Vaginal Birth after Cesarean after Zavanelli Maneuver: A Woman’s Right to Choose

Introduction: Vaginal birth after cesarean (VBAC) plays an essential role in lowering cesarean rates. Despite endorsement, trial of labor after cesarean (TOLAC) attempt rates remain low, in part due to fear of lawsuits. Zavanelli maneuver is a last resort procedure in the management of shoulder dystocia. We discuss a case of a woman determined to have a vaginal birth after her prior birth was complicated by shoulder dystocia requiring a Zavanelli maneuver. Her physicians were reluctant to allow her a TOLAC given her prior obstetric history. Case: A 34-year-old para 1 with prior cesarean delivery due to shoulder dystocia that required Zavanelli maneuver presents determined to pursue VBAC in her current pregnancy. She considered her delivery route options and addressed her modifiable risk factors. She consulted with multiple perinatologists who agreed that a TOLAC was reasonable, however she had to travel more than 70 miles (from Pennsylvania to New Jersey) to find an obstetrical practice and hospital willing to consider VBAC. She transferred care and the remainder of her prenatal course was uncomplicated. She went into labor at 41 weeks and had a successful VBAC without complication. In a thank you letter to her obstetrician, she described her birth experience as euphoric. Conclusion: This case illustrates how a woman’s choice of delivery route may be impacted by fear of litigation. Local providers focused on her prior delivery instead of her overall improved risk profile. Delivery route decisions should be based on a thorough evaluation of all risk factors and individualized to meet the reproductive goals of each woman. .

Prediction of Success Rates of Vaginal Birth after Cesarean Delivery According to the Previous Indication for Cesarean Delivery

Background: Trial of labor after cesarean delivery (TOLAC) has long been accepted as a safe option for women with previous cesarean delivery. Previous efforts have been exerted in trials to predict the success rates of TOLAC according to specific parameters related to previous cesarean section and before TOLAC. We aimed to investigate the different indications of previous cesarean delivery as independent predictors for successful vaginal birth. Methods: A retrospective study was conducted in Armed Forces Hospitals of the Southern Region between December 15, 2019, and July 1, 2020. The included 566 patients with previous cesarean section who were willing to undergo a trial of labor were divided into two groups according to the success of vaginal birth (VBAC). Results: The nonrecurring indications for previous cesarean delivery were higher in the successful group (fetal distress 54.7% vs 41.1%, malpresentation 26% vs 21.4%, multifetal pregnancy 3.8% vs 2.7%). Additionally, the successful VBAC group had a significantly higher percentage of previous successful VBAC (47.7% vs 21.9%) and prior vaginal deliveries (58.5% vs 44.2%) and less coincidence of medical disorders and meconium-stained liquor (18.1% vs 26.3% and 3.2% vs 8.2%, respectively) than the unsuccessful group. Conclusion: During counseling regarding trial of labor after cesarean section, indications for previous cesarean section not related to arrest of labor can predict higher success of VBAC. Moreover, previous successful vaginal delivery or VBAC improves the success rates.

Comparative study for success rate of vaginal birth after cesarean section following labor induction by two forms of vaginal dinosprostone: A pilot study

Background: Cesarean delivery has become the most common major surgical procedure in many parts of the world. Induction of labor in women with prior cesarean delivery is an alternative to mitigate the rising cesarean rates. Objectives: To compare the VBAC success rate between two vaginal forms of dinoprostone for labor induction in women with prior cesarean section. Material and Methods: A pilot study was conducted at a large Governmental Hospital, Dhahran, Saudi Arabia, including 200 women with prior cesarean section and planned for labor induction. Participants were randomly allocated into two groups. Group A (n = 100) received dinoprostone 1.5 mg vaginal tablet. Group B (n = 100) received 10 mg dinoprostone sustained release vaginal pessary. Primary outcome was vaginal delivery rate. Secondary outcomes included maternal and neonatal outcomes. Results: The dinoprostone vaginal tablet and dinoprostone vaginal pessary had a comparable vaginal delivery rate (67% and 64%, respectively;p = 0.78). The median patient satisfaction with the birth process was superior in the dinoprostone vaginal pessary group (p = 0.04). Maternal and neonatal outcomes were similar in both groups. Conclusion: Both forms of dinoprostone were effective methods for labor induction in women with prior cesarean section. However, the patient satisfaction with the birth process was in favor of the dinoprostone sustained release vaginal pessary.

Risk Factors Associated with Unsuccessful Vaginal Birth after One Cesarean (VBAC-1) in Puerto Rico

Background: Cesarean section (CS) has increased steadily over the last decade, with an estimated one-third of women delivering by cesarean section worldwide. Objective: Our study aimed to investigate the demographic and associated factors influencing vaginal birth after one cesarean (VBAC-1) success focusing on variables like pre-pregnancy BMI, diabetes, hypertension, education, and smoking. Study Design and Methods: In this retrospective study, we analyzed 285 cases (81 unsuccessful VBAC-1, 204 successful VBAC-1) from San Juan City Hospital (Puerto Rico) between January 1, 2019, and December 31, 2020. We used odds ratios and model selection comparison to assess the impact of variables on successful VBAC-1, using a significance threshold of 95% CI. Model selection assessed binomial model combinations using a generalized linear approach to identify key risk factors. Results: Unsuccessful VBAC-1 (a repeat cesarean), was associated with diabetes (OR: 0.376, p = 0.086), hypertension (OR: 0.23, p = 0.006), and university-educated women (OR: 1.372, p = 0.711). High school-educated women had an OR of 3.966 (p = 0.105), while overweight women were 0.481 times more likely to have unsuccessful VBAC-1 (p = 0.041). Significant associations were not found with obesity (OR: 0.574, p = 0.122), underweight/normal (OR: 1.01, p = 0.810), or smoking (OR: 1.227, p = 0.990). Conclusion: Results revealed women with higher education levels, hypertension, or diabetes are less likely to have a successful VBAC-1. Understanding the complex interactions affecting these outcomes is aimed at establishing guidelines for healthcare professionals to conduct systematic risk/benefit assessments. This study lays a foundation for evidence-based practices and policies, offering initial insights into VBAC-1 success factors in Puerto Rico.

Vaginal Birth after a Cesarean Section at Good Shepherd Mission Hospital at Tshikaji in Democratic Republic of the Congo (DRC)

Background: The success rate of vaginal birth after cesarean section with a single cesarean scar is greater than 50%, the lack of the information about the safety of vaginal birth after cesarean delivery pushes most of obstetricians to increase the num ber of cesarean sections following a previous cesarean section. Guidelines for Vaginal birth after cesarean (VBAC) indicate that TOLAC offers women with no contraindications and one previous transverse low-segment cesarean. The objective of the current study was to study the outcome of trial of labour after caesarean section (TOLAC), the indications for emergency repeat cesarean section and to determine the maternal and fetal prognosis in vaginal birth after caesarian section (VBAC) at Tshikaji Mission Hospital. Patients, Material and Methods: This is a retrospective study of the records of 126 women were selected to undergo the TOLAC in the department of gynecology and obstetrics at the Tshikaji Mission Hospital over the period from January 1st to December 31st, 2021. The data on demography, antenatal care, labour and delivery and outcomes were collected from the maternity unit of this hospital. The data were analyzed using SPSS version 2.0. Results: The TOLAC in 126 studied women. The course of work allowed vaginal delivery 107 parturient women, a success rate of successful VBAC of 85% after the TOLAC. The repeat emergency cesarean section was necessary for delivery in 15% of cases for failed TOLAC. There was no maternal mortality, but we recorded one fetal death or 0.8% of perinatal mortality, 2 cases of cicatricial dehiscence, the incidence of 1.6%. Maternal morbidity after delivery on cicatricial uterus was dominated by postpartum hemorrhages, with 19 cases or 15.1% of cases. Cervical dilatation of more than 3 cm at the time of admission, the parity more than 3 and were the significant factors in favor of a successful VBAC. Birth weight of more than 3500 g, fetal distress and malpresentation were associated with a lower success rate of VBAC. The TOLAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. Conclusion: Pregnancy on a cicatricial uterus represents a high-risk pregnancy. Trial of VBAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. There is a significantly high vaginal birth after caesarian section (VBAC) success rate among selected women undergoing trial of scar in Tshikaji Hospital. TOLAC remains the option for childbirth in low resource settings as Kasai region in DRC. Adequate patient education and counselling in addition to appropriate patient selection for TOLAC remain the cornerstone to achieving high VBAC success rate.

Labor Onset, Oxytocin Use, and Epidural Anesthesia for Vaginal Birth after Cesarean Section and Associated Effects on Maternal and Neonatal Outcomes in a Tertiary Hospital in China： A Retrospective Study

Background：In the mainland of China, the trial of labor after cesarean section is still a relatively new technique. In this study, we aimed to investigate the effects of labor onset, oxytocin use, and epidural anesthesia on maternal and neonatal outcomes for vaginal birth after cesarean section （VBAC） in a tertiary hospital in China.Methods：This was a retrospective study carried out on 212 VBAC cases between January 2015 and June 2017 in Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Relevant data were acquired on a form, including maternal age, gravidity and parity, body mass index before pregnancy, weight gain during pregnancy, type of labor onset, gestational age, the use of oxytocin and epidural anesthesia, birth mode, the duration of labor, and neonatal weight. The factors affecting maternal and neonatal outcomes for cases involving VBAC, especially with regards to postpartum hemorrhage （PPH） and fetal distress, were evaluated by univariate analysis and multivariable logistic regression.Results：Data showed that 36 women （17.0%） had postpartum hemorrhage （PPH） and 51 cases （24.1%） featured fetal distress. Normal delivery took place for 163 infants （76.9%） while 49 infants （23.1%） underwent operative vaginal deliveries with forceps. There were 178 cases （84.0%） of spontaneous labor and 34 cases （16.0%） required induction. Oxytocin was used in 54 cases （25.5%） to strengthen uterine contraction, and 65 cases （30.7%） received epidural anesthesia. The rate of normal delivery in cases involving PPH was significantly lower than those without PPH （61.1% vs. 80.1%; χ2 = 6.07, P = 0.01）. Multivariate logistic analysis showed that the intrapartum administration of oxytocin （odds ratio [OR] = 2.47; 95% confidence interval [CI] = 1.07–5.74; P = 0.04） and birth mode （OR = 0.40; 95% CI = 0.18–0.87; P = 0.02） was significantly associated with PPH in VBAC cases. Operative vaginal delivery occurred more frequently in the group with fetal distress than the group without （49.0% vs. 14.9%, χ2 = 25.36, P = 0.00）. Multivariate logistic analysis also revealed that the duration of total labor （OR = 1.01; 95% CI = 1.00–1.03; P = 0.04） and the gestational week of delivery （OR = 1.08; 95% CI = 1.05–1.11; P = 0.00） were significantly associated with fetal distress in VBAC.Conclusions：The administration of oxytocin during labor and birth was identified as a protective factor for PPH in VBAC while birth mode was identified as a risk factor. Finally, the duration of total labor and the gestational week of delivery were identified as risk factors for fetal distress in cases of VBAC. This information might help obstetricians provide appropriate interventions during labor and birth for VBAC.

激励式心理干预联合加速康复外科在选择性剖宫产患者中的应用效果

目的:分析激励式心理干预联合加速康复外科(enhanced recovery after surgery,ERAS)在选择性剖宫产患者中的应用效果。方法:纳入2022年5—7月在暨南大学附属顺德医院接受基础护理的选择性剖宫产产妇30例作为对照组,2022年8—10月接受ERAS护理的选择性剖宫产产妇30例作为ERAS组,2022年11月—2023年1月接受激励式心理干预的选择性剖宫产产妇30例作为心理干预组,2023年2—4月接受激励式心理和ERAS联合干预的选择性剖宫产产妇30例作为联合组。对比经护理干预后四组的围手术期临床指标、负性情绪指标、术后疼痛评分和并发症。结果:联合组的肠鸣音恢复时间、排便时间和离床时间及术后泌乳时间均明显早于对照组、ERAS组和心理干预组(P<0.05)。分娩后焦虑自评量表(SAS)和抑郁自评量表(SDS)评分及术后2、12 h的疼痛评分均明显低于对照组、ERAS组和心理干预组(P<0.05)。四组围手术期并发症总发生率对比,差异无统计学意义(P>0.05)。结论:激励式心理干预联合EARS护理选择性剖宫产患者,可减轻术后疼痛,调节负面情绪,促进其早日康复。

多元共享决策模式对瘢痕子宫再次妊娠分娩方式的影响

目的探究决策辅助手册联合在线分娩决策支持的多元共享决策模式对瘢痕子宫再次妊娠女性分娩方式的影响。方法选取2019年9月至2022年10月在某三甲医院产检的94例瘢痕子宫再次妊娠女性为研究对象,采用随机数字表法分为观察组与对照组。对照组接受常规孕期宣教,观察组在常规孕期宣教的基础上接受多元共享决策干预。分别对两组分娩决策冲突程度、分娩方式偏好、分娩后决策后悔程度和最终分娩方式进行比较。结果观察组在接受多元共享决策干预后,决策冲突量表得分降低(P<0.001),在分娩方式偏好调查中表示“不确定”的人数减少,选择经阴道生产的人数增加;最终观察组孕妇行剖宫产者30人(68.2%),阴道分娩者14人(31.8%);观察组孕妇对本次分娩决策后悔程度低于对照组(P<0.001)。结论对瘢痕子宫再次妊娠女性开展多元共享决策可降低其决策冲突程度、增强阴道试产意愿并帮助其做出理性科学的分娩决策。

剖宫产术后6h产妇下床活动对产后康复的影响

目的探讨剖宫产术后6 h产妇下床活动对产后康复的影响。方法选择厦门大学附属第一医院2022年1—12月收治的100例剖宫产产妇,以剖宫产术后首次下床活动时间的不同将其分为50例观察组和50例对照组。对照组产妇于产后24 h后协助下床活动,观察组患者则在术后6 h开始分阶段协助下床活动。比较2组产妇胃肠恢复时间、排气时间、拔尿管时间、泌乳始动时间等恢复时间指标,产妇产后24 h的视觉模拟评分(visual analogue scale,VAS),子宫复旧情况、产妇乳汁分泌量以及产后5 d母乳喂养率,产妇发生产后出血和深静脉血栓的并发症以及对术后恢复效果的满意度。结果观察组产妇胃肠恢复时间、排气时间、拔尿管时间和泌乳始动时间均短于对照组产妇(P<0.05)。其产后24 h VAS评分为(1.49±0.58)分,低于对照组的(2.45±0.83)分(P<0.05)。观察组产妇24 h宫底高度低于对照组,乳汁分泌量优于对照组(P<0.05)。观察组5 d母乳喂养率达到92.00%,高于对照组的50.00%(P<0.05)。观察组并发症总发生率低于对照组(P<0.05)。观察组产妇对产后恢复的满意度高达100%,高于对照组的78.00%(P<0.05)。结论剖宫产术后6 h产妇下床活动对其产后康复有积极意义,可缩短恢复时间,减轻疼痛感,促进子宫复旧和乳汁的分泌,降低并发症发生率,提高产妇满意度。

麦角新碱联合卡孕栓对剖宫产术后再次妊娠阴道分娩产妇产后出血的影响

目的探究麦角新碱联合卡孕栓对剖宫产术后再次妊娠阴道分娩(VBAC)产妇产后出血的影响。方法回顾性选取100例于2019年3月至2021年2月在首都医科大学附属北京妇产医院进行VBAC的产妇作为研究对象,根据产妇分娩后接受预防产后出血用药方案的差异分为观察组(n=50)和对照组(n=50)。对照组使用缩宫素联合卡孕栓治疗,观察组在对照组基础上加用麦角新碱治疗。比较两组产妇出血及止血情况、实验室检查结果、临床表现和安全性。结果对照组产妇的产后2 h及产后24 h出血量均大于观察组,对照组产妇的止血时间也长于观察组(P<0.05);治疗后,两组产妇的活化部分凝血活酶时间(APTT)、凝血酶凝固时间(TT)、血红蛋白(Hb)和纤维蛋白原(FIB)均有所降低,且对照组产妇的APTT、TT、FIB均高于观察组,Hb低于观察组(P<0.05);观察组产妇的宫缩持续时间较对照组更长,恶露持续时间和住院时间较对照组显著更短(P<0.05);观察组和对照组产妇的总不良反应发生率分别为14.00%和18.00%,差异无统计学意义(P>0.05)。结论麦角新碱联合卡孕栓能有效改善VBAC产妇产后出血的情况。

共享决策在剖宫产术后再次妊娠分娩方式中的应用进展

就再次妊娠妇女面临的分娩方式决策挑战以及共享决策在再次妊娠分娩方式中的实施过程、应用效果、阻碍因素和发展策略进行综述,以期为剖宫产术后再次妊娠妇女的分娩管理提供依据。

Effect of China's Universal Two-child Policy on the Rate of Cesarean Delivery: A Case Study of a Big Childbirth Center in China

China's universal two child policy was released in October of 2015.How would this new policy influence the rate of overall cesarcan delivery(CD)in China?The objective of this paper is to investigate the trend of overall CD rate with the increase of number of multiparous women based on a big childbirth center of China(a tertiary hospital)in 2016.In this study,22530 cases from the medical record department of a big childbirth center of China from January 1 to December 31 in 2016 were entolled as research objects.Electronic health records of these selected objects were retrieved.According t0 the history of childbirth,the selected cases were divided into primiparous group containing 16340 cases and multiparous group containing 6190 cases.Chi-square test was carried out to compare the rate of CD,neuraxial labor analgesia,maternity insurance between the two groups;1-test was performed to compare the in-hospital days and gestational age at birth between the two groups.Pearson corrclation coefficient was used to evaluate the rclationship among observed monthly rate of multiparas,overall CD rate,and Elective Repeat Cesarean Delivery(ERCD)rate.The results showed that the CD rate in multiparous group was 55.46%,which was higher than that in primiparous group(34.66%,P<0.05).The rate of neuraxial labor analgesia in multiparas group was 9.29%,which was lower than that in primiparas group(35.94%,P<0.05).However,the rate of maternity insurance was higher in multiparas group(57.00%)than that in primiparas group(41.08%,P<0.05).The hospital cost and in-hospital days in multiparas group were higher,and the gcstational age at birth in multiparas group was lower than in primiparas group(P<0.05).The overall CD rate slightly dropped in the first 4 months of the year(P<0.05),then increased from 36.27%(April)to 43.21%(Dcember)(P<0.05).The rate of multiparas women and ERCD had the same trend(P<0.05).There were linear correlations among the rate of overall CD,the rate of multiparas women and the rate of ERCD rate(P<0.05).With the opening of China's two-child policy,the increasing rate of overall CD is directly related with the high rate of ERCD.Trials of Labor After Cesarean Section(TOLAC)in safe mode to reduce overall CD rate are warranted in the future.

rh-aFGF凝胶联合点阵CO_(2)激光治疗对剖宫产术后切口瘢痕愈合和美观满意度的影响

目的:探讨重组人酸性成纤维细胞生长因子(Recombinant Human acidic fibroblast growth factor,rh-aFGF)凝胶联合点阵CO_(2)激光治疗对剖宫产术后切口瘢痕愈合和美观满意度的影响。方法:选取2020年6月-2022年6月在笔者医院收治的85例剖宫产术后皮肤瘢痕患者,根据治疗方法将其分为对照组(42例)和联合组(43例)。对照组在患者剖宫产术后3个月左右瘢痕出现后采取点阵CO_(2)激光治疗,联合组在对照组基础上予以rh-aFGF凝胶联合治疗。观察比较两组患者治疗前、治疗后1个月、治疗后3个月和治疗后6个月时的温哥华瘢痕量表(Vancouver scar scale,VSS)评分情况,治疗3个月时的临床治愈情况、美观满意度和不良反应发生情况。结果:治疗后1个月、3个月和6个月时,联合组VSS评分均低于对照组,且联合组临床总治愈率和美观满意度均较对照组高(P<0.05);联合组不良反应发生率低于对照组(P<0.05)。结论:相比于单纯使用点阵CO_(2)治疗,rh-aFGF凝胶联合点阵激光治疗对剖宫产术后切口瘢痕愈合效果更好,能有效提高患者对瘢痕恢复的满意程度,且不增加患者不良反应。

不同剂量缩宫素对剖宫产术后再次妊娠经阴道试产孕妇母婴结局的影响

目的探究不同剂量缩宫素(oxytocin,OT)对剖宫产术后再次妊娠经阴道试产(trial of labor after cesareansection,TOLAC)孕妇产程进展、凝血功能和母婴结局的影响。方法回顾性分析138例TOLAC孕妇临床病历资料,根据产程中OT总用量分为低剂量组61例、中剂量组45例和高剂量组32例,比较三组的产程进展、凝血功能、分娩方式、妊娠结局及围产儿结局。结果三组第一产程、第二产程、第三产程及总产程比较,差异均无统计学意义(P>0.05);与用药前比,三组用药后凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)均降低,纤维蛋白原(FIB)水平均升高,差异有统计学意义(P<0.05),三组间用药后PT、APTT、FIB比较差异无统计学意义(P>0.05)。低剂量组及中剂量组孕产妇的胎盘早剥、新生儿高胆红素血症发生率均低于高剂量组,差异有统计学意义(P<0.05)。结论OT可增强TOLAC孕妇子宫收缩力,改善凝血功能,但大剂量OT可能增加胎盘早剥及新生儿高胆红素血症发生风险。

气囊仿生助产联合硬膜外麻醉分娩镇痛对剖宫产后阴道分娩女性盆底功能的影响

目的探讨气囊仿生助产联合硬膜外麻醉分娩镇痛对剖宫产后阴道分娩(vaginal birth after cesarean section,VBAC)女性盆底功能的影响。方法选取2020年1月至2021年12月南宁市妇幼保健院剖宫产后再次妊娠并成功阴道分娩的经产妇120例为研究对象,根据随机数字表法将其分为观察组和对照组,每组各60例。观察组产妇在分娩过程中采用气囊仿生助产联合硬膜外麻醉分娩镇痛,对照组产妇单纯采用硬膜外麻醉分娩镇痛。比较两组产妇的疼痛视觉模拟评分法(visual analogue scale,VAS)评分、会阴裂伤情况、总产程、产后出血量、新生儿窒息率及产妇产后6~8周尿失禁发生率、阴道或子宫脱垂发生率、盆底肌肌力及功能状态。结果观察组产妇的总产程显著短于对照组,产后出血量显著少于对照组,尿失禁发生率显著低于对照组(P<0.05)。观察组产妇的盆底肌肌力、盆底肌疲劳度、盆底动态压力均显著优于对照组(P<0.05)。两组产妇的会阴裂伤或侧切、阴道和子宫脱垂发生率比较差异均无统计学意义(P>0.05)。结论剖宫产后阴道试产时采用气囊仿生助产联合硬膜外麻醉镇痛可缩短产程,减少产后出血,改善产后盆底功能状况。

剖宫产术后产妇疼痛灾难化与家庭关怀度、情绪状态的相关性研究

目的研究剖宫产术后产妇疼痛灾难化与家庭关怀度、情绪状态的相关性,为临床护理提供多元化的干预策略。方法选取2023年11月至2024年2月在中山大学孙逸仙纪念医院产科行剖宫产手术的111名产妇,使用一般资料调查表、疼痛灾难化量表(PCS)、家庭关怀度指数问卷(APGAR)及正性负性情绪量表调查剖宫产术后产妇疼痛灾难化情况,并分析剖宫产术后产妇疼痛灾难化水平与家庭关怀度、情绪状态的相关性。结果最终纳入的109名产妇中,PCS≥30分51名(46.8%),PCS总分为(26.04±13.19)分,APGAR总分为(8.21±2.28)分,正性情绪为(28.64±5.60)分,负性情绪为(25.70±6.33)分;单因素分析结果显示,PCS得分与是否有生育保险、居住地、年龄、文化程度、产次及产后睡眠质量无关(P>0.05);PCS总分与APGAR总分和正性情绪呈负相关,与负性情绪呈正相关(P<0.01,P<0.05);多元线性回归分析结果显示,负性情绪可正向影响剖宫产术后产妇疼痛灾难化水平,APGAR总分及正性情绪可负向影响剖宫产术后产妇疼痛灾难化水平(P<0.05)。结论46.8%的剖宫产术后产妇达到疼痛灾难化,并且与家庭关怀度及情绪状态相关,家庭关怀有利于改善产妇的疼痛状态,从而减轻疼痛感。

剖宫产后再次妊娠孕妇分娩决策冲突的质性研究

目的:分析剖宫产后再次妊娠孕妇的分娩决策行为冲突,为制定决策支持策略提供依据。方法:通过目的抽样法选取13名剖宫产术后再次妊娠孕妇为研究对象,采用描述性质性研究方法对其进行半结构式访谈,应用内容分析法进行分析。结果:剖宫产后妊娠孕妇的分娩决策行为冲突包括决策认知受限是行为冲突前因(分娩决策复杂、信息限制)、知情决策不足是行为过程冲突诱因(价值观冲突、多元决策主体冲突)、决策冲突行为及体验(决策行为表现、决策情感体验)。结论:剖宫产后妊娠孕妇在分娩决策过程中受多重因素影响,护士应制定适宜的决策支持策略,以期尽可能降低其决策冲突,提升决策质量,以降低盲目再次剖宫产率。

前次剖宫产手术时机对再孕阴道分娩母婴并发症的影响

目的探讨前次剖宫产手术时机对再孕阴道分娩母婴并发症的影响。方法回顾性分析本院收治的1034例足月剖宫产术后阴道分娩(VBAC)孕产妇资料。按前次剖宫产手术时机分为择期组(择期行剖宫产术)426例、第一产程组(第一产程行剖宫产术)278例、第二产程组(第二产程行剖宫产术)330例。分析前次剖宫产手术时机对VBAC孕产妇的产程、产后并发症及新生儿出生情况的影响。结果第二产程组子宫收缩乏力比例、产后24 h出血量、产后出血发生率及产后住院天数均大于择期组和第一产程组(P<0.05),而择期组与第一产程组比较,以上指标差异无统计学意义(P>0.05)。3组间第二、第三产程时限、助产率、会阴裂伤率、产后尿潴留率、发热比例及新生儿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)。结论前次第二产程剖宫产手术孕产妇再孕阴道分娩时发生子宫收缩乏力及产后出血风险增加。

剖宫产术后子宫瘢痕妊娠患者蜕膜组织中TGF-β1、 CTGF和VEGF表达的研究

目的 通过检测剖宫产术后子宫瘢痕妊娠(CSP)的瘢痕蜕膜组织、宫腔蜕膜组织和剖宫产后正常妊娠的瘢痕蜕膜组织、宫腔蜕膜组织中的转化生长因子β1(TGF-β1)、血管内皮生长因子(VEGF)、结缔组织生长因子(CTGF)的表达,探索CSP的发病机制。方法 选取于贵州医科大学附属医院妇产科早孕行人工流产术后的CSP组蜕膜组织120例,同期行剖宫产的正常妊娠组蜕膜组织120例,用免疫组织化学法观察比较两组蜕膜组织中TGF-β1、CTGF和VEGF相对表达量。结果 CSP组剖宫产瘢痕蜕膜组织TGF-β1、CTGF相对表达量比CSP组宫腔蜕膜组织和正常妊娠组剖宫产瘢痕蜕膜组织更高,差异有统计学意义(P<0.05)。CSP组剖宫产瘢痕蜕膜组织VEGF相对表达量与CSP组宫腔蜕膜组织和正常妊娠组剖宫产瘢痕蜕膜组织比较,差异无统计学意义(P>0.05)。蜕膜组织TGF-β1与CTGF呈正相关(r=0.910,P<0.05),TGF-β1与VEGF无相关性(r=-0.032,P>0.05)。结论 TGF-β1、CTGF在CSP瘢痕部位蜕膜组织中的高表达可能是CSP发生的高危因素,采取措施抑制瘢痕部位TGF-β1、CTGF的产生,为预防CSP的发生开辟新的途径。

经阴道子宫下段瘢痕妊娠病灶清除术联合子宫壁修补术治疗剖宫产术后瘢痕子宫妊娠的临床效果

目的:分析经阴道子宫下段瘢痕妊娠病灶清除术联合子宫壁修补术在剖宫产术后瘢痕子宫妊娠患者中的效果。方法:选取2021年11月—2022年12月鹰潭一八四医院收治的50例剖宫产术后瘢痕子宫妊娠患者,按照随机数字表法将其分成对照组(n=25)、观察组(n=25)。对照组给予子宫动脉栓塞术+甲氨蝶呤+清宫术治疗,观察组行经阴道子宫下段瘢痕妊娠病灶清除术+子宫壁修补术,术后随访3个月。对比两组围手术期指标、术后恢复情况、生活质量、并发症。结果:观察组术中出血量为(65.21±4.48)mL,少于对照组的(87.49±6.37)mL(P<0.05);观察组住院时间为(6.96±1.54)d、月经复潮时间为(31.35±2.56)d、血β-人绒毛膜促性腺激素(β-hCG)恢复正常时间为(18.36±1.59)d,均短于对照组的(8.37±1.89)、(42.58±4.39)、(25.44±2.57)d(P<0.05);观察组并发症发生率为8.00%(2/25),低于对照组的32.00%(8/25),差异有统计学意义(P<0.05)。术前,两组世界卫生组织生存质量测定量表(WHOQOL-BREF)各维度评分比较,差异均无统计学意义(P>0.05);术后,观察组WHOQOL-BREF各维度评分分别为(75.96±3.42)、(74.39±4.08)、(76.84±3.44)、(72.49±3.49)分,高于对照组的(69.84±2.98)、(68.44±3.57)、(70.38±2.96)、(66.84±2.96)分,差异均有统计学意义(P<0.05)。结论:经阴道子宫下段瘢痕妊娠病灶清除术+子宫壁修补术具有创伤小、手术时间短等优势,有助于剖宫产术后瘢痕子宫妊娠患者术后恢复,提升生活质量,且并发症较少。