瘢痕子宫再次妊娠阴道分娩试产失败的影响因素分析

Analysis of the influencing factors of vaginal delivery trial-production failure in re-pregnancy with scarred uterus

目的探讨瘢痕子宫再次妊娠阴道分娩试产失败的影响因素。方法回顾性分析2015年1月~2019年12月大连市妇幼保健院收治的88例瘢痕子宫再次妊娠阴道分娩试产产妇的临床资料,根据阴道分娩试产结果的不同进行分组,将瘢痕子宫再次妊娠阴道分娩试产失败的28例产妇的临床资料纳入观察组,将阴道分娩试产成功的60例产妇的临床资料纳入对照组。收集所有产妇的基线资料,分析可能引发瘢痕子宫再次妊娠阴道分娩试产失败的影响因素。结果两组的胎儿胎龄、分娩期间缩宫素使用情况比较,差异无统计学意义(P>0.05);观察组中的产妇年龄≥35岁、产妇距上次剖宫产时间2~3年、产妇子宫下段厚度<2 cm、娩出胎儿体重≥3.5 kg占比均高于对照组,差异有统计学意义(P<0.05);Logistic多因素分析显示,年龄≥35岁、产妇距上次剖宫产时间2~3年、产妇子宫下段厚度<2 cm、娩出胎儿体重≥3.5 kg是瘢痕子宫再次妊娠阴道分娩试产失败的危险因素(OR>1,P<0.05)。结论产妇高龄、产妇距上次剖宫产时间较短、产妇子宫下段肌层薄、胎儿为巨大儿是引发瘢痕子宫再次妊娠阴道分娩试产失败的危险因素,要关注以上危险因素,采取有效措施进行干预,不断提升阴道分娩试产成功率。

Objective To investigate the influencing factors of vaginal delivery trial-production failure in re-pregnancy with scarred uterus.Methods The clinical data of 88 cases of pregnant women who had a second vaginal delivery trial-production in the scarred uterus from January 2015 to December 2019 treated in Dalian Maternal and Child Health Hospital were retrospectively analyzed,and they were grouped according to the results of vaginal delivery trial.The clinical data of 28 pregnant women who failed to have a trial of vaginal delivery after pregnancy in a scarred uterus were included in the observation group,and the clinical data of 60 pregnant women who successfully tried trial delivery of vaginal delivery were included in the control group.All the maternal baseline data,through single factor and multi-factor were collected,the influencing factors which might cause the trial failure pf re-pregnancy vaginal delivery in scarred uterus were analyzed.Results There were no statistical differences in the gestational age and use of oxytocin between the two groups(P>0.05).The proportions of age≥35 years old,2-3 years from the last cesarean section,thickness of lower uterine segment<2 cm,and fetal weight≥3.5 kg in the observation group were higher than those in the control group,the differences were statistically significant(P<0.05).Logistic multivariate analysis showed that age≥35 years old,2-3 years from the last cesarean section,thickness of lower uterine segment<2 cm,and fetal weight≥3.5 kg were the risk factors for vaginal delivery trial-production failure in re-pregnancy with scarred uterus(OR>1,P<0.05).Conclusion Advanced age,shorter time since the last cesarean section,lower thickness of lower uterine segment,and higher fetal weight are the risk factors for vaginal delivery trial-production failure in re-pregnancy with scarred uterus,and the above risk factors should be paid attention,at the same time,effective measures should be taken to improve the success rate of vaginal delivery.