in obstetrics department of the hospital from March 2015 to March 2019 as the study subjects.80 pregnant women who underwent successful vaginal trial labor and re-pregnancy of scar uterus were enrolled as the control group according to 1∶1.The basic data before delivery,delivery situation and psychological status were analyzed in the two groups.And the regression analysis was performed on the suspected influencing factors.Results(1)In the analysis of basic data in the two groups,there were no significant differences in the age,gestational weeks,height,weight before pregnancy,weight before delivery,labor induction history and cervical bishop score between the two groups(P>0.05).(2)In terms of delivery situation,the second stage of labor,perineal incision rate and vaginal midwifery utilization rate in observation group were significantly higher than those in control group(P<0.05).(3)In terms of scores of psychological state,the pregnancy pressure,hospital anxiety and hospital depression in observation group were significantly higher than those in the control group while the social support score was significantly lower than that in the control group(P<0.05).(4)Logistic analysis showed the second stage of labor,pregnancy stress,social support and anxiety were the influencing factors affecting the feasibility of vaginal trial production(P<0.05).Conclusion In vaginal trial labor of re-pregnancy of scar uterus,the psychological states and delivery progress of pregnant women are the influencing factors of feasibility of this vaginal trial production.