疤痕子宮經陰道分娩的危險因素分析

The risk factors of trial of labor after cesarean delivery

目的探討剖宮產術後,疤痕子宮再次妊娠經陰道分娩的危險因素及其對妊娠結局影響。方法回顧性收集2019年12月~2020年12月在本院婦產科分娩的疤痕子宮再次妊娠患者的資料共66例,按照阴道試產情况分為失敗組和成功組,分析疤痕子宮再次妊娠後經陰道試產的不同分娩結局的臨床情况及其影響因素。結果經陰道分娩成功率為80.3%(53/66);陰道分娩組住院時間短於剖宮產組(P<0.05);入院時胎膜早破是影響疤痕子宮再次妊娠陰道分娩的主要危險因素(OR=0.076,95%CI:0.015-0.374,P<0.05)。結論在嚴格指征及密切監護下,疤痕子宮再次妊娠經陰道分娩具有較高的安全性及可行性。入院時胎膜早破可能為其高危因素。

Objective To explore the risk factors and outcomes of trial of labor after cesarean delivery(TOLAC).Methods The clinical data of 66 patients attempted TOLAC were included from December 2019 to December 2020.Patients who successfully delivered were classified into the TOLAC success group.Patients who attempted TOLAC but had a repeat Cesarean delivery due to medical issues were classified into the TOLAC failure group.Clinical data including age,height,BMI,gestational weight gain,gestational age,complications of pregnancy,duration of hospital stay after delivery,postpartum hemorrhage,weight of newborns and 5 min Apgar score were compared between the 2 groups.Logistic regression analysis was used to analyze the risk factors of vaginal delivery and the pregnancy outcomes in both groups were observed.Results The success rate of TOLAC was 80.3%(53/66).The total duration of hospital stay after delivery in TOLAC success group is shorter than that of TOLAC failure group(P<0.05).Logistic regression analysis showed that prematureruptureofmembranes(PROM)(OR=0.076,95%CI:0.015-0.374,P<0.05)waspositivelyassociated withTOLAC failure.Conclusion TOLAC is safe and feasible on the basis of strict grasp of the indications and close monitoring.PROM may be a risk factor for TOLAC failure.