Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China.
Department of Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China.
Int J Hyperthermia. 2022;39(1):900-906. doi: 10.1080/02656736.2022.2083700.
To assess the feasibility of vaginal delivery after HIFU.
A total of 37 women who met the trial of labor after HIFU (TOLAH) inclusion criteria and 368 women who met the trial of labor after cesarean delivery (TOLAC) inclusion criteria gave birth at Shanghai First Maternity and Infant Hospital between 14 June 2018 and 24 September 2021. The delivery outcomes of the two groups were compared. Multivariable logistic regression analysis was used to estimate the adjusted risk of postpartum hemorrhage (PPH).
In the Qualified Candidates for TOLAH group, vaginal delivery is substantially less common ( = 0.000). The prevalence of PPH in the Qualified Candidates for TOLAH group is lower than in the Candidates for TOLAC group (8.82% vs 10.51%, = 0.534; 0% vs 2.51%, = 0.418). Hemoglobin drop in the Qualified Candidates for TOLAH group is also lower (7.03 ± 7.39vs 12.11 ± 12.62, = 0.001). The rate of using more than two types of uterotonic medications to promote contraction is significantly lower in the Qualified Candidates for TOLAH group (54.05% vs 69.84%, = 0.04), and the percentage of abnormal uterine contraction is lower in the Qualified Candidates for TOLAH group (35.14% vs 49.18%, = 0.072). PPH is strongly predicted by abnormal uterine contraction (aOR: 17.177, 95% CI:5.046 ∼ 58.472, = 0.000), but not by HIFU (aOR:1.105; 95% CI:0.240 ∼ 5.087, = 0.898). No uterine rupture occurred in the cases after HIFU.
No uterine rupture occurred in our study group after HIFU. HIFU is not a risk for PPH. It is promising for those after HIFU to choose vaginal delivery.
评估高强度聚焦超声（HIFU）后阴道分娩的可行性。
2018 年 6 月 14 日至 2021 年 9 月 24 日，上海第一妇婴保健院共有 37 名符合高强度聚焦超声后试产（TOLAH）纳入标准的妇女和 368 名符合剖宫产术后试产（TOLAC）纳入标准的妇女分娩。比较两组的分娩结局。采用多变量逻辑回归分析估计产后出血（PPH）的调整风险。
在 TOLAH 合格候选组中，阴道分娩明显较少（=0.000）。TOLAH 合格候选组的 PPH 发生率低于 TOLAC 候选组（8.82%比 10.51%，=0.534；0%比 2.51%，=0.418）。TOLAH 合格候选组的血红蛋白下降也较低（7.03±7.39 比 12.11±12.62，=0.001）。TOLAH 合格候选组使用超过两种促宫缩药物的比例明显较低（54.05%比 69.84%，=0.04），TOLAH 合格候选组的宫缩异常比例较低（35.14%比 49.18%，=0.072）。宫缩异常强烈预测 PPH（优势比：17.177，95%置信区间：5.04658.472，=0.000），而 HIFU 则不预测 PPH（优势比：1.105；95%置信区间：0.2405.087，=0.898）。HIFU 后无子宫破裂发生。
本研究组 HIFU 后无子宫破裂发生。HIFU 不是 PPH 的危险因素。对于 HIFU 后选择阴道分娩的患者有一定的前景。
