摘要
目的探讨建立一个能有效预测一次剖宫产术后阴式试产(TOLAC)成功的评分系统,为一次剖宫产术后再次妊娠女性的分娩选择给予医学参考。方法回顾性分析2013年1月至2019年9月于中国医科大学附属盛京医院产科行TOLAC产妇的年龄、孕周、身高、体重等临床资料及妊娠结局,依据是否成功阴式分娩进行分组,进行单因素及logistic多因素分析,研究影响因素,构造评分系统并进行Hosmer-Lemeshow检验判断模型拟合优度。结果332例TOLAC中,排除双胎8例后,剖宫产术后经阴道分娩(VBAC)成功率为93.8%(304/324)。是否临产、早产、胎膜早破、身高、分娩间隔、新生儿体重及前次妊娠手术指征为TOLAC患者的影响因素。对构造的评分系统给予赋值后,>18分时,TOLAC成功率大于86%。结论对于TOLAC患者,若构建的评分系统的评分达18分以上,可以建议阴式试产,应鼓励早产瘢痕子宫妊娠患者行阴式试产。
Objective According to the analysis of clinical data,an effective predictive score system was created for women who attempt to trial of labor after cesarean section(TOLAC),and provide medical evidence for them.Methods We looked into the TOALC cases from January 1 st,2013 to September 30 st,2019 in Shengjing Hospital of China Medical University to collect the clinical data,including age,gestational weeks,maternal height,maternal weight and pregnancy outcome.Single factor analysis was performed before logistic regression to find out the effective factors,then we created the final score system and evaluate the fitness and the sensitivity of the score system by Hosmer-Lemeshow test.Results After excluding 8 cases of bigeminal pregnancy from 332 TOLAC patients,the successful VBAC rate is93.8%in 324 cases which meet the criteria.Admission labor,preterm labor,premature rupture of membranes,maternal height,scar time,neonatal weight and previous indication of CS are the risk factors related to the outcome of TOLAC,in the score system,when the total score is more than 18,the successful TOLAC rate is more than 86%.Conclusion For TOLAC patients whose total score are more than 18,we suggest vaginal birth.We also encourage TOLAC patients who were less than 37 weeks to try vaginal birth.
作者
虞金哲
刘彩霞
王紫微
熊小双
崔红
YU Jin-zhe;LIU Cai-xia;WANG Zi-wei;XIONG Xiao-shuang;CUI Hong(Department of Obstetrics and Gynecology,Shengjing Hospital of China Medical University,Shenyang 110004,China)
出处
《中国实用妇科与产科杂志》
CAS
CSCD
北大核心
2021年第7期782-785,共4页
Chinese Journal of Practical Gynecology and Obstetrics
基金
国家重点研发计划(2018YFC1002900)。
