为了分析改良剖宫产术后阴道分娩(vaginal birth after cesarean section,VBAC)评分法联合护理干预在剖宫产术后阴道试产孕妇中的临床价值,本研究选取在医院就诊的240例剖宫产术后阴道试产孕妇,随机分为两组,每组120例。对照组给予VBAC...为了分析改良剖宫产术后阴道分娩(vaginal birth after cesarean section,VBAC)评分法联合护理干预在剖宫产术后阴道试产孕妇中的临床价值,本研究选取在医院就诊的240例剖宫产术后阴道试产孕妇,随机分为两组,每组120例。对照组给予VBAC评分法联合护理干预,实验组为改良VBAC评分法联合护理干预。统计分析两组孕妇试产时情况(产程时间,产时出血量和产后住院时间)、孕妇术后并发症(产褥感染,产后出血和尿潴留)、新生儿并发症(早产,肺炎和新生儿窒息)和分娩成功率。研究结果显示,相对于未改良VBAC评分组,改良VBAC评分法联合护理干预可明显改善剖宫产后阴道试产时的孕妇临床指数,降低孕妇术后并发症和新生儿并发症的发生率,以及升高分娩成功率(p<0.05)。改良VBAC评分法联合护理干预在剖宫产后阴道试产孕妇中具有重要的临床效果和价值,值得临床推广和运用。展开更多
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 o...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.展开更多
Background: Delivery in a scarred uterus is nowadays a real problem in Obstetrics practice, due to the inflation in the number of caesarean sections and the non-unanimous attitude of Obstetrics’ teams towards uterine...Background: Delivery in a scarred uterus is nowadays a real problem in Obstetrics practice, due to the inflation in the number of caesarean sections and the non-unanimous attitude of Obstetrics’ teams towards uterine scars. The factors associated with failed vaginal birth attempts after caesarean section (VBAC) are crucial information that would contribute effectively to deciding on the most appropriate mode of delivery for the mother and her fetus. Their identification would enable us to detect pregnant women at high risk of failure to attempt vaginal birth after caesarean section, and thus contribute to reducing the complications associated with this failure. Objective: We will study the factors associated with failure to vaginal delivery trial after caesarean section at the University Clinics of Kinshasa (UCK). Methods: This study will be a cross-sectional descriptive study with analytical aims. The minimum sample size will be 239. Our study population will consist of records of pregnant women with unicatricial uterus who underwent attempted vaginal delivery after caesarean section at UCK from January 2014 to June 2023. Results will be reported as percentage proportion and mean plus or minus standard deviation. Comparison of means between groups will be made using Student’s t-test, and of proportions using Pearson’s Chi-square test. Logistic regression will be used to generate Odds Ratios to measure the strength of association between variables. The test will be statistically significant for a p value 0.05. Data will be collected and processed confidentially and anonymously. Conclusion: This study will identify the factors associated with the failure of attempted vaginal delivery after caesarean section in order to contribute to the reduction of complications related to its failure in our setting. .展开更多
剖宫产后再次妊娠产妇分娩方式的选择一直是产科争论焦点。剖宫产后再次妊娠阴道试产包括剖宫产后再次妊娠阴道分娩(vaginal birth after cesarean,VBAC)与阴道试产失败转剖宫产两种。有研究表明,再次剖宫产会对母婴安全造成威胁,而VBA...剖宫产后再次妊娠产妇分娩方式的选择一直是产科争论焦点。剖宫产后再次妊娠阴道试产包括剖宫产后再次妊娠阴道分娩(vaginal birth after cesarean,VBAC)与阴道试产失败转剖宫产两种。有研究表明,再次剖宫产会对母婴安全造成威胁,而VBAC具有静脉栓塞与感染几率低以及失血量少等优势[1]。但是,阴道分娩带来的产痛极大影响产妇对分娩方式的选择。近几年来,剖宫产后再次妊娠产妇对分娩镇痛的需求越来越高,实施分娩镇痛可减少产妇的顾虑,使其更易接受阴道试产[2]。但是国内对VBAC行分娩镇痛仍持有不同态度。鉴于此,本文对接受分娩镇痛的剖宫产后再次妊娠产妇分娩结局的影响因素进行了探究,从而为临床安全、有效应用分娩镇痛提供参考。展开更多
目的探讨单次子宫下段横切口剖宫产术后再次妊娠后阴道试产的安全性及妊娠结局。方法回顾性分析2016年1月1日至2018年5月31日复旦大学附属妇产科医院产检及分娩的单次子宫下段横切口剖宫产术后再次妊娠、符合我院剖宫产后再次妊娠阴道试...目的探讨单次子宫下段横切口剖宫产术后再次妊娠后阴道试产的安全性及妊娠结局。方法回顾性分析2016年1月1日至2018年5月31日复旦大学附属妇产科医院产检及分娩的单次子宫下段横切口剖宫产术后再次妊娠、符合我院剖宫产后再次妊娠阴道试产(trail of labor after cesarean section,TOLAC)纳入标准、分娩孕周≥28周的810例孕妇的临床资料。其中270例为期间所有TOLAC病例(TOLAC组),其余540例为随机选择的同期无TOLAC禁忌证但选择重复剖宫产分娩的病例(elective repeated cesarean section,ERCS组)。比较两组不同分娩方式的妊娠结局。结果TOLAC组自然临产者占89.3%。TOLAC组孕妇年龄(33.0±4.2)岁、孕前体重指数(21.1±2.4)、分娩前体重指数(26.2±3.3)、产后出血量250(80~1500)mL、新生儿体重(3267±482)g、住院天数4(1~18)天,均小于ERCS组(P<0.05)。TOLAC组子宫破裂率1.9%(5/270)、膀胱损伤率0.4%(1/270),产后出血≥1000mL的发生率、输血治疗率均为1.1%(3/270),新生儿1minApgar评分≤7分发生率1.5%(4/270)、新生儿缺血缺氧性脑病的发生率0.4%(1/270),入住新生儿重症监护室率为4.4%(12/270)。与ERCS组比较,上述指标差异无统计学意义。结论在严格选择TOLAC人群、加强产前产时管理、可即刻提供紧急救治的医疗机构里,对于大多数单次子宫下段横切口剖宫产后再次妊娠孕妇,阴道试产是可选择的安全可行的分娩方式。展开更多
文摘为了分析改良剖宫产术后阴道分娩(vaginal birth after cesarean section,VBAC)评分法联合护理干预在剖宫产术后阴道试产孕妇中的临床价值,本研究选取在医院就诊的240例剖宫产术后阴道试产孕妇,随机分为两组,每组120例。对照组给予VBAC评分法联合护理干预,实验组为改良VBAC评分法联合护理干预。统计分析两组孕妇试产时情况(产程时间,产时出血量和产后住院时间)、孕妇术后并发症(产褥感染,产后出血和尿潴留)、新生儿并发症(早产,肺炎和新生儿窒息)和分娩成功率。研究结果显示,相对于未改良VBAC评分组,改良VBAC评分法联合护理干预可明显改善剖宫产后阴道试产时的孕妇临床指数,降低孕妇术后并发症和新生儿并发症的发生率,以及升高分娩成功率(p<0.05)。改良VBAC评分法联合护理干预在剖宫产后阴道试产孕妇中具有重要的临床效果和价值,值得临床推广和运用。
文摘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.
文摘Background: Delivery in a scarred uterus is nowadays a real problem in Obstetrics practice, due to the inflation in the number of caesarean sections and the non-unanimous attitude of Obstetrics’ teams towards uterine scars. The factors associated with failed vaginal birth attempts after caesarean section (VBAC) are crucial information that would contribute effectively to deciding on the most appropriate mode of delivery for the mother and her fetus. Their identification would enable us to detect pregnant women at high risk of failure to attempt vaginal birth after caesarean section, and thus contribute to reducing the complications associated with this failure. Objective: We will study the factors associated with failure to vaginal delivery trial after caesarean section at the University Clinics of Kinshasa (UCK). Methods: This study will be a cross-sectional descriptive study with analytical aims. The minimum sample size will be 239. Our study population will consist of records of pregnant women with unicatricial uterus who underwent attempted vaginal delivery after caesarean section at UCK from January 2014 to June 2023. Results will be reported as percentage proportion and mean plus or minus standard deviation. Comparison of means between groups will be made using Student’s t-test, and of proportions using Pearson’s Chi-square test. Logistic regression will be used to generate Odds Ratios to measure the strength of association between variables. The test will be statistically significant for a p value 0.05. Data will be collected and processed confidentially and anonymously. Conclusion: This study will identify the factors associated with the failure of attempted vaginal delivery after caesarean section in order to contribute to the reduction of complications related to its failure in our setting. .
文摘剖宫产后再次妊娠产妇分娩方式的选择一直是产科争论焦点。剖宫产后再次妊娠阴道试产包括剖宫产后再次妊娠阴道分娩(vaginal birth after cesarean,VBAC)与阴道试产失败转剖宫产两种。有研究表明,再次剖宫产会对母婴安全造成威胁,而VBAC具有静脉栓塞与感染几率低以及失血量少等优势[1]。但是,阴道分娩带来的产痛极大影响产妇对分娩方式的选择。近几年来,剖宫产后再次妊娠产妇对分娩镇痛的需求越来越高,实施分娩镇痛可减少产妇的顾虑,使其更易接受阴道试产[2]。但是国内对VBAC行分娩镇痛仍持有不同态度。鉴于此,本文对接受分娩镇痛的剖宫产后再次妊娠产妇分娩结局的影响因素进行了探究,从而为临床安全、有效应用分娩镇痛提供参考。
文摘目的探讨单次子宫下段横切口剖宫产术后再次妊娠后阴道试产的安全性及妊娠结局。方法回顾性分析2016年1月1日至2018年5月31日复旦大学附属妇产科医院产检及分娩的单次子宫下段横切口剖宫产术后再次妊娠、符合我院剖宫产后再次妊娠阴道试产(trail of labor after cesarean section,TOLAC)纳入标准、分娩孕周≥28周的810例孕妇的临床资料。其中270例为期间所有TOLAC病例(TOLAC组),其余540例为随机选择的同期无TOLAC禁忌证但选择重复剖宫产分娩的病例(elective repeated cesarean section,ERCS组)。比较两组不同分娩方式的妊娠结局。结果TOLAC组自然临产者占89.3%。TOLAC组孕妇年龄(33.0±4.2)岁、孕前体重指数(21.1±2.4)、分娩前体重指数(26.2±3.3)、产后出血量250(80~1500)mL、新生儿体重(3267±482)g、住院天数4(1~18)天,均小于ERCS组(P<0.05)。TOLAC组子宫破裂率1.9%(5/270)、膀胱损伤率0.4%(1/270),产后出血≥1000mL的发生率、输血治疗率均为1.1%(3/270),新生儿1minApgar评分≤7分发生率1.5%(4/270)、新生儿缺血缺氧性脑病的发生率0.4%(1/270),入住新生儿重症监护室率为4.4%(12/270)。与ERCS组比较,上述指标差异无统计学意义。结论在严格选择TOLAC人群、加强产前产时管理、可即刻提供紧急救治的医疗机构里,对于大多数单次子宫下段横切口剖宫产后再次妊娠孕妇,阴道试产是可选择的安全可行的分娩方式。