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剖宫产术后再次阴道分娩母婴结局及相关因素分析。

Analysis of Maternal and Infant Outcomes and Related Factors of Vaginal Delivery of Second Pregnancy after Cesarean Section.

机构信息

Department of Obstetrics, Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, Suzhou, Jiangsu 215000, China.

Department of Gynaecology, Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, Suzhou, Jiangsu 215000, China.

出版信息

Comput Math Methods Med. 2022 Oct 13;2022:4243174. doi: 10.1155/2022/4243174. eCollection 2022.

Abstract

OBJECTIVE

To explore the clinical effect of different delivery methods and the safety of vaginal delivery of second pregnancy after cesarean section and analyze the related factors.

METHODS

A total of 738 eligible pregnant women who underwent cesarean section from September 2018 to August 2020 were randomly selected from our hospital. Among them, 527 pregnant women successfully delivered vaginally were selected as the observation group, and 211 pregnant women who failed vaginal delivery were selected as the control group. To analyze the factors that influence the success of vaginal delivery of second pregnancy after cesarean section and compare the outcomes of mother and infant in two groups.

RESULTS

There was no significant difference in age, prenatal body mass index (BMI), and thickness of lower uterine segment between the two groups ( > 0.05). There were significant differences in fetal head orientation, fetal abdominal circumference, fetal biparietal diameter, uterine height, premature rupture of membranes, Bishop score, and epidural anesthesia during labor between the two groups ( < 0.05). Multivariate logistic regression analysis showed that fetal abdominal circumference, fetal head orientation, Bishop score, and epidural anesthesia during labor were independent factors affecting the success of VBAC ( < 0.05). There was no significant difference in the incidence of uterine rupture between the two groups ( > 0.05). The amount of postpartum hemorrhage in the observation group was significantly lower than that in the control group ( < 0.05). There was no significant difference in Apgar score, asphyxia rate, and hospitalization rate between the two groups ( > 0.05). There was no significant difference in the incidence of complications between the two groups ( > 0.05).

CONCLUSION

There are many factors that influence the success of vaginal delivery after cesarean section. Through prenatal comprehensive evaluation of vaginal delivery conditions, we can guide the parturient to choose a reasonable mode of delivery, reduce the incidence of complications, and improve the outcome of mother and baby.

摘要

目的

探讨不同分娩方式对剖宫产术后再次妊娠阴道分娩的临床效果及安全性,并分析相关影响因素。

方法

选取 2018 年 9 月至 2020 年 8 月在我院行剖宫产术的 738 例孕妇为研究对象,随机选取其中阴道分娩成功的 527 例孕妇为观察组,阴道分娩失败的 211 例孕妇为对照组。分析影响剖宫产术后再次妊娠阴道分娩成功率的相关因素,并对比两组母婴结局。

结果

两组孕妇年龄、产前体质量指数(BMI)、子宫下段厚度比较,差异无统计学意义(>0.05);胎儿头位、胎儿腹围、胎儿双顶径、宫高、胎膜早破、Bishop 评分、分娩时硬膜外麻醉比较,差异有统计学意义(<0.05)。多因素 logistic 回归分析显示,胎儿腹围、胎儿头位、Bishop 评分、分娩时硬膜外麻醉是影响 VBAC 成功率的独立因素(<0.05)。两组子宫破裂发生率比较,差异无统计学意义(>0.05)。观察组产后出血量明显少于对照组,差异有统计学意义(<0.05)。两组新生儿 Apgar 评分、窒息率、住院率比较,差异无统计学意义(>0.05)。两组产妇并发症发生率比较,差异无统计学意义(>0.05)。

结论

剖宫产术后再次妊娠阴道分娩成功率受多种因素影响,通过产前综合评估阴道分娩条件,可指导产妇选择合理的分娩方式,降低并发症发生率,提高母婴结局。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b102/9584657/04cef003b305/CMMM2022-4243174.001.jpg

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