【摘要】 目的探讨剖宫产术后瘢痕子宫妊娠阴道分娩失败的危险因素及妊娠结局。方法选取2015年5月至2018年5月剖宫产术后瘢痕子宫妊娠阴道试分娩产妇89例作为研究对象,根据阴道分娩是否成功分为成功组67例与失败组22例。两组入院后完善相关检查,比较年龄、孕周、是否临产住院、产前BMI、子宫下段厚度、距离上次剖宫产时间及是否定期产检,对上述因素进行相关因素及多因素logistic回归分析;比较两组胎儿窘迫、子宫破裂、新生儿窒息、前置胎盘及产后出血发生率。结果相关因素结果显示,两组孕周、是否临产住院、距离上次剖宫产时间及是否定期产检比较,差异无统计学意义(P> 0. 05),两组年龄、产前BMI、子宫下段厚度比较,差异有统计学意义(P <0. 05)。经多因素logistic回归分析结果显示,年龄、产前BMI、子宫下段厚度是影响剖宫产术后瘢痕子宫妊娠阴道分娩失败的独立危险因素。成功组胎儿窘迫、子宫破裂、新生儿窒息、前置胎盘及产后出血发生率均低于失败组(P <0. 05)。结论剖宫产术后瘢痕子宫妊娠阴道分娩失败率相对较高,会影响妊娠结局,且危险因素较多,应根据危险因素制定有效的干预措施,提高妊娠结局。更多还原

【Abstract】 Objective To explore the risk factors of vaginal delivery failure in scarred uterus pregnancy after cesarean section and the pregnancy outcomes. Methods To select 89 cases of pregnant women with scarred uterus who tried to have vaginal delivery after cesarean section from May 2015 to May2018 as the study subjects. According to the success of vaginal delivery,we selected 67 successful cases as the successful group and 22 failed cases as the failed group. After the two groups of patients were admitted to the hospital,the relevant examinations were completed. We compared the factors such as the age,gestational week,parturient hospitalization,prenatal BMI,lower uterine thickness,time from the last cesarean section,and whether they had regular prenatal examination. Relevant factors and multivariate logistic regression analysis were performed on the above factors. We compared the incidence of fetal distress,uterine rupture,neonatal asphyxia,placenta previa and postpartum hemorrhage. Results The results of related factors showed that there was no significant statistical difference between the two groups in the gestational week,whether they had parturient hospitalization,time from the last cesarean section and whether they had regular prenatal examination( P > 0. 05). The comparative difference in age,prenatal BMI,and lower uterine thickness in the two groups had statistical significance( P < 0. 05). Multivariate logistic regression analysis showed that age,prenatal BMI,and lower uterine thickness were independent risk factors for vaginal delivery failure after cesarean section. The incidence of fetal distress,uterine rupture,neonatal asphyxia,placenta previa and postpartum hemorrhage in the successful group were lower than those in the failed group( P < 0. 05). Conclusion The failure rate of vaginal delivery in scar uterus after cesarean section is relatively high,which will affect the pregnancy outcome of the patients. At the same time,there are many risk factors for it. We should make effective intervention measures according to risk factors to improve pregnancy outcome.更多还原