BACKGROUND Vaginal delivery is the ideal mode of delivery for the termination of a pregnancy.However,the cesarean section rate in China is much higher than the published by the World Health Organization in the Lancet ...BACKGROUND Vaginal delivery is the ideal mode of delivery for the termination of a pregnancy.However,the cesarean section rate in China is much higher than the published by the World Health Organization in the Lancet in 2010.AIM To retrospectively analyze the factors related to failed trial of labor and the clinical indications for cesarean section conversion,explore how to promote the trial of labor success rate,and determine the feasibility of reducing the rate of conversion to cesarean section.METHODS A retrospective analysis was performed on 9240 maternal women who met vaginal delivery conditions and required a trial of labor from January 2016 to December 2018 at our hospital.Among them,8164 pregnant women who had a successful trial of labor were used as a control group,and 1076 pregnant women who had a failed trial of labor and converted to an emergency cesarean section were used as an observation group.The patients’clinical data during hospitalization were collected for comparative analysis,the related factors of the failed trial of labor were discussed,and reasonable prevention and resolution strategies were proposed to increase the success rate of trial of labor.RESULTS The analysis revealed that advanced age(≥35 years old),macrosomia(≥4000 g),delayed pregnancy(≥41 wk),use of uterine contraction drugs,primipara,and fever during labor were associated with conversion to an emergency cesarean section in the failed trial of labor.Multivariate regression analysis showed that age,gestational age,primipara,use of uterine contraction drugs,fever duringbirth,and newborn weight led to a higher probability of conversion to an emergency cesarean section in the failed trial of labor.The analysis indicated that the following clinical indications were associated with the conversion to cesarean section in the failed trial of labor:Fetal distress(44.3%),social factors(12.8%),malpresentation(face presentation,persistent occipitoposterior position,and persistent occipitotransverse position)(9.4%),and cephalopelvic disproportion(8.9%).CONCLUSION The conversion to emergency cesarean section in failed trial of labor is affected by many factors.Medical staff should take appropriate preventive measures for the main factors,increase the trial of labor success rate,improve the quality of delivery,ensure the safety of mother and child during the perinatal period,and improve the relationship between doctors and patients.展开更多
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 s...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.展开更多
目的探讨产科共病指数(OCI)对高龄产妇阴道试产失败的预测价值。方法选取佛山禅城永安医院2018年10月至2022年10月行阴道试产的113例高龄产妇作为研究对象,根据阴道试产结局将其分为试产成功组(n=95)和试产失败组(n=18)。收集产妇临床...目的探讨产科共病指数(OCI)对高龄产妇阴道试产失败的预测价值。方法选取佛山禅城永安医院2018年10月至2022年10月行阴道试产的113例高龄产妇作为研究对象,根据阴道试产结局将其分为试产成功组(n=95)和试产失败组(n=18)。收集产妇临床资料并进行OCI评估;在产妇分娩前1 d、分娩后1 d内检测C反应蛋白(CRP)和中性粒细胞/淋巴细胞比值(NLR)水平;统计产妇产后出血量、产褥期感染、新生儿体重和新生儿1 min Apgar评分情况。结果试产成功组和试产失败组年龄、孕前体重指数(BMI)、入院时宫颈Bishop评分、OCI比较,差异具有统计学意义(P>0.05);二元Logistic回归分析结果显示,入院时宫颈Bishop评分、OCI是高龄产妇阴道试产结局的独立影响因素(P<0.05);受试者工作特征(ROC)曲线结果显示,OCI用于高龄产妇阴道试产失败预测曲线下面积为0.917,标准误为0.030(95%CI:0.858~0.977),最佳截断值为8分,此时灵敏度为94.40%,特异度为87.50%。OCI>8分者分娩前CRP及NLR、分娩后CRP及NLR、产后出血量高于OCI≤8分者,新生儿1 min Apgar评分低于OCI≤8分者(P<0.05)。结论OCI对高龄产妇阴道试产失败有较好的预测价值,其最佳阈值为8分,适宜在临床中用于高龄产妇阴道试产的指导和管理。展开更多
基金Supported by Liaoning Provincial Natural Science Foundation Guidance Program,No.2019-ZD-1037。
文摘BACKGROUND Vaginal delivery is the ideal mode of delivery for the termination of a pregnancy.However,the cesarean section rate in China is much higher than the published by the World Health Organization in the Lancet in 2010.AIM To retrospectively analyze the factors related to failed trial of labor and the clinical indications for cesarean section conversion,explore how to promote the trial of labor success rate,and determine the feasibility of reducing the rate of conversion to cesarean section.METHODS A retrospective analysis was performed on 9240 maternal women who met vaginal delivery conditions and required a trial of labor from January 2016 to December 2018 at our hospital.Among them,8164 pregnant women who had a successful trial of labor were used as a control group,and 1076 pregnant women who had a failed trial of labor and converted to an emergency cesarean section were used as an observation group.The patients’clinical data during hospitalization were collected for comparative analysis,the related factors of the failed trial of labor were discussed,and reasonable prevention and resolution strategies were proposed to increase the success rate of trial of labor.RESULTS The analysis revealed that advanced age(≥35 years old),macrosomia(≥4000 g),delayed pregnancy(≥41 wk),use of uterine contraction drugs,primipara,and fever during labor were associated with conversion to an emergency cesarean section in the failed trial of labor.Multivariate regression analysis showed that age,gestational age,primipara,use of uterine contraction drugs,fever duringbirth,and newborn weight led to a higher probability of conversion to an emergency cesarean section in the failed trial of labor.The analysis indicated that the following clinical indications were associated with the conversion to cesarean section in the failed trial of labor:Fetal distress(44.3%),social factors(12.8%),malpresentation(face presentation,persistent occipitoposterior position,and persistent occipitotransverse position)(9.4%),and cephalopelvic disproportion(8.9%).CONCLUSION The conversion to emergency cesarean section in failed trial of labor is affected by many factors.Medical staff should take appropriate preventive measures for the main factors,increase the trial of labor success rate,improve the quality of delivery,ensure the safety of mother and child during the perinatal period,and improve the relationship between doctors and patients.
文摘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.
文摘目的探讨产科共病指数(OCI)对高龄产妇阴道试产失败的预测价值。方法选取佛山禅城永安医院2018年10月至2022年10月行阴道试产的113例高龄产妇作为研究对象,根据阴道试产结局将其分为试产成功组(n=95)和试产失败组(n=18)。收集产妇临床资料并进行OCI评估;在产妇分娩前1 d、分娩后1 d内检测C反应蛋白(CRP)和中性粒细胞/淋巴细胞比值(NLR)水平;统计产妇产后出血量、产褥期感染、新生儿体重和新生儿1 min Apgar评分情况。结果试产成功组和试产失败组年龄、孕前体重指数(BMI)、入院时宫颈Bishop评分、OCI比较,差异具有统计学意义(P>0.05);二元Logistic回归分析结果显示,入院时宫颈Bishop评分、OCI是高龄产妇阴道试产结局的独立影响因素(P<0.05);受试者工作特征(ROC)曲线结果显示,OCI用于高龄产妇阴道试产失败预测曲线下面积为0.917,标准误为0.030(95%CI:0.858~0.977),最佳截断值为8分,此时灵敏度为94.40%,特异度为87.50%。OCI>8分者分娩前CRP及NLR、分娩后CRP及NLR、产后出血量高于OCI≤8分者,新生儿1 min Apgar评分低于OCI≤8分者(P<0.05)。结论OCI对高龄产妇阴道试产失败有较好的预测价值,其最佳阈值为8分,适宜在临床中用于高龄产妇阴道试产的指导和管理。
