瘢痕子宫产妇再次妊娠行阴道试产的可行性及影响因素

Feasibility and Influencing Factors of Vaginal Trial Production in Pregnant Women with Scar Uterus

目的探讨瘢痕子宫产妇再次妊娠行阴道试产的可行性,分析对分娩结局造成影响的相关因素。方法选取我院2016年2月至2019年2月收治的76例瘢痕子宫产妇再次妊娠产妇,按分娩方式的差异,进行分组。两组均行阴道试产,分娩成功共38例,为观察组,转行剖宫产共38例,设为对照组。对比两组分娩结局,包括新生儿阿氏评分、产妇产后出血量,根据产妇资料评估瘢痕子宫产妇再次妊娠行阴道试产的可行性及影响因素。结果观察组新生儿阿氏评分较高、产妇产后出血量较少,与对照组相比,差异具有统计学意义(P<0.05)。主要影响因素包括是否伴有并发症、子宫前壁瘢痕处厚度以及距上次剖宫产时间。结论瘢痕子宫产妇再次妊娠行阴道试产具有一定的可行性,应重视评估产妇是否存在并发症、子宫前壁瘢痕处厚度应在3.50 mm以上,距初次剖宫产时间应大于2年。

Objective To investigate the feasibility of vaginal trial production in women with scar uterus and to analyze the factors affecting the outcome of delivery.Methods Seventy-six women with scar uterus who were admitted to our hospital from February 2016 to February 2019 were enrolled in the same period of pregnancy.The vaginal trials were performed in both groups,and 38 cases were successfully delivered,which was set as the observation group;converted to cesarean section in 38 cases,which was set as the control group.Comparing the two components of the outcome,including neonatal Apgar score,maternal postpartum hemorrhage,according to maternal data to assess the feasibility and influencing factors of vaginal trial production of scar uterus.Results In the observation group,the newborns had higher Apgar score and less postpartum hemorrhage.Compared with the control group,the difference was statistically significant(P<0.05).The main influencing factors included complications,thickness of the anterior wall of the uterus,and time from the last cesarean section.Conclusion It is feasible to test the vaginal pregnancy in the uterus of the scar uterus.It is necessary to pay attention to the evaluation of the maternal complications.The thickness of the anterior wall of the uterus should be more than 3.50 mm,and the time from the initial cesarean section should be more than 2 years.