促进疤痕子宫再次妊娠阴道分娩成功因素及措施探讨

Discussion on the Factors and Measures to Promote the Success of Vaginal Delivery in Scar Pregnancy

目的总结探讨剖宫产术后再次妊娠阴道试产(TOLAC)成功的因素及措施提高阴道试产成功率。方法回顾分析2016年12月-2018年12月该院产科2年内TOLAC的孕妇90例临床资料,分为阴道试产成功组与失败组,比较两组患者的临床资料,对可能影响阴道试产成功的因素进行对比分析。结果阴道试产成功61例(67.8%),试产失败29例(32.2%)。比较分析两组孕妇的一般资料,既往有阴道分娩史34例,成功28例;无阴道分娩史56例,成功33例,两组比较差异有统计学意义(χ^2=5.315,P<0.05);入院时临产者65例,成功49例;入院时无临产者25例,成功12例,两组比较差异有统计学意义(χ^2=6.200,P<0.05);宫口扩张者52例,成功41例;宫口无扩张者38例,成功20例,两组比较差异有统计学意义(χ^2=6.909,P<0.05)。显示既往有阴道分娩史、入院时临产、宫口扩张是影响阴道试产成功的因素。其他因素包括孕妇的年龄<35岁、距前次剖宫产时间2≤X<10年、产前BMI<30 kg/m^2、新生儿体重<3.5 kg也是影响阴道试产成功的因素,组间对比差异有统计学意义(P<0.05)。结论对剖宫产术后再次妊娠的孕妇加强孕期管理,根据个体情况进行产前筛选,充分评估对符合TOLAC的孕妇进行产前指导,可提高TOLAC的成功率,降低剖宫产率,保障母婴安全。

Objective To summarize the factors and measures to improve the success of vaginal trials after cesarean section.Methods A retrospective analysis of 90 clinical data of TOLAC pregnant women in the obstetrics department of the hospital from December 2016 to December 2018 was divided into two groups:the successful vaginal trial group and the failed group.The clinical data of the two groups were compared,which may affect the vaginal trial production.Comparative analysis of factors for success.Results There were 61 successful vaginal trials(67.8%)and 29 failed trials(32.2%).A comparative analysis of the general data of two groups of pregnant women,with 34 cases of previous vaginal delivery history and 28 successful cases;56 cases without vaginal delivery history and 33 successful cases,the difference between the two groups was statistically significant(χ^2=5.315,P<0.05);65 cases,49 cases were successful;25 cases were not in labor at the time of admission,12 cases were successful,and the difference between the two groups was statistically significantly different(χ^2=6.200,P<0.05);52 cases of uterine expansion were successful,41 cases were successful;There were 38 cases and 20 cases successfully.The difference between the two groups was statistically significant(χ^2=6.909,P<0.05).It shows that a previous history of vaginal delivery,labor at the time of admission,and dilation of the cervix are factors that affect the success of vaginal trials.Other factors include the age of the pregnant woman<35 years,the time between the previous cesarean section 2≤X<10 years,the antenatal BMI<30 kg/m2,and the neonatal weight<3.5 kg are also factors that affect the success of vaginal trials.The difference between the two groups was statistically significant(P<0.05).Conclusion Strengthening pregnancy management for pregnant women who have re-pregnant after cesarean section,prenatal screening based on individual circumstances,and full evaluation of prenatal guidance for pregnant women who meet TOLAC can improve the success rate of TOLAC,reduce cesarean delivery,and protect mothers and babies'safety.