瘢痕子宫妊娠经阴道试产的可行性分析及其对应激相关因子和母婴结局的影响

Feasibility analysis of vaginal trial labor in scarred uterus pregnancy and its effect on stress-related factors and maternal and infant outcomes

目的:探索瘢痕子宫妊娠经阴道试产的可行性分析及其对应激相关因子和母婴结局的影响。方法:回顾性选取周口市中医院2020年7月至2023年4月收治的96例瘢痕子宫妊娠孕妇作为研究对象,依照实际情况及自身意愿选择不同分娩方式,分为对照组和治疗组。对照组48例行剖宫产,治疗组48例行阴道分娩,对比两组应激相关因子、新生儿情况、母体并发症。结果:两组产后24 h血清血管紧张素-Ⅱ(Ang-Ⅱ)、醛固酮(ALD)、皮质醇(Cor)水平较入院时升高,治疗组低于对照组(P<0.05)。治疗组1、5 min Apgar评分高于对照组(P<0.05);经Fisher确切概率法检验,新生儿肺炎发生率2.08%(1/48)、新生儿呼吸窘迫综合征发生率0与对照组6.25%(3/48)、4.17%(2/48)经比较无差异(P>0.05)。经Fisher确切概率法检验,治疗组产后出血发生率2.08%(1/48)、产后发热发生率0、尿潴留发生率0与对照组4.17%(2/48)、4.17%(2/48)、6.25%(3/48)经比较无差异(P>0.05)。结论:瘢痕子宫妊娠经阴道试产可调节应激相关因子水平,改善新生儿情况,降低母体并发症。

Objective:To explore the feasibility analysis of vaginal trial labor in scarred uterus pregnancy and its influence on stress-related factors and maternal and infant outcomes.Methods:Ninety-six pregnant women with cicatricial uterus were retrospectively selected from Zhoukou Hospital of Traditional Chinese Medicine from July 2020 to April 2023 as the study object,and were divided into control group and treatment group according to the actual situation and their own will.The control group had 48 cases of cesarean section and the treatment group had 48 cases of vaginal delivery.The stress-related factors,neonatal conditions and maternal complications were compared between the two groups.Results:Serum levels of angiotensin-ⅱ(Ang-Ⅱ),aldosterone(ALD)and cortisol(Cor)at 24 h postpartum in both groups were higher than those at admission,and those in treatment group were lower than those in control group(P<0.05).Apgar scores at 1 min and 5 min in treatment groups were higher than those in control group(P<0.05).By Fisher's exact probability test,the incidence of neonatal pneumonia was 2.08%(1/48),and the incidence of neonatal respiratory distress syndrome was 0 compared with 6.25%(3/48)and 4.17%(2/48)in the control group(P>0.05).By Fisher's exact probability test,the incidence of postpartum hemorrhage 2.08%,postpartum fever(0)and urinary retention(0)in the treatment group was not different from that in the control group 4.17%(2/48),4.17%(2/48)and 6.25%(3/48)(P>0.05).Conclusion:Vaginal trial labor of cicatricial pregnancy can regulate the level of stress-related factors,improve newborn conditions and reduce maternal complications.