剖宫产后瘢痕子宫再次妊娠选择经阴道分娩的可行性分析

Possibility of vaginal delivery in the second pregnancy of scar uterus after cesarean section

目的对比剖宫产后瘢痕子宫再次妊娠不同的分娩方式,探讨经阴道分娩的可行性。方法回顾性分析分析唐山市妇幼保健院在2017年3月至2021年10月接收的500例剖宫产后瘢痕子宫再次妊娠阴道试产产妇的临床资料,根据最终分娩方式的不同分为剖宫产组348例(采用剖宫产术)和阴道分娩组152例(经阴道自然分娩),观察两组产妇的一般情况及妊娠结局,同时对影响其阴道顺利分娩的因素进行分析。结果(1)一般资料:两组产妇的BMI、瘢痕厚度、距离上次分娩时间及胎膜早破和羊水污染发生率比较差异均有统计学意义(P<0.01)。(2)妊娠结局:阴道分娩组产妇的产时出血量、产后24 h出血量比剖宫产组更少,新生儿体重更低,住院时间更短,差异均有统计学意义(P<0.01)。(3)多因素分析:logistic回归分析结果示,BMI≥30、羊水污染、新生儿体重高是阴道试产失败的影响因素(P<0.01),瘢痕厚度大是阴道试产成功的影响因素(P<0.05)。结论对于剖宫产后瘢痕子宫再次妊娠产妇,经阴道自然分娩可减少产妇出血量,不会增加新生儿窒息风险,在一定程度上改善妊娠结局,符合条件者可首选阴道分娩,但应注意BMI≥30、羊水污染、新生儿体重对阴道试产失败的影响,严格掌握阴道试产指征。

Objective To analyze the feasibility of vaginal delivery in the second pregnancy of scar uterus after cesarean section.Methods A retrospective analysis was performed on the clinical data of 500 second-pregnant women with scar uterus after cesarean section preparing for vaginal trial delivery in Tangshan Maternal and Child Health Hospital from March 2017 to October 2021.According to different modes of delivery,they were divided into cesarean section group(n=348)and vaginal delivery group(n=152).The general situation and pregnancy outcome of the parturients were observed and compared between two groups,and the factors affecting the smooth vaginal delivery were analyzed.Results There were significant differences in BMI,scar thickness,time interval between two delivery,and the rates of premature rupture of membranes and amniotic fluid contamination between two groups(P<0.01).Compared with those in cesarean section group,intrapartum bleeding,postpartum hemorrhage in 24 h,neonatal weight and hospital stay statistically decreased in vaginal delivery group(P<0.01).Logistic regression analysis showed that BMI≥30,amniotic fluid contamination and high neonatal weight were the influencing factors of the failure of vaginal trial delivery(P<0.01).Large scar thickness was the success factor of vaginal trial delivery(P<0.05).Conclusion For the parturients with uterine scar after cesarean section,transvaginal natural childbirth can reduce maternal blood loss without increasing the risk of neonatal asphyxia.However,more attentions should be paid to the influence of BMI≥30,amniotic fluid contamination,and neonatal weight on the failure of vaginal trial production,and the vaginal delivery indications should be strictly controlled.