剖宫产术后瘢痕子宫再次妊娠产妇经阴道分娩失败的影响因素探究

The study of the influencing factors of vaginal delivery failure in puerpera with re-pregnancy with scar uterus after sesarean section

目的探讨剖宫产术后瘢痕子宫再次妊娠产妇经阴道分娩失败的影响因素。方法回顾性分析2017年1月至2019年4月马鞍山市妇幼保健院收治的剖宫产术后瘢痕子宫再次妊娠行阴道试产的529例产妇的临床资料,分析剖宫产术后瘢痕子宫再次妊娠产妇经阴道分娩失败的危险因素。结果529例产妇中,444例(83.93%)经阴道试产成功,纳入成功组,其余85例经阴道试产失败者纳入失败组。失败组产妇年龄≥35岁、产前体质指数≥30 kg/m^(2)、子宫下段厚度≤3.9 mm、新生儿体重≥4 kg的占比均显著高于成功组(均P<0.05),多因素Logistic回归分析结果显示,产妇年龄、产前体质指数、子宫下段厚度和新生儿体重均是剖宫产术后瘢痕子宫再次妊娠产妇经阴道试产失败的独立危险因素(均P<0.05)。结论剖宫产术后瘢痕子宫再次妊娠产妇经阴道试产失败的危险因素较多,针对危险因素给予产妇个性化干预,对提高剖宫产后瘢痕子宫再次妊娠经阴道分娩成功率具有重要意义。

Objective To investigate the influencing factors of vaginal delivery failure in puerpera with re-pregnancy with scar uterus after cesarean section.Method A total of 529 parturients with scar uterus underwent vaginal trial production after cesarean section from January 2017 to April 2019 in Maanshan Maternal and Child Health Care Hospital were selected as research objects.The risk factors of vaginal delivery failure of scar uterus after cesarean section were investigated.Result Among 529 parturients,444 cases(83.93%)parturients succeeded in trial delivery via vagina were included in success group,and 85 parturients failed in trial delivery via vagina were included in failure group.The proportion of maternal age≥35 years old,prenatal body mass index≥30 kg/m^(2),lower uterine segment thickness≤3.9 mm,neonatal weight≥4 kg in failure group were significantly higher than those in success group(all P<0.05).Multivariate Logistic regression analysis showed that maternal age,prenatal body mass index,lower uterine segment thickness and the neonatal weight were independent risk factors for the failure of the re-pregnancy vaginal trial production of cesarean scar uterus(all P<0.05).Conclusion There are many risk factors for the failure of the re-pregnancy vaginal trial production of cesarean scar uterus.It is important to give individualized intervention to pregnant women with risk factors to improve the success rate of re-pregnancy vaginal trial production of cesarean scar uterus.