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.

Comparison of Sexual Function in Primiparous Women Pre-Pregnancy and Postpartum: Difference of the Sexual Function after the Normal Vaginal Delivery and the Cesarean Section

Introduction: Sexual function is undoubtedly an important dimension of adult life. Due to all the conflicting results with regard to sexual function after the normal vaginal delivery (NVD) or the Cesarean Section (CS), in the present study, we aimed to compare the sexual function in women pre-pregnancy and postpartum and also after the NVD and CS. Materials and Methods: In this cohort study, two groups of healthy women, with antenatal normal pregnancies, who underwent NVD (n = 90) and CS (n = 113), were prospectively studied. The sexual function of the participants was assessed through a Female Sexual Function Index (FSFI) questionnaire in two stages: once before pregnancy and then within 3 to 6 months after delivery, which lasted from June 2011 to September 2012. The data were analyzed by descriptive and inferential statistics. Data were analyzed using chi-square test, Mann-Whitney test, and T Test. Results: Based on the data gathered from 206 women who completed the FSFI questionnaire in two stages, the mean (±SD) self-reported timing of the resumption of sexual activity was 8.9 ± 1.3. There was no significant statistical difference found between the two groups by timing of the resumption of sexual activity in NVD and CS groups. There was also no statistically significant difference found in the overall sexual function scores between the two groups (NVD vs. CS). The average score for female sexual function in desire, arousal, orgasm, and satisfaction within 3 to 6 months after delivery was significantly lower than that of their pre-pregnancy period (p < 0.004). The mean coitus in postpartum period was 1.84 ± 1.20 per week. Conclusion: Based on the findings of this study, there was no significant relationship between the mode of delivery and changes in sexual function. Therefore, it can be claimed that CS is not preferred to NVD with regard to preserving normal sexual functioning.

Trial of Labour after Caesarean Section: A 5-Year Review

Background: Trial of labour after Caesarean section (TOLAC) refers to an attempt at vaginal delivery after a previous caesarean section. Outcome is influenced by a number of factors which are important in patient’s selection. Objectives: The aim of this study was to find out the incidence and feto-maternal outcome of the practice of Trial of labour after Caesarean section. Methodology: This is a retrospective study of cases of vaginal birth after Caesarean section Data were retrieved from the case notes of patients who attempted vaginal birth after Caesarean section from January 1, 2013 to December 31, 2017, a period of five years. Result: There were 10,669 deliveries, 3179 of which were through Caesarean section. This gave a Caesarean section rate of 29.8%. A total of 217 patients attempted vaginal birth after Caesarean section and 83 ended up as repeat Caesarean section (38.2%) while 138 (61.8%) had successful vaginal birth after Caesarean section. Patients with previous vaginal delivery, age range 25 - 29 years and interdelivery interval of greater than or equal to 2 years were more successful at achieving vaginal birth after Caesarean section. The leading indications for the repeat Caesarean section include cephalopelvic disproportion (45.8%), poor progress of labour (19.3%) and hypertensive disorders of pregnancy (8.4%). Conclusion: Vaginal birth after Caesarean section was successful in most of the parturients that attempted it in this study especially in patients within the age range of 25 - 29 years, those that have had previous vaginal delivery and with interdelivery interval of greater than or equal to 2 years.

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.

Induction of Labor at 39 Weeks versus Expecting Labour till 41 Weeks: Randomized Controlled Trial on Class I Obese Egyptian Women, with Mode of Delivery Being a Study Endpoint

Background: Maternal obesity is reported to be associated with increased incidence of gestational diabetes mellitus and hypertension. These cause failure of labour induction, leading to higher incidence of cesarean section (CS). The aim of this study was to assess which reduces CS rate, labor induction at 39 weeks or leaving women for spontaneous labor onset till 41 weeks. Methodology: A randomized controlled trial was conducted in Ain Shams Maternity Hospital in Egypt from 2016 to 2018. Study population consisted of 200 term primigravida pregnant obese women delivered in Ain Shams Maternity Hospital. They were divided into two groups: Group A: induction of labor at 39 + 0 weeks (n = 100) by vaginal administration of 25 μg misoprostol (PGE1) every 6 hours for 5 doses;Group B: waiting spontaneous labor onset till 41 + 0 weeks (n = 100), and if no spontaneous labor occurred at 41 weeks, induction was performed in the same way. Results: Induction (Group A) vs. waiting spontaneous labor (Group B) showed the followings, which were significant: CS: 22% vs 39%, p = 0.009;maternal birth injury: 4% vs 12%, p = 0.037;non-assisted vaginal deliveries: 93.6% vs 78.7%, p = 0.034;APGAR scores at 1 & 5 min: 7.6 ± 0.8 vs 7.3 ± 1.1 p = 0.038, 8.4 ± 1.0 vs 8.1 ± 1.3 p = 0.040, respectively;birth weight;3.3 ± 0.1 vs 3.5 ± 0.2 kg, p < 0.001. The following did not show significance between Group A vs Group B but Group A showed lower incidence;postpartum hemorrhage: 3% vs 5%, blood transfusion: 1% vs 3%. Conclusion: CS rate was significantly lower in women with induction of labor at 39 weeks than those waiting for spontaneous labor onset till 41 weeks in obese Egyptian pregnant women.

胎儿体质量估计对初产妇巨大儿分娩方式及围产结局的临床观察

目的观察胎儿体质量估计对初产妇巨大儿的分娩方式和围产结局的影响。方法选取2022年1月至2023年12月北京市海淀区妇幼保健院分娩的足月单胎初产妇206例,根据估计体质量分为甲组(估计胎儿体质量<4000 g,118例)和乙组(估计胎儿体质量≥4000 g,88例)。比较两组产妇及新生儿的分娩方式和分娩结局等。结果206例初产妇年龄21~39岁,平均(30.6±3.4)岁。与乙组相比,甲组阴道分娩比例较高(61.9%比40.9%)、剖宫产比例较低(32.2%比56.8%),两组分娩方式的差异有统计学意义(P<0.05)。甲组试产率明显高于乙组(90.7%比59.1%),差异有统计学意义(P<0.05)。甲组产后出血量(容积法)和校正产后出血量均高于乙组[350(300,500)ml比300(300,380)ml,440(230,720)ml比360(160,560)ml],差异有统计学意义(P<0.05)。两组胎儿窘迫、肩难产、新生儿窒息比例的差异无统计学意义(P>0.05)。结论低估胎儿体质量可增加初产妇巨大儿试产率及阴道分娩率,也增加了产后出血量,但并未增加胎儿窘迫、肩难产、新生儿窒息等分娩并发症。建议胎儿估计体质量<4500 g且有阴道分娩意愿的产妇,应该在充分告知的情况下,增加试产机会。

剖宫产术后瘢痕子宫再次妊娠行阴道试产的临床可行性分析

目的 研究剖宫产术后瘢痕子宫再次妊娠行阴道试产的临床可行性。方法 选择剖宫产术后再次妊娠行阴道试产的66例产妇作为瘢痕组,另选择同期非瘢痕子宫妊娠行阴道试产的66例产妇作为非瘢痕组。比较两组阴道试产结果,阴道试产成功产妇产程,产后出血量、住院时间及产后胎盘残留发生情况,不良妊娠结局发生情况,新生儿Apgar评分。结果 瘢痕组与非瘢痕组的阴道试产成功率(78.79%VS 84.85%)、转剖宫产率(21.21%VS 15.15%)比较,差异无统计学意义(P>0.05)。瘢痕组阴道试产成功产妇第一、二、三产程及总产程时间与非瘢痕组比较,差异无统计学意义(P>0.05)。瘢痕组产后出血量(210.28±56.36)ml、住院时间(3.69±1.62)d和产后胎盘残留发生率12.12%与非瘢痕组的(205.17±49.69)ml、(3.71±1.59)d、7.58%(5/66)比较,差异无统计学意义(P>0.05)。瘢痕组不良妊娠结局发生率(13.64%)与非瘢痕组(10.61%)比较,差异无统计学意义(P>0.05)。瘢痕组出生后1、5、10 min的新生儿Apgar评分比较,差异无统计学意义(P>0.05)。两组新生儿预后良好,无转入新生儿科记录。结论 剖宫产术后瘢痕子宫再次妊娠产妇的阴道试产成功率与非瘢痕子宫妊娠产妇基本一致,且未增加产程时间及产后出血量,不良妊娠结局发生率无明显升高,临床应用安全性可靠,证实该类产妇经阴道分娩的可行性较强,对提升阴道分娩率及降低剖宫产率具有重要应用价值。

剖宫产术后再次妊娠经阴道分娩的相关影响因素

目的探讨剖宫产术后再次妊娠时经阴道分娩的影响因素。方法选取本院80例剖宫产后再次妊娠孕妇为研究对象,根据分娩方式不同划分为经阴道分娩组与剖宫产组,各40例。回顾性分析两组的基础资料,包含年龄、产次、孕前体质量指数、上次剖宫产间隔时间等,总结分析剖宫产术后再次妊娠经阴道分娩的影响因素。结果多因素分析结果显示,年龄≤30岁、孕前体质量指数≤25kg/m²、上次剖宫产间隔时间>2年、子宫下段厚度>2mm、分娩前子宫颈Bishop评分>5分、有不良妊娠结局史是剖宫产术后再次妊娠经阴道分娩的影响因素(P<0.05)。结论年龄、孕前体质量指数、上次剖宫产间隔时间、子宫下段厚度、分娩前子宫颈Bishop评分、不良妊娠结局史是剖宫产术后再次妊娠经阴道分娩的影响因素,临床需要在分娩前高度重视,提前做好相关准备,以尽可能提高经阴道分娩成功率,改善母婴结局,提升分娩质量。

新产程标准下阴道试产失败中转剖宫产的影响因素分析及风险预测模型构建

目的分析新产程标准下阴道试产失败中转剖宫产的影响因素,构建风险预测的列线图模型。方法选取2021年1月1日至12月31日在南京医科大学附属泰州人民医院产科阴道试产的1888例产妇作为研究对象,依据是否发生阴道试产失败中转剖宫产将产妇分为中转剖宫产组(352例)与阴道分娩组(1536例),收集并比较两组产妇的临床资料。采用多因素Logistic回归模型分析阴道试产失败中转剖宫产的影响因素,建立列线图模型,并绘制受试者工作特征曲线及校准曲线对该模型进行验证。结果阴道分娩组与中转剖宫产组产次、身高、孕前体质量指数(BMI)、住院时间、胎儿腹围、孕妇焦虑评分、妊娠压力评分、人工破膜、无痛分娩、导乐分娩、妊娠期高血压疾病、接受辅助生殖技术、巨大儿、羊水过多、胎膜早破、缩宫素引产、水囊引产、胎心监护分类为Ⅱ类方面比较,差异均有统计学意义(P<0.05)。产次≥1次、身高高、人工破膜、无痛分娩、导乐分娩是阴道试产失败中转剖宫产的独立保护因素(P<0.05);妊娠期高血压疾病、巨大儿、羊水过多、孕前BMI升高、住院时间延长、胎膜早破、缩宫素引产、水囊引产、胎心监护分类为Ⅱ类、胎儿腹围增加、孕妇焦虑评分升高和妊娠压力评分升高是阴道试产失败中转剖宫产的独立危险因素(P<0.05)。阴道试产失败中转剖宫产预测模型的曲线下面积为0.90。当列线图总分≥275.60分时,预测阴道试产失败中转剖宫产的灵敏度为84.4%,特异度为79.0%。结论新产程标准下阴道试产失败中转剖宫产风险预测模型有较高的准确率,可以应用并降低阴道试产失败中转剖宫产的风险,提高产妇和新生儿的安全性。

产时Ⅱ度及以上会阴裂伤风险预测模型的构建和验证

目的 构建产时Ⅱ度及以上会阴裂伤风险预测随机森林算法模型,并初步评价模型的预测性能。方法 采用方便抽样法,选取经阴道分娩的1 366例产妇为研究对象,将其按照7∶3的比例随机分为训练集和验证集。采用LASSO回归分析筛选产时Ⅱ度及以上会阴裂伤的风险因素,采用随机森林算法构建预测模型,计算ROC曲线下面积、预测准确率、灵敏度和特异度等评价模型的性能。结果 共计8个预测因子被纳入随机森林模型中,分别为孕前BMI、孕期体质量增加、初产妇、剖宫产史、硬膜外麻醉、催产、引产和胎儿估计体质量,其中胎儿估计体质量对产时Ⅱ度及以上会阴裂伤的影响最大,其次是初产妇和催产。随机森林模型在验证集中的ROC曲线下面积为0.698(95%CI:0.645~0.751),预测准确率为80.0%(95%CI:75.8%~83.8%),灵敏度和特异度分别为50.5%和89.1%。结论 基于随机森林算法构建的产时Ⅱ度及以上会阴裂伤风险预测模型具有一定的预测价值,但预测性能仍有待提高。

剪切波弹性成像联合盆底超声用于评估不同分娩方式对产后盆底功能影响的价值

目的探讨剪切波弹性成像技术联合盆底超声评估不同分娩方式对产后不同时期盆底功能影响的价值。方法选取医院2022年12月至2023年6月分别于产后42 d及产后5个月行盆底检查的产妇82例,按分娩方式的不同分为阴道分娩组(58例)和剖宫产组(24例),应用剪切波弹性成像技术测量产妇静息及缩肛状态下双侧耻骨直肠肌的杨氏模量值,应用盆底超声测量产妇膀胱颈移动度、尿道旋转角及最大ValsalVa状态肛提肌裂孔面积及盆底各器官的位置。结果剖宫产组产后42 d双侧耻骨直肠肌在静息及缩肛状态下的杨氏模量值均显著大于阴道分娩组(P<0.05),膀胱颈移动度、尿道旋转角及最大ValsalVa状态下肛提肌裂孔面积均显著小于阴道分娩组(P<0.05),膀胱膨出发生率显著低于阴道分娩组(P<0.05)。剖宫产组产后5个月膀胱颈移动度显著小于阴道分娩组(P<0.05)。结论剪切波弹性成像联合盆底超声对不同分娩方式产妇产后盆底功能具有较好的评估价值。剖宫产对产后早期的盆底功能具有保护作用,但从远期来看,二者对盆底功能的影响相当。

43例子宫破裂的临床分析

目的:探讨子宫破裂产妇的临床特点和妊娠结局。方法:回顾性分析2016年12月-2022年12月在南京医科大学附属妇产医院分娩的43例子宫破裂产妇的临床资料,按照是否有子宫手术史,分为瘢痕子宫组和非瘢痕子宫组,比较其临床特点和妊娠结局,并对20例经阴道试产发生子宫破裂产妇的产时情况进行分析。结果:43例子宫破裂产妇中瘢痕子宫33例,非瘢痕子宫10例;与瘢痕子宫组相比,非瘢痕子宫组术中出血量≥1000 mL的比例(P<0.001)、累积出血量≥1000 mL的比例(P=0.003)更高,输血率更高(P=0.012)。43例子宫破裂中预期剖宫产23例,余20例阴道试产者中产后发现子宫破裂组(13例)与产时发现子宫破裂组(7例)相比,产后发现子宫破裂组中完全性子宫破裂占比明显增加(P=0.044),输血率显著增加(P<0.001),两组相比差异有统计学意义。此外,与产后发现子宫破裂组相比,产时发现子宫破裂组中羊水异常比例和胎心改变比例增高,虽差异无统计学意义(P>0.05),但仍需引起临床高度重视。结论:非瘢痕子宫发生子宫破裂时出血量更多,阴道试产者于产后发现子宫破裂的并发症更严重,分娩前后应密切注意羊水、胎心、生命体征等情况,及时发现子宫破裂,降低母儿不良妊娠结局的发生率。

分娩方式对“二孩”产妇产后盆底肌电的影响

目的探讨分娩“二孩”的产妇盆底肌电情况,为促进产妇盆底康复提供相关临床依据。方法选取2019年12月至2022年1月在福建省妇幼保健院产后盆底筛查的7629例分娩两次的产妇作为研究对象,采用Glazer盆底表面肌电评估方案采集盆底肌电值,按照分娩方式分为顺产-剖宫产组(631例,编号为“1组”)、剖宫产-顺产组(158例,编号为“2组”)、剖宫产-剖宫产组(2202例,编号为“3组”)与顺产-顺产组(4638例,编号为“4组”),比较四组产后盆底肌电值的特征。结果1组的前静息阶段平均值、快速收缩最大值、紧张收缩阶段平均值、耐力收缩阶段平均值、后静息阶段平均值高于2组、4组,低于3组,差异有统计学意义(P<0.05)。3组的前静息阶段平均值、快速收缩最大值、紧张收缩阶段平均值、耐力收缩阶段平均值、后静息阶段平均值高于2组、4组,差异有统计学意义(P<0.05)。结论“二孩”产后盆底肌电特征主要与二孩分娩方式有关。阴道分娩对盆底肌的损害大于剖宫产,剖宫产对盆底肌有保护作用,但容易导致静息电位升高。

阴道试产中转剖宫产术前Ⅲ型安尔碘阴道灌洗预防产褥感染效果

目的:分析阴道试产中转剖宫产术前Ⅲ型安尔碘阴道灌洗预防产褥感染效果。方法:回顾性分析2022年1月-2023年12月本院产科阴道试产失败中转剖宫产产妇400例临床资料,其中2022年1-12月术前作外阴备皮、冲洗的200例纳入对照组,2023年1-12月术前作外阴备皮、Ⅲ型安尔碘阴道灌洗、冲洗的200例产妇纳入观察组,对比两组术后体温、24h出血量、产褥感染率、切口感染率及白细胞计数(WBC)、C反应蛋白(CRP)和降钙素原(PCT)水平变化情况。结果:观察组术后24h(36.90±0.17℃)、48h(36.70±0.15℃)、72h体温(36.50±0.12℃)均低于对照组(37.00±0.21℃、36.80±0.16℃、36.60±0.13℃),术后24h出血量(287.3±21.5ml)少于对照组(296.2±23.7ml),产褥感染率(0.5%)低于对照组(3.5%)(均P<0.05),两组切口感染率(0.5%、1.0%)无差异(P>0.05)。观察组术后72h WBC(10.07±2.28×10^(9)/L)、CRP(2.23±0.39mg/L)、PCT(4.05±0.62ng/ml)水平均低于对照组[(12.77±3.59)×10^(9)/L、5.06±1.28mg/L、7.33±1.51ng/ml](均P<0.05)。结论:阴道试产中转剖宫产术前Ⅲ型安尔碘阴道灌洗可有效控制术后产妇体温和WBC、CRP、PCT水平,减少产褥感染发生。

自由体位联合无痛暗示对足月无痛分娩产妇的效果及睡眠质量的影响

目的:探究足月无痛分娩产妇于护理期间联合应用自由体位、无痛暗示护理的干预价值。方法:选取2022年6月至2023年1月福建省立医院南院收治的足月无痛分娩产妇86例作为研究对象,按照随机数字表法分为对照组和观察组,每组43例。对照组实施常规护理,观察组予以自由体位联合无痛暗示护理,对比2组护理效果,评估指标包含产程时间、顺转剖宫产率及睡眠质量。结果:测定2组产妇产程,所得结果均显示为观察组第一、二、三产程以及总产程时间偏短,与对照组比较,差异均有统计学意义(均P<0.05);相较于对照组,观察组顺转剖宫产等风险事件发生率较低,差异有统计学意义(P<0.05);术后,评估2组产妇睡眠质量,观察组各项指标数值均偏低于对照组,差异均有统计学意义(均P<0.05)。结论:足月无痛分娩的产妇予以其自由体位、无痛暗示护理在缩短产程的同时可以提高产妇睡眠质量,降低了顺转剖宫产率以及风险事件发生率。

经会阴四维盆底超声评估不同分娩方式对产妇盆底结构及功能的影响

目的观察经会阴四维盆底超声评估不同分娩方式对产妇盆底结构及功能的影响。方法选择2021年1月至2022年12月于本院分娩的120例产妇,依据分娩方式将其分为顺产组(60例,经阴道分娩)和手术组(60例,经剖宫产术分娩),同期纳入于我院体检的60例健康女性为对照组。所有研究对象均给予经会阴四维彩色多普勒超声成像仪检测。比较研究对象的三维超声指标、盆底功能异常发生情况、肛提肌裂孔超声指标及膀胱超声指标。结果顺产组的尿道膀胱连接部移动度(UVJ-M)、膀胱尿道后角角度(As、Ar)、膀胱颈距离耻骨联合下缘距离(Ds、Dr)大于手术组,肛直肠连接部距耻骨联合下缘距离(ARJ-VD)小于手术组(P<0.05)。顺产组的膀胱膨出、子宫脱垂、阴道前壁脱垂发生率显著高于手术组(P<0.05)。静息状态及最大Valsava状态下,顺产组的肛提肌裂孔前后径、肛提肌裂孔左右径、肛提肌裂孔面积均大于手术组及对照组,手术组的肛提肌裂孔前后径、肛提肌裂孔左右径、肛提肌裂孔面积均大于对照组(P<0.05)。静息状态及最大Valsava状态下,顺产组的膀胱旋转角度、膀胱颈位移距离均大于手术组与对照组,手术组的膀胱颈角度、膀胱旋转角度以及膀胱颈位移距离大于对照组(P<0.05);最大Valsava状态下,顺产组的膀胱颈角度大于手术组与对照组(P<0.05)。结论经会阴四维盆底超声针对不同分娩方式产妇可准确评估其盆底结构与功能,可用于早期诊断盆底功能障碍情况,且经阴道顺产产妇的盆底功能障碍发生风险高于剖宫产产妇。

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。

产时超声监测对分娩结局的影响研究

目的探究阴道触诊与产时超声监测对分娩结局的影响。方法选取2021年12月至2022年11月在南浔区人民医院住院分娩的200例单胎足月孕妇作为研究对象。采用随机数字表法将其分为A组和B组,各100例。B组进行阴道触诊,A组进行经腹部联合经会阴超声。比较两组的检查次数、破膜总时间、平均产程时间、钳产率、顺产率、剖宫产率、宫腔操作率、宫颈前后唇距离、胎方位符合率,比较两组的数字疼痛评分法(NRS)评分,比较两组不良事件发生情况。结果A组检查次数、剖宫产率显著低于B组,A组胎方位符合率显著高于B组,A组NRS评分显著低于B组,A组不良事件总发生率显著低于B组,差异均具有统计学意义(P<0.05)。结论孕妇采取经腹部联合经会阴超声进行检测,能够有效提高检测质量,减少孕妇检查次数及疼痛评分,降低不良事件的发生风险。

剖宫产术后瘢痕子宫再次妊娠阴道分娩的临床研究

目的研究剖宫产术后瘢痕子宫再次妊娠阴道分娩的可行性。方法选取88例剖宫产术后瘢痕子宫再次妊娠经剖宫产分娩的产妇作为观察组,另外选择34例剖宫术后瘢痕子宫再次妊娠经阴道分娩的产妇作为对照组。比较两组决定分娩方式的条件(前次子宫下段横切、单胎妊娠、头先露情况、宫颈长度、子宫下段厚度)、妊娠结局[平均出血量、新生儿阿氏评分(Apgar评分)、产后泌乳时间、住院时间]、妊娠合并症(产后出血、产后感染、脏器拉伤、宫缩乏力、尿潴留、腹膜粘连)发生情况。结果观察组前次子宫下段横切、单胎妊娠、头先露占比分别为69.32%、73.86%、51.14%,均低于对照组的100.00%、91.18%、85.29%,宫颈长度(19.41±3.63)mm、子宫下段厚度(2.76±0.52)mm小于对照组的(26.82±4.98)、(4.59±0.85)mm,差异有统计学意义(P<0.05)。观察组平均出血量(212.36±39.67)ml、新生儿Apgar评分(9.59±1.79)分、产后泌乳时间(1.17±0.22)d、住院时间(3.57±0.67)d与对照组的(205.80±38.18)ml、(9.32±1.73)分、(1.16±0.22)d、(3.52±0.65)d比较无明显差异(P>0.05)。观察组妊娠合并症发生率29.55%与对照组的32.35%比较无明显差异(P>0.05)。结论剖宫产术后瘢痕子宫产妇再次妊娠可以实施阴道分娩和剖宫产分娩两种方式,但限制剖宫产分娩的原因是多方面的,及时筛查阴道试产的适应证和剖宫产指征可避免产妇出现严重的妊娠风险,考虑产妇的实际情况灵活的选择分娩途径。

剖宫产术后瘢痕子宫再次妊娠阴道试产结局分析

目的 分析剖宫产术后瘢痕子宫再次妊娠孕产妇进行阴道试产的结局及其安全性。方法 160例剖宫产术后瘢痕子宫再次妊娠产妇,将80例进行剖宫产术后再次妊娠阴道试产(TOLAC)的瘢痕子宫产妇纳入观察组, 80例行选择性再次剖宫产(ERCS)的瘢痕子宫产妇纳入对照组。分析观察组产妇TOLAC失败情况及其原因,比较两组产妇住院时间、产时及产后24 h总出血量、妊娠结局、围生儿结局。结果 观察组产妇TOLAC成功率为85.00%(68/80),失败率为15.00%(12/80),失败原因包括产程异常、产妇惧怕宫缩疼痛、胎儿宫内窘迫以及产妇子宫不全破裂。与对照组的住院时间(5.36±1.36)d、产时及产后24 h总出血量(417.53±21.18)ml相比,观察组的住院时间(3.12±1.01)d更短、产时及产后24 h总出血量(245.36±19.95)ml更少(P<0.05)。两组产妇羊水污染、产后出血、输血、子宫破裂、子宫切除、膀胱受损发生率比较,差异较小(P>0.05)。与对照组新生儿出生体质量(3526.95±155.96)g对比,观察组新生儿的出生体质量(3335.29±163.25)g较低(P<0.05);两组新生儿的Apgar评分、窒息发生率、缺血缺氧性脑病发生率比较,差异均较小(P>0.05)。结论 对于具有阴道试产指征的剖宫产术后瘢痕子宫再次妊娠产妇,对其进行产前的综合评估以及产程中的严密监测,选择TOLAC是安全且可行的。