胎儿头盆/头位评分与有剖宫产史孕妇阴道试产失败的关系及后者危险因素探讨

Study on the relationship between fetal cephalic pelvic/cephalic scores and the failure of vaginal delivery in pregnant women with history of cesarean section and the risk factors for the failure of vaginal delivery

目的探讨胎儿头盆/头位评分与有剖宫产史孕妇阴道试产失败的关系。方法选取2014年8月至2018年8月重庆市开州区人民医院妇产科诊治的500例有剖宫产史孕妇的临床资料作回顾性分析。500例孕妇均经阴道试产,根据阴道试产是否成功记为失败组和成功组,对比两组胎儿头盆/头位评分和可能影响阴道试产失败的危险因素构成比,并以Logistic回归分析确定胎儿头盆/头位评分与阴道试产失败的关系,探讨阴道试产失败的影响因素。结果500例孕妇阴道试产失败率为17.40%,胎儿阴道分娩失败率为17.73%;胎儿阴道试产失败者头盆评分、头盆/头位评分低于阴道试产成功者,差异具有统计学意义(P<0.05);阴道试产失败者高龄产妇、距前次剖宫产时间<3年、产前BMI≥30kg/m^2、子宫下段肌层厚度<0.4cm、双胎、胎儿头盆评分≤8分、胎儿头盆/头位评分≤10分、需要纠正胎方位构成比均高于阴道试产成功者,差异具有统计学意义(P<0.05),经Logistic回归分析证实其均为阴道试产失败的危险因素(OR=7.207、6.855、2.645、3.261、2.192、7.121、6.443、2.467,P<0.05);阴道试产失败者有阴道分娩史、成功纠正胎方位、催产素滴注、导乐陪伴分娩构成比均低于阴道试产成功者,差异具有统计学意义(P<0.05),经Logistic回归分析证实其均为阴道试产失败的保护因素(OR=0.532、0.471、0.498、0.457,P<0.05)。结论胎儿头盆/头位评分下降可增加有剖宫产史孕妇阴道试产失败率,胎儿头盆评分≤8分、胎儿头盆/头位评分≤10分、高龄产妇等均是阴道试产失败的危险因素,而有阴道分娩史、成功纠正胎方位等均是其保护因素。

Objective To explore the relationship between fetal cephalic pelvic/cephalic scores and the failure of vaginal delivery in pregnant women with history of cesarean section.Methods The clinical data of 500 pregnant women with histories of cesarean section in Chongqing Kaizhou People's Hospital from August 2014 to August 2018 were retrospectively analyzed.According to the success of vaginal trial delivery,they were divided into failure group and success group.The rates of fetal cephalic pelvic/cephalic scores and the proportion of risk factors that might affect the failure of vaginal delivery were compared.Logistic regression analysis was used to determine the relationship between the fetal cephalic/cephalic scores and the failure of vaginal delivery,and to explore the influencing factors for the failure of vaginal delivery.Results The failure rate of vaginal trial delivery and vaginal delivery was 17.40%and 17.73%respectively.The cephalopelvic scores and cephalopelvic/cephalopelvic position scores of those who failed in vaginal delivery were lower than those who succeeded in vaginal delivery,with statistically significant differences(P<0.05).There were statistically significant differences in the proportion of elderly women,less than 3 years from the previous cesarean section,prenatal BMI≥30kg/m^2,lower uterine muscle thickness<0.4cm,twins,fetal cephalopelvic scores≤8,fetal cephalopelvic/cephalopelvic scores≤10,and the need to correct fetal positions between those who succeed and failed in vaginal trial delivery,with statistically significant differences(P<0.05).And all the factors mentioned above were confirmed as risk factors for failure of vaginal delivery by Logistic regression analysis(OR=7.207,6.855,2.645,3.261,2.192,7.121,6.443,2.467,P<0.05).The proportions of women with histories of vaginal delivery,successfully corrected fetal orientation,oxytocin drip,Doula accompanied delivery in the those who failed in vaginal trial delivery were lower than those with successful vaginal trial delivery,with statistically significant differences(P<0.05),which were protective factors for failure of vaginal delivery confirmed by Logistic regression analysis(OR=0.532,0.471,0.498,0.457,P<0.05).Conclusions Fetal cephalopelvic/cephalopelvic scores decreasing can increase the failure risk of vaginal delivery in pregnant women with cesarean section history.Fetal cephalopelvic score≤8,fetal cephalopelvic/cephalopelvic score≤10,elderly parturients and so on are risk factors for failure of vaginal delivery,while vaginal delivery history,successful correction of fetal orientation and so on are all protective factors.