摘要
目的探讨剖宫产后阴道试产(trial of labor after caesarean,TOLAC)成功阴道分娩的影响因素。方法回顾性分析2017年1月至2019年12月北京积水潭医院产科仅有1次剖宫产史,无子宫手术史,无引产史的妊娠28周及以上TOLAC孕妇161例的临床资料,并根据阴道分娩结局分为成功组(n=101)和失败组(n=60),采用logistic回归法分析各种因素在两组之间的差异。结果161例孕妇中,TOLAC成功101例,失败60例,成功率为62.7%,无子宫破裂和孕妇死亡,新生儿结局均良好。两组孕妇的孕周、体质指数(body mass index,BMI)、妊娠前BMI、瘢痕厚度、初次剖宫产试产比较,差异均无统计学意义(P>0.05)。logistic单因素回归分析显示,年龄<35岁、与前次分娩间隔时间<8年、新生儿体质量<3500 g及初次分娩宫口扩张≥3 cm为TOLAC成功的有利因素,差异有统计学意义(P<0.05);logistic多因素回归分析上述因素,差异均无统计学意义(P>0.05);两组是否自然临产比较,差异有统计学意义(P<0.05),成功组自然临产率明显高于失败组(P<0.05)。结论剖宫产术后再次妊娠孕妇在严密监测下行TOLAC是安全可行的,自然临产TOLAC成功率高。
Objective To explore the factors that influence the sucess of trial of labor after caesarean(TOLAC).Methods A retrospective analysis was performed on the clinical data of 161 pregnant women with TOLAC whose Gestational age≥28 weeks,had only one history of cesarean section,without surgery of uterus,and no history of induced labor in the Department of Obstetrics of Beijing Jishuitan Hospital from January 2017 to December 2019.According to the outcome of vaginal delivery,they were divided into successful group(n=101)and failed group(n=60).Logistic regression was used to analyze the differences of various factors between the two groups.Results Among the 161pregnant women,101 succeeded and 60 failed,the success rate is 62.7%.There was no uterine rupture or maternal death,and the neonatal outcome was good.There was no statistical significance(P>0.05)between two groups in gestational weeks,body mass index(BMI),BMI of nonpregnant,thickness of uterine scar,trial of labor at the previous caesarean.Logistic single factor regression analysis showed that age<35 years,less than 8 years of inter-delivery interval,newborn less than 3500 g of the natal weight and more than 3cm of the cervical dilatation during the previous caesarean at first delivery were the favorable factors,and the difference was statistically significant(P<0.05).Logistic multifactor regression analysis of the above factors showed no statistical significance(P>0.05).There was statistical significance(P<0.05)in spontaneous labor rate.The spontaneous labor rate is higher in successful group compared to the failed group(P<0.05).Conclusion Pregnant women with TOLAC is feasible and safe under Closely monitor.The success rate of TOLAC in Spontaneous labor is high.
作者
龚康子
孙丽芳
GONG Kangzi;SUN Lifang(Department of Obstetrics and Gynecology,Beijing Jishuitan Hospital,Beijing 100096,China)
出处
《中国妇产科临床杂志》
CSCD
2022年第4期394-397,共4页
Chinese Journal of Clinical Obstetrics and Gynecology
关键词
剖宫产后阴道试产
自然临产
新生儿体质量
分娩间隔时间
分娩结局
trial of labor after caesarean
spontaneous labor
neonatal weight
inter-delivery interval
outcomes of pregancy
