Logistic回归分析瘢痕子宫再次妊娠产妇阴道分娩妊娠结局的影响因素

Logistic regression analysis of factors affecting outcome of vaginal delivery in pregnant women with scar uterus re-pregnancy

目的探究瘢痕子宫再次妊娠孕妇阴道分娩妊娠结局影响因素。方法选取2017年1月至2018年12月山东省单县东大医院建档并进行按期体检的300例瘢痕子宫再次妊娠产妇作为研究对象。根据妊娠结局分为妊娠良好组(n=210)及妊娠不良组(n=90),统计妊娠不良产妇的妊娠结局。从年龄、产前体重指数、子宫瘢痕厚度、距上次剖宫产手术时间和有无阴道分娩史等方面分析妊娠不良组产妇与分娩良好组产妇的区别;分析瘢痕子宫再次妊娠阴道分娩出现不良妊娠结局的危险因素。结果90例妊娠不良组产妇中出现产后出血43例(47.78%),产褥感染20例(22.22%),新生儿窒息10例(11.11%),子宫破裂9例(10.00%),子宫切除8例(8.89%);与妊娠良好组产妇相比,妊娠不良组产妇的年龄更高、产前体重指数显著升高、子宫瘢痕厚度显著下降,差异均具有统计学意义(均P<0.05);与妊娠良好组产妇相比,妊娠不良组产妇的自然分娩史率下降、临产入院率升高,差异均具有统计学意义(均P<0.05);与妊娠良好组产妇相比,妊娠不良组产妇家庭月收入更低,差异具有统计学意义(P<0.05)。以妊娠是否良好作为自变量,对以上结果中分析得出的具有统计学差异的因变量进行拟合多因素逐步Logistic回归分析,结果显示,年龄>30、产前体重指数>30kg/m^2、子宫瘢痕厚度≤4mm及家庭月收入<500元是瘢痕子宫再次妊娠孕妇阴道分娩妊娠结局的独立危险因素,差异具有统计学意义(P<0.05)。结论瘢痕子宫再次妊娠经阴道分娩是一项可行措施,年龄>30、产前体重指数>30kg/m^2、子宫瘢痕厚度及家庭月收入<5000元是瘢痕子宫再次妊娠孕妇阴道分娩妊娠结局的独立危险因素,在今后的临床研究中应该注意以上因素的影响,以减少不良妊娠结局的发生率。

Objective To investigate the influencing factors of outcomes of vaginal delivery in pregnant women with scar uterus re-pregnancy.Methods 300 pregnant women with scar uterus re-pregnancy received antenatal care in our hospital from January 2017 to February 2018 were selected as the research object.According to the pregnancy outcome,they were divided into good pregnancy outcome group(210 cases)and adverse pregnancy outcome group(90 cases).The maternal age,prenatal body mass index(BMI),uterine scar thickness,time from the previous cesarean section,and history of vaginal delivery were compared between the two groups.Risk factors for adverse pregnancy outcomes were analyzed.Results Among the 90 cases of adverse pregnancy outcomes,there were 43 cases of postpartum hemorrhage,20 cases of puerperal infection,10 cases of neonatal asphyxia,9 cases of uterine rupture,and 8 cases of hysterectomy.Compared with the good pregnancy outcome group,the ages of pregnant women were higher,the prenatal body mass index was increased,the thickness of the uterine scar was decreased,all with statistically dignificant differences(all P<0.05).The probability of spontaneous childbirth was decreased,the probability of admission to hospital was increased,both with statistically dignificant differences(all P<0.05),and the monthly income of the family was decreased,with statistically dignificant difference(P<0.05).Using the pregnancy status as an independent variable,the statistically significant dependent variables were analyzed by multivariate stepwise logistic regression analysis.The results showed that age>30,prenatal BMI>30 kg/m^2,uterine scar thickness≤4 mm and family monthly income<5000 Yuan were all independent risk factor for gestational outcome of vaginal delivery in pregnant women with scar uterus re-pregnancy(P<0.05).Conclusions Vaginal delivery is a feasible measure for scar uterus re-pregnancy.Age>30,prenatal BMI>30 kg/m^2,uterine scar thickness≤4 mm and family monthly income<5000 Yuan are independent risk factors for gestational outcome of vaginal delivery in pregnant women with scar uterus re-pregnancy.In the future clinical research,more attention should be paid to the influence of above factors to increase the incidence of good pregnancy outcomes.