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 o...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.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
目的探讨阴道分娩对疤痕子宫再妊娠孕妇围产期应激反应和免疫功能的影响。方法选取2013年5月至2017年5来佛山市南海区第四人民医院孕检并分娩的疤痕子宫再妊娠孕妇60例作为研究对象,根据分娩方式将其分为两组,26例成功剖宫产术后经阴道...目的探讨阴道分娩对疤痕子宫再妊娠孕妇围产期应激反应和免疫功能的影响。方法选取2013年5月至2017年5来佛山市南海区第四人民医院孕检并分娩的疤痕子宫再妊娠孕妇60例作为研究对象,根据分娩方式将其分为两组,26例成功剖宫产术后经阴道分娩孕妇作为VBAC组,34例择期重复剖宫产孕妇作为ERCS组,分析VBAC成功率,比较两组产前及产后12h、48h外周血皮质醇(Cor)、去甲肾上腺素(NE)、T淋巴细胞水平(CD4^+、CD8^+、CD4^+/CD8^+),并比较两组分娩结果。结果 36例孕妇符合VBAC条件,其中26例(72.22%)按计划顺利完成VBAC。两组产后12h、48 h Cor、NE水平较产前降低,差异具有统计学意义(P<0.05),但两组间比较差异无统计学意义(P>0.05);两组产后12h、48h CD4^+、CD4^+/CD8^+水平均较产前降低,CD8^+水平较产前升高,差异具有统计学意义(P<0.05),且VBAC组产后12h、48 h CD4^+、CD4^+/CD8^+水平略高于ERCS组,CD8^+水平略低于ERCS组,差异具有统计学意义(P<0.05);两组新生儿体重及新生儿Apgar评分为8分～10分、产后出血、产褥感染、新生儿窒息、子宫破裂发生几率比较,差异无统计学意义(P>0.05);VBAC组24h出血量、住院费用少于ERCS组,住院时间短于ERCS组,差异具有统计学意义(P<0.05)。结论与ERCS相比,符合VBAC适应证的疤痕子宫再次妊娠孕妇行VBAC,可减轻产后免疫抑制,显著减少术后出血量、住院费用,缩短住院时间,且对新生儿健康、围产期应激反应无明显影响。展开更多
目的:调查剖宫产后再次妊娠分娩方式、临产情况及其对分娩结局的影响。方法:回顾性分析2015年1月至2017年12月我院剖宫产后再次妊娠产妇630例临床资料,记录630例产妇择期再次剖宫产(elective cesarean section,ERCS)及再次妊娠阴道试产(...目的:调查剖宫产后再次妊娠分娩方式、临产情况及其对分娩结局的影响。方法:回顾性分析2015年1月至2017年12月我院剖宫产后再次妊娠产妇630例临床资料,记录630例产妇择期再次剖宫产(elective cesarean section,ERCS)及再次妊娠阴道试产(trial of labor after cesarean section,TOLAC)分娩方式选择情况,将选择ERCS分娩的产妇纳入ERCS组,并根据TOLAC分娩方式分为经阴道分娩(vaginal birth after cesarean section,VBAC)组(A组)及阴道试产失败转为剖宫产组(B组)。记录A组、B组、ERCS组一般资料(年龄、分娩前体质指数、孕周、孕次、产次),并分析TOLAC组不同临产方式阴道试产失败原因,比较3组母儿结局差异。结果:630例产妇中选择ERCS分娩465例(73.81%),纳入ERCS组;选择TOLAC分娩165例(26.19%),其中成功124例(75.15%),纳入A组;失败41例(24.85%),纳入B组。3组年龄、孕周、孕次、产次比较,差异无统计学意义(P>0.05);B组与ERCS组分娩前BMI比较,差异无统计学意义(P>0.05),但均高于A组(P<0.05)。165例TOLAC分娩中,自然临产98例(59.39%),缩宫素引产18例(10.91%),双球囊引产49例(29.70%);其中自然临产失败10例(10.20%),缩宫素引产失败8例(44.44%),双球囊引产失败23例(46.94%),且失败主要原因均为要求剖宫产。3组子宫破裂、新生儿呼吸窘迫综合征发生率比较,差异无统计学意义(P>0.05);A组与ERCS组先兆子宫破裂、新生儿入住重症监护室发生率比较,差异无统计学意义(P>0.05),但均低于B组(P<0.05);B组与ERCS组产后发热发生率比较,差异无统计学意义(P>0.05),但均高于A组(P<0.05);3组新生儿体质量比较,A组<ERCS组<B组(P<0.05)。结论:剖宫产后再次妊娠倾向于选择ERCS分娩,但选择TOLAC分娩对我国母婴保健更有利。展开更多
基金This study was supported by the Health and Farmily Planning Commission of Hubei Province(No.WJ2018H0133).
文摘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.
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。
文摘目的探讨阴道分娩对疤痕子宫再妊娠孕妇围产期应激反应和免疫功能的影响。方法选取2013年5月至2017年5来佛山市南海区第四人民医院孕检并分娩的疤痕子宫再妊娠孕妇60例作为研究对象,根据分娩方式将其分为两组,26例成功剖宫产术后经阴道分娩孕妇作为VBAC组,34例择期重复剖宫产孕妇作为ERCS组,分析VBAC成功率,比较两组产前及产后12h、48h外周血皮质醇(Cor)、去甲肾上腺素(NE)、T淋巴细胞水平(CD4^+、CD8^+、CD4^+/CD8^+),并比较两组分娩结果。结果 36例孕妇符合VBAC条件,其中26例(72.22%)按计划顺利完成VBAC。两组产后12h、48 h Cor、NE水平较产前降低,差异具有统计学意义(P<0.05),但两组间比较差异无统计学意义(P>0.05);两组产后12h、48h CD4^+、CD4^+/CD8^+水平均较产前降低,CD8^+水平较产前升高,差异具有统计学意义(P<0.05),且VBAC组产后12h、48 h CD4^+、CD4^+/CD8^+水平略高于ERCS组,CD8^+水平略低于ERCS组,差异具有统计学意义(P<0.05);两组新生儿体重及新生儿Apgar评分为8分～10分、产后出血、产褥感染、新生儿窒息、子宫破裂发生几率比较,差异无统计学意义(P>0.05);VBAC组24h出血量、住院费用少于ERCS组,住院时间短于ERCS组,差异具有统计学意义(P<0.05)。结论与ERCS相比,符合VBAC适应证的疤痕子宫再次妊娠孕妇行VBAC,可减轻产后免疫抑制,显著减少术后出血量、住院费用,缩短住院时间,且对新生儿健康、围产期应激反应无明显影响。
文摘目的:调查剖宫产后再次妊娠分娩方式、临产情况及其对分娩结局的影响。方法:回顾性分析2015年1月至2017年12月我院剖宫产后再次妊娠产妇630例临床资料,记录630例产妇择期再次剖宫产(elective cesarean section,ERCS)及再次妊娠阴道试产(trial of labor after cesarean section,TOLAC)分娩方式选择情况,将选择ERCS分娩的产妇纳入ERCS组,并根据TOLAC分娩方式分为经阴道分娩(vaginal birth after cesarean section,VBAC)组(A组)及阴道试产失败转为剖宫产组(B组)。记录A组、B组、ERCS组一般资料(年龄、分娩前体质指数、孕周、孕次、产次),并分析TOLAC组不同临产方式阴道试产失败原因,比较3组母儿结局差异。结果:630例产妇中选择ERCS分娩465例(73.81%),纳入ERCS组;选择TOLAC分娩165例(26.19%),其中成功124例(75.15%),纳入A组;失败41例(24.85%),纳入B组。3组年龄、孕周、孕次、产次比较,差异无统计学意义(P>0.05);B组与ERCS组分娩前BMI比较,差异无统计学意义(P>0.05),但均高于A组(P<0.05)。165例TOLAC分娩中,自然临产98例(59.39%),缩宫素引产18例(10.91%),双球囊引产49例(29.70%);其中自然临产失败10例(10.20%),缩宫素引产失败8例(44.44%),双球囊引产失败23例(46.94%),且失败主要原因均为要求剖宫产。3组子宫破裂、新生儿呼吸窘迫综合征发生率比较,差异无统计学意义(P>0.05);A组与ERCS组先兆子宫破裂、新生儿入住重症监护室发生率比较,差异无统计学意义(P>0.05),但均低于B组(P<0.05);B组与ERCS组产后发热发生率比较,差异无统计学意义(P>0.05),但均高于A组(P<0.05);3组新生儿体质量比较,A组<ERCS组<B组(P<0.05)。结论:剖宫产后再次妊娠倾向于选择ERCS分娩,但选择TOLAC分娩对我国母婴保健更有利。
