摘要
目的探讨剖宫产术后阴道试产(TOLAC)产妇的妊娠结局,以及剖宫产术后阴道分娩(VBAC)的影响因素。方法选择2015年1月至2019年6月,在北部战区总医院和平院区住院分娩,既往有1次剖宫产术分娩史,并自愿选择TOLAC的193例产妇为研究对象。根据其最终分娩方式,将其分别纳入TOLAC成功组(n=122,VBAC者)与TOLAC失败组(n=71,TOLAC失败后,中转剖宫产术分娩者)。进一步将TOLAC成功组产妇,以2017年1月本院对有剖宫产术分娩史产妇开展TOLAC为时间节点,分为开展前亚组(n=25,2015年1月至2016年12月选择VBAC产妇)与开展后亚组(n=97,2017年1月至2019年6月选择VBAC产妇)。回顾性分析这193例TOLAC产妇的临床病例资料,包括本次妊娠距前次剖宫产术分娩间隔时间、入院时宫颈评分、是否自然临产、新生儿出生体重等。采用成组t检验、χ^2检验及Mann-Whitney U检验,对VBAC的可能影响因素进行单因素分析。结合已有研究结果及临床经验,以及单因素分析结果,将可能影响产妇VBAC的9项因素,进行多因素非条件logistic回归分析。采用成组t检验、χ^2检验,对TOLAC成功组与TOLAC失败组,开展前亚组与开展后亚组产妇妊娠结局进行比较。本研究遵循的程序符合病例收集医院伦理委员会要求,并获得批准(审批文号:202H2019PJ039)。TOLAC成功组与TOLAC失败组产妇年龄、学历构成比、孕次及产次等一般临床资料比较,差异均无统计学意义(P>0.05)。结果①2015年1月至2019年6月,本院孕妇TOLAC率为5.01%(193/3851),VBAC率为63.21%(122/193);自2017年1月开展TOLAC后,VBAC率由2017年1月前的47.17%(25/53),上升至2017年1月后的69.29%(97/140),二者比较,差异有统计学意义(χ^2=8.086,P=0.004)。②影响VBAC因素的单因素分析结果显示,TOLAC成功组产妇孕期体重增加值、分娩前产妇人体质量指数(BMI)、本次妊娠距前次剖宫产术分娩间隔时间、分娩孕龄、分娩巨大儿所占比例及�
Objective To explore pregnancy outcomes of trial of labor after cesarean section(TOLAC)and influencing factors of vaginal birth after cesarean section(VBAC).Methods A total of 193 pregnant women with one prior cesarean section and TOLAC in Heping Branch of General Hospital of Northern War Zone from January 2015 to June 2019 were selected as research subjects.All subjects were divided into successful TOLAC group(n=122,by VBAC)and failed TOLAC group(n=71,by repeated cesarean section after failure of TOLAC)according to the final delivery mode.According to the time of accepting TOLAC,successful TOLAC group were further divided into pre-implementing subgroup(n=25,before implement of TOLAC from January 2015 to December 2016)and post-implementing subgroup(n=97,after implement of TOLAC from January 2017 to June 2019).The clinical data such as interval time between this delivery and last cesarean delivery,Bishop score of cervix at admission,spontaneous onset of labor,birth weight of neonate,etc.were reviewed retrospectively.Univariate analysis was conducted on influencing factors of VBAC by independent-samples t test,chi-square test and Mann-Whitney U test.Then,combined with the existing research results,clinical experiences and univariate analysis results,9 possible influencing factors of VBAC were analyzed by multivariate unconditional logistic regression analysis.The pregnant outcomes between successful TOLAC group and failed TOLAC group,between pre-implementing subgroup and post-implementing subgroup were compared by independent-samples t test and chi-square test.The study was approved by the institutional research ethics committee of Heping Branch of General Hospital of Northern War Zone(Approval No.202H2019PJ039).There were no significant differences on maternal age,constituent ratio of education levels,gravidity and parity between successful TOLAC group and failed TOLAC group(P>0.05).Results①From January 2015 to June 2019,the TOLAC rate in our hospital was 5.01%(193/3851)and the VBAC rate was 63.21%(122/193).Afte
作者
陈震宇
孙静莉
陈晓明
仲莞
金珈汐
Chen Zhenyu;Sun Jingli;Chen Xiaoming;Zhong Wan;Jin Jiaxi(Department of Obstetrics and Gynecology,Heping Branch of General Hospital of Northern War Zone,Shenyang 110003,Liaoning Province,China)
出处
《中华妇幼临床医学杂志（电子版）》
CAS
2020年第3期278-287,共10页
Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)
基金
辽宁省自然科学基金项目(20180551133)。
关键词
剖宫产后阴道分娩
剖宫产术
再
剖宫产术后再次妊娠阴道试产
妊娠结局
宫颈成熟
影响因素
产妇
Vaginal birth after cesarean
Cesarean section
repeat
Trial of labor after cesarean section
Pregnancy outcome
Cervical ripening
Influencing factors
Puerpera
