大于胎龄儿对剖宫产术后阴道试产成功率及母婴并发症的影响

Effect of large for gestational age on the success rate of vaginal trial delivery after cesarean section and maternal-infant complications

目的探讨足月大于胎龄儿(LGA)对剖宫产术后阴道试产(TOLAC)成功率及母婴并发症的影响。方法采用回顾性分析方法,选择2015年1月至2022年12月4所医院收治的1577例足月TOLAC孕产妇作为研究对象,按新生儿出生体重分为LGA组(125例)与非LGA组(1452例),比较两组TOLAC成功率;再分别根据TOLAC成功与否,分为TOLAC失败LGA组(36例)、TOLAC失败非LGA组(299例)和剖宫产术后阴道分娩(VBAC)LGA组(89例)、VBAC非LGA组(1153例),比较同种分娩方式下LGA对母婴并发症的影响。结果LGA组TOLAC成功率低于非LGA组(71.20%vs.79.41%)(P<0.05)。TOLAC失败两组母婴并发症比较,差异无统计学意义(P>0.05)。VBAC-LGA组第二产程时限、子宫收缩乏力比例、产后24 h出血量、产后出血发生率及输血率(63.46±16.17 min、6.74%、424.65±118.34 mL、4.49%、2.25%)大于VBAC非LGA组(57.34±19.49 min、2.78%、385.27±132.81 mL、1.04%、0.43%)(P<0.05);VBAC两组第三产程时限、肩难产发生率、助产率、III/IV会阴裂伤率、产后尿潴留率、发热比例与新生儿产伤、1 min Apgar评分、新生儿窒息发生率及转入新生儿科比例比较,差异无统计学意义(P>0.05)。结论LGA降低了TOLAC的成功率,且在VBAC时,LGA第二产程时限较非LGA延长,产后子宫收缩乏力及产后出血发生率增加。

Objective To investigate the effect of full-term large for gestational age(LGA)on the success rate and maternal-infant complications of trial of labor after cesarean section(TOLAC).Methods Using a retrospective analysis method,1577 full-term TOLAC pregnant women admitted to 4 hospitals from January 2015 to December 2022 were selected as the study subjects.According to the birth weight of newborns,they were divided into LGA group(125 cases)and non-LGA group(1452 cases).The success rate of TOLAC was compared between the two groups.According to the success or failure of TOLAC,they were divided into TOLAC failure LGA group(36 cases),TOLAC failure non-LGA group(299 cases),vaginal delivery after cesarean section(VBAC)LGA group(89 cases)and VBAC non-LGA group(1153 cases).The effects of LGA on maternal and infant complications under the same delivery method were compared.Results The success rate of TOLAC in the LGA group was lower than that in the non-LGA group(71.20%vs.79.41%)(P<0.05).There was no statistically significant difference in the comparison of maternal and infant complications between the two groups with TOLAC failure(P>0.05).The duration of the second stage of labor,the rate of uterine atony,the amount of bleeding at 24 hours after delivery,the incidence of postpartum hemorrhage and the rate of blood transfusion in the VBAC-LGA group(63.46±16.17 min、6.74%、424.65±118.34 mL、4.49%、2.25%)were higher than those in the non-LGA group(57.34±19.49 min、2.78%、385.27±132.81 mL、1.04%、0.43%)(P<0.05).There was no statistically significant difference between the two groups with VBAC in the duration of the third stages of labor,the incidence of shoulder dystocia,midwifery rate,III/IV perineal laceration rate,postpartum urinary retention rate,fever ratio,neonatal birth injury,1 min Apgar score,neonatal asphyxia rate and the proportion of transfer to neonatal department(P>0.05).Conclusion LGA reduces the success rate of TOLAC,and at VBAC,the second stage of labor is longer than that of non-LGA,and the incidence of postpartum uterine inertia and postpartum hemorrhage is increased.