目的探讨单次子宫下段横切口剖宫产术后再次妊娠后阴道试产的安全性及妊娠结局。方法回顾性分析2016年1月1日至2018年5月31日复旦大学附属妇产科医院产检及分娩的单次子宫下段横切口剖宫产术后再次妊娠、符合我院剖宫产后再次妊娠阴道试...目的探讨单次子宫下段横切口剖宫产术后再次妊娠后阴道试产的安全性及妊娠结局。方法回顾性分析2016年1月1日至2018年5月31日复旦大学附属妇产科医院产检及分娩的单次子宫下段横切口剖宫产术后再次妊娠、符合我院剖宫产后再次妊娠阴道试产(trail of labor after cesarean section,TOLAC)纳入标准、分娩孕周≥28周的810例孕妇的临床资料。其中270例为期间所有TOLAC病例(TOLAC组),其余540例为随机选择的同期无TOLAC禁忌证但选择重复剖宫产分娩的病例(elective repeated cesarean section,ERCS组)。比较两组不同分娩方式的妊娠结局。结果TOLAC组自然临产者占89.3%。TOLAC组孕妇年龄(33.0±4.2)岁、孕前体重指数(21.1±2.4)、分娩前体重指数(26.2±3.3)、产后出血量250(80~1500)mL、新生儿体重(3267±482)g、住院天数4(1~18)天,均小于ERCS组(P<0.05)。TOLAC组子宫破裂率1.9%(5/270)、膀胱损伤率0.4%(1/270),产后出血≥1000mL的发生率、输血治疗率均为1.1%(3/270),新生儿1minApgar评分≤7分发生率1.5%(4/270)、新生儿缺血缺氧性脑病的发生率0.4%(1/270),入住新生儿重症监护室率为4.4%(12/270)。与ERCS组比较,上述指标差异无统计学意义。结论在严格选择TOLAC人群、加强产前产时管理、可即刻提供紧急救治的医疗机构里,对于大多数单次子宫下段横切口剖宫产后再次妊娠孕妇,阴道试产是可选择的安全可行的分娩方式。展开更多
目的探讨剖宫产后阴道试产(trail of labor after cesarean,TOLAC)的产程特点,为临床安全管理其产程提供依据。方法回顾性分析2016年1月至2018年12月自然临产的246例足月TOLAC孕妇,以及同时期340例自然临产、阴道分娩足月初产妇(SVB组)...目的探讨剖宫产后阴道试产(trail of labor after cesarean,TOLAC)的产程特点,为临床安全管理其产程提供依据。方法回顾性分析2016年1月至2018年12月自然临产的246例足月TOLAC孕妇,以及同时期340例自然临产、阴道分娩足月初产妇(SVB组)的临床资料。研究TOLAC的产程特点,以及前次剖宫产时机、既往阴道分娩史、妊娠间隔(1.5~3年、>3年)等对TOLAC产程的影响。结果自然临产的足月TOLAC成功率90.2%。伴有阴道分娩史的自然临产的足月TOLAC产妇的第一、第二、总产程时间较无阴道分娩史的自然临产的足月TOLAC(wTOLAC)缩短(P<0.05)。前次妊娠临产前和临产后行剖宫产的两组,以及妊娠间隔处于1.5~3年和>3年的两组的第一、第二、总产程时间均无明显差异。wTOLAC组与SVB组比较,两组的产前体质指数、分娩孕周、产程中干预措施、产后出血量、产后出血率、输血治疗率、妊娠合并症发生率、新生儿1 min Apgar评分、产钳助产率均无明显差异。wTOLAC组的年龄、孕前体质指数、新生儿体重较SVB组大(P<0.05),分娩镇痛率较低(P<0.0001)。应用协方差分析校正上述4个指标的组间差异:两组的产程进展模式类似,第一、总产程时限无明显差异,但第一产程宫口扩张2 cm后,尤其是宫口扩张6 cm后,wTOLAC组产程进展较快(P<0.01);wTOLAC组的第二产程短于SVB组(P<0.001),wTOLAC组内行分娩镇痛的第二产程亦短于SVB组内行分娩镇痛的(P<0.001);wTOLAC组内行分娩镇痛的第二产程和总产程长于未行分娩镇痛者(P<0.05)。结论自然临产的足月TOLAC的产程模式与初产妇类似,宫口扩张6 cm后产程进展较快,且整个产程进展较初产妇稍快,分娩镇痛会延长产程。前次剖宫产时机和妊娠间隔对自然临产的足月TOLAC产程的影响较小,既往阴道分娩史是促进TOLAC产程进展的有利因素。展开更多
China's universal two child policy was released in October of 2015.How would this new policy influence the rate of overall cesarcan delivery(CD)in China?The objective of this paper is to investigate the trend of o...China's universal two child policy was released in October of 2015.How would this new policy influence the rate of overall cesarcan delivery(CD)in China?The objective of this paper is to investigate the trend of overall CD rate with the increase of number of multiparous women based on a big childbirth center of China(a tertiary hospital)in 2016.In this study,22530 cases from the medical record department of a big childbirth center of China from January 1 to December 31 in 2016 were entolled as research objects.Electronic health records of these selected objects were retrieved.According t0 the history of childbirth,the selected cases were divided into primiparous group containing 16340 cases and multiparous group containing 6190 cases.Chi-square test was carried out to compare the rate of CD,neuraxial labor analgesia,maternity insurance between the two groups;1-test was performed to compare the in-hospital days and gestational age at birth between the two groups.Pearson corrclation coefficient was used to evaluate the rclationship among observed monthly rate of multiparas,overall CD rate,and Elective Repeat Cesarean Delivery(ERCD)rate.The results showed that the CD rate in multiparous group was 55.46%,which was higher than that in primiparous group(34.66%,P<0.05).The rate of neuraxial labor analgesia in multiparas group was 9.29%,which was lower than that in primiparas group(35.94%,P<0.05).However,the rate of maternity insurance was higher in multiparas group(57.00%)than that in primiparas group(41.08%,P<0.05).The hospital cost and in-hospital days in multiparas group were higher,and the gcstational age at birth in multiparas group was lower than in primiparas group(P<0.05).The overall CD rate slightly dropped in the first 4 months of the year(P<0.05),then increased from 36.27%(April)to 43.21%(Dcember)(P<0.05).The rate of multiparas women and ERCD had the same trend(P<0.05).There were linear correlations among the rate of overall CD,the rate of multiparas women and the rate of ERCD rate(P<0.05).With the opening of China's two-child policy,the increasing rate of overall CD is directly related with the high rate of ERCD.Trials of Labor After Cesarean Section(TOLAC)in safe mode to reduce overall CD rate are warranted in the future.展开更多
Background: With an aim to reduce the rates of repeat cesarean section in women with a previous scar, prediction of scar rupture or dehiscence is important. If we could predict the risk of rupture by measuring the sca...Background: With an aim to reduce the rates of repeat cesarean section in women with a previous scar, prediction of scar rupture or dehiscence is important. If we could predict the risk of rupture by measuring the scar thickness closer to term, we could pursue a trial of scar safely. Aims: To evaluate the use of ultrasound measured thickness of lower uterine segment as one of the predictors of scar rupture or dehiscence in labour and establish a cut off beyond which trial of labour can be attempted safely. Methodology: 187 randomly selected pregnant women with history of one previous cesarean section in the past who satisfied the inclusion criteria, attending the outpatient clinic over a period of six months, at a tertiary level teaching institution in southern India were selected and counseled to undergo a transvaginal measurement of the scar region. These women were then followed up until delivery and the outcome of trial of scar, successful vaginal delivery, rupture or dehiscence of uterus was analysed in relation to the scar thickness and various other contributing factors. Results: 187 women with history of previous cesarean section, attending the outpatient clinic were randomly chosen to undergo trans vaginal scan at term. 52 underwent elective cesarean section and 135 went through trial of scar. The median cut-off of the lower uterine segment in this study population of 135 was 2.4 mm. The sensitivity was 90.9%, specificity was 43.5%, positive predictive value was 12.5%, and negative predictive value was 98.3% at this cut-off for scar rupture or dehiscence. Conclusions: The lower uterine scar thickness could be a useful tool to predict scar rupture. This could aid in making decisions regarding induction of labour with oxytocin in women with previous cesarean section.展开更多
目的探讨孕产妇首次剖宫术后再次妊娠经阴道试产(trial of labor after previous cesarean delivery,TOLAC)引起子宫破裂的重要因素及预防。方法选取2015-10至2017-10剖宫产术后再次妊娠,在孕30周首次筛查符合阴道试产条件的,无试产绝...目的探讨孕产妇首次剖宫术后再次妊娠经阴道试产(trial of labor after previous cesarean delivery,TOLAC)引起子宫破裂的重要因素及预防。方法选取2015-10至2017-10剖宫产术后再次妊娠,在孕30周首次筛查符合阴道试产条件的,无试产绝对禁忌证者共412例,分析样本的分娩方式及导致子宫破裂重要因素。结果经过回顾性分析得出,共有215例进行了TOLAC,试产阴道分娩(vaginal birth after cesarean,VBAC)成功率为72.56%(156/215),剖宫产率为27.44%(59/215),完全子宫破裂发生率仅为0.47%(1/215)。根据试产结局将样本分为两组,阴道分娩组及再次剖宫产组,其中阴道分娩组的产后出血量明显低于再次剖宫产组(P<0.01);对13例发生子宫破裂的孕产妇样本数据进行比对,探究共同特征,得出胎心及宫缩异常等指标是共性因素。结论 TOLAC绝对危险性很小,产妇年龄、巨大儿及瘢痕厚度等均不是绝对禁忌证,但在做最后决策时,必须考虑本文推断出的共性因素,即胎心和宫缩情况,以提高TOLAC的成功率,降低子宫破裂发生率。展开更多
Background: Cesarean delivery has become the most common major surgical procedure in many parts of the world. Induction of labor in women with prior cesarean delivery is an alternative to mitigate the rising cesarean ...Background: Cesarean delivery has become the most common major surgical procedure in many parts of the world. Induction of labor in women with prior cesarean delivery is an alternative to mitigate the rising cesarean rates. Objectives: To compare the VBAC success rate between two vaginal forms of dinoprostone for labor induction in women with prior cesarean section. Material and Methods: A pilot study was conducted at a large Governmental Hospital, Dhahran, Saudi Arabia, including 200 women with prior cesarean section and planned for labor induction. Participants were randomly allocated into two groups. Group A (n = 100) received dinoprostone 1.5 mg vaginal tablet. Group B (n = 100) received 10 mg dinoprostone sustained release vaginal pessary. Primary outcome was vaginal delivery rate. Secondary outcomes included maternal and neonatal outcomes. Results: The dinoprostone vaginal tablet and dinoprostone vaginal pessary had a comparable vaginal delivery rate (67% and 64%, respectively;p = 0.78). The median patient satisfaction with the birth process was superior in the dinoprostone vaginal pessary group (p = 0.04). Maternal and neonatal outcomes were similar in both groups. Conclusion: Both forms of dinoprostone were effective methods for labor induction in women with prior cesarean section. However, the patient satisfaction with the birth process was in favor of the dinoprostone sustained release vaginal pessary.展开更多
Background: Trial of labor after cesarean delivery (TOLAC) has long been accepted as a safe option for women with previous cesarean delivery. Previous efforts have been exerted in trials to predict the success rates o...Background: Trial of labor after cesarean delivery (TOLAC) has long been accepted as a safe option for women with previous cesarean delivery. Previous efforts have been exerted in trials to predict the success rates of TOLAC according to specific parameters related to previous cesarean section and before TOLAC. We aimed to investigate the different indications of previous cesarean delivery as independent predictors for successful vaginal birth. Methods: A retrospective study was conducted in Armed Forces Hospitals of the Southern Region between December 15, 2019, and July 1, 2020. The included 566 patients with previous cesarean section who were willing to undergo a trial of labor were divided into two groups according to the success of vaginal birth (VBAC). Results: The nonrecurring indications for previous cesarean delivery were higher in the successful group (fetal distress 54.7% vs 41.1%, malpresentation 26% vs 21.4%, multifetal pregnancy 3.8% vs 2.7%). Additionally, the successful VBAC group had a significantly higher percentage of previous successful VBAC (47.7% vs 21.9%) and prior vaginal deliveries (58.5% vs 44.2%) and less coincidence of medical disorders and meconium-stained liquor (18.1% vs 26.3% and 3.2% vs 8.2%, respectively) than the unsuccessful group. Conclusion: During counseling regarding trial of labor after cesarean section, indications for previous cesarean section not related to arrest of labor can predict higher success of VBAC. Moreover, previous successful vaginal delivery or VBAC improves the success rates.展开更多
目的探讨剖宫产术后阴道试产(trial of labor after cesarean delivery,TOLAC)过程中完全性子宫破裂及不完全性子宫破裂的临床表现及胎心监护特点,以期早期识别。方法收集2016年1月1日至2019年12月31日北京和睦家医院进行TOLAC过程中子...目的探讨剖宫产术后阴道试产(trial of labor after cesarean delivery,TOLAC)过程中完全性子宫破裂及不完全性子宫破裂的临床表现及胎心监护特点,以期早期识别。方法收集2016年1月1日至2019年12月31日北京和睦家医院进行TOLAC过程中子宫破裂孕产妇的临床资料,分为完全性子宫破裂组及不完全性子宫破裂组,比较两组临床资料、分娩前2 h胎心监护结果及分娩结局。结果TOLAC孕产妇共486例,TOLAC过程中发生子宫破裂13例,发生率为2.67%,其中完全性子宫破裂5例,发生率为1.03%;不完全性子宫破裂8例,发生率为1.65%。完全性子宫破裂组与不完全性子宫破裂组孕产妇年龄、BMI、孕次、距前次剖宫产时间、分娩孕周、孕期体质量增加、合并妊娠糖尿病情况、临产方式、临产后试产时间、决定剖宫产时宫口、决定剖宫产时胎先露位置、新生儿体质量、5 min Apgar评分、脐血pH值及碱剩余、产后出血量比较,差异均无统计学意义(P>0.05),仅决定剖宫产至胎儿娩出时间完全性子宫破裂组显著短于不完全性子宫破裂组[(26.4±9.0)min比(57.8±27.8)min,P=0.035]。分娩前2 h胎心监护比较发现,分娩前20 min,完全性子宫破裂组全部病例均为Ⅱ类胎心监护(2例,40%)和Ⅲ类胎心监护(3例,60%);不完全性子宫破裂组有3例(37.5%)为Ⅰ类胎心监护,3例(37.5%)为Ⅱ类胎心监护,2例(25%)出现Ⅲ类胎心监护。完全性子宫破裂组中可见宫缩模式改变,即宫缩强度递减,随后胎心减速。结论对TOLAC产程中持续胎心监护,尽量做到子宫破裂的早期识别及快速反应,尽量缩短决定剖宫产至胎儿娩出时间,是减少TOLAC子宫破裂导致的母体及新生儿严重并发症的有效保障。展开更多
文摘目的探讨单次子宫下段横切口剖宫产术后再次妊娠后阴道试产的安全性及妊娠结局。方法回顾性分析2016年1月1日至2018年5月31日复旦大学附属妇产科医院产检及分娩的单次子宫下段横切口剖宫产术后再次妊娠、符合我院剖宫产后再次妊娠阴道试产(trail of labor after cesarean section,TOLAC)纳入标准、分娩孕周≥28周的810例孕妇的临床资料。其中270例为期间所有TOLAC病例(TOLAC组),其余540例为随机选择的同期无TOLAC禁忌证但选择重复剖宫产分娩的病例(elective repeated cesarean section,ERCS组)。比较两组不同分娩方式的妊娠结局。结果TOLAC组自然临产者占89.3%。TOLAC组孕妇年龄(33.0±4.2)岁、孕前体重指数(21.1±2.4)、分娩前体重指数(26.2±3.3)、产后出血量250(80~1500)mL、新生儿体重(3267±482)g、住院天数4(1~18)天,均小于ERCS组(P<0.05)。TOLAC组子宫破裂率1.9%(5/270)、膀胱损伤率0.4%(1/270),产后出血≥1000mL的发生率、输血治疗率均为1.1%(3/270),新生儿1minApgar评分≤7分发生率1.5%(4/270)、新生儿缺血缺氧性脑病的发生率0.4%(1/270),入住新生儿重症监护室率为4.4%(12/270)。与ERCS组比较,上述指标差异无统计学意义。结论在严格选择TOLAC人群、加强产前产时管理、可即刻提供紧急救治的医疗机构里,对于大多数单次子宫下段横切口剖宫产后再次妊娠孕妇,阴道试产是可选择的安全可行的分娩方式。
文摘目的探讨剖宫产后阴道试产(trail of labor after cesarean,TOLAC)的产程特点,为临床安全管理其产程提供依据。方法回顾性分析2016年1月至2018年12月自然临产的246例足月TOLAC孕妇,以及同时期340例自然临产、阴道分娩足月初产妇(SVB组)的临床资料。研究TOLAC的产程特点,以及前次剖宫产时机、既往阴道分娩史、妊娠间隔(1.5~3年、>3年)等对TOLAC产程的影响。结果自然临产的足月TOLAC成功率90.2%。伴有阴道分娩史的自然临产的足月TOLAC产妇的第一、第二、总产程时间较无阴道分娩史的自然临产的足月TOLAC(wTOLAC)缩短(P<0.05)。前次妊娠临产前和临产后行剖宫产的两组,以及妊娠间隔处于1.5~3年和>3年的两组的第一、第二、总产程时间均无明显差异。wTOLAC组与SVB组比较,两组的产前体质指数、分娩孕周、产程中干预措施、产后出血量、产后出血率、输血治疗率、妊娠合并症发生率、新生儿1 min Apgar评分、产钳助产率均无明显差异。wTOLAC组的年龄、孕前体质指数、新生儿体重较SVB组大(P<0.05),分娩镇痛率较低(P<0.0001)。应用协方差分析校正上述4个指标的组间差异:两组的产程进展模式类似,第一、总产程时限无明显差异,但第一产程宫口扩张2 cm后,尤其是宫口扩张6 cm后,wTOLAC组产程进展较快(P<0.01);wTOLAC组的第二产程短于SVB组(P<0.001),wTOLAC组内行分娩镇痛的第二产程亦短于SVB组内行分娩镇痛的(P<0.001);wTOLAC组内行分娩镇痛的第二产程和总产程长于未行分娩镇痛者(P<0.05)。结论自然临产的足月TOLAC的产程模式与初产妇类似,宫口扩张6 cm后产程进展较快,且整个产程进展较初产妇稍快,分娩镇痛会延长产程。前次剖宫产时机和妊娠间隔对自然临产的足月TOLAC产程的影响较小,既往阴道分娩史是促进TOLAC产程进展的有利因素。
基金This study was supported by the Health and Farmily Planning Commission of Hubei Province(No.WJ2018H0133).
文摘China's universal two child policy was released in October of 2015.How would this new policy influence the rate of overall cesarcan delivery(CD)in China?The objective of this paper is to investigate the trend of overall CD rate with the increase of number of multiparous women based on a big childbirth center of China(a tertiary hospital)in 2016.In this study,22530 cases from the medical record department of a big childbirth center of China from January 1 to December 31 in 2016 were entolled as research objects.Electronic health records of these selected objects were retrieved.According t0 the history of childbirth,the selected cases were divided into primiparous group containing 16340 cases and multiparous group containing 6190 cases.Chi-square test was carried out to compare the rate of CD,neuraxial labor analgesia,maternity insurance between the two groups;1-test was performed to compare the in-hospital days and gestational age at birth between the two groups.Pearson corrclation coefficient was used to evaluate the rclationship among observed monthly rate of multiparas,overall CD rate,and Elective Repeat Cesarean Delivery(ERCD)rate.The results showed that the CD rate in multiparous group was 55.46%,which was higher than that in primiparous group(34.66%,P<0.05).The rate of neuraxial labor analgesia in multiparas group was 9.29%,which was lower than that in primiparas group(35.94%,P<0.05).However,the rate of maternity insurance was higher in multiparas group(57.00%)than that in primiparas group(41.08%,P<0.05).The hospital cost and in-hospital days in multiparas group were higher,and the gcstational age at birth in multiparas group was lower than in primiparas group(P<0.05).The overall CD rate slightly dropped in the first 4 months of the year(P<0.05),then increased from 36.27%(April)to 43.21%(Dcember)(P<0.05).The rate of multiparas women and ERCD had the same trend(P<0.05).There were linear correlations among the rate of overall CD,the rate of multiparas women and the rate of ERCD rate(P<0.05).With the opening of China's two-child policy,the increasing rate of overall CD is directly related with the high rate of ERCD.Trials of Labor After Cesarean Section(TOLAC)in safe mode to reduce overall CD rate are warranted in the future.
文摘Background: With an aim to reduce the rates of repeat cesarean section in women with a previous scar, prediction of scar rupture or dehiscence is important. If we could predict the risk of rupture by measuring the scar thickness closer to term, we could pursue a trial of scar safely. Aims: To evaluate the use of ultrasound measured thickness of lower uterine segment as one of the predictors of scar rupture or dehiscence in labour and establish a cut off beyond which trial of labour can be attempted safely. Methodology: 187 randomly selected pregnant women with history of one previous cesarean section in the past who satisfied the inclusion criteria, attending the outpatient clinic over a period of six months, at a tertiary level teaching institution in southern India were selected and counseled to undergo a transvaginal measurement of the scar region. These women were then followed up until delivery and the outcome of trial of scar, successful vaginal delivery, rupture or dehiscence of uterus was analysed in relation to the scar thickness and various other contributing factors. Results: 187 women with history of previous cesarean section, attending the outpatient clinic were randomly chosen to undergo trans vaginal scan at term. 52 underwent elective cesarean section and 135 went through trial of scar. The median cut-off of the lower uterine segment in this study population of 135 was 2.4 mm. The sensitivity was 90.9%, specificity was 43.5%, positive predictive value was 12.5%, and negative predictive value was 98.3% at this cut-off for scar rupture or dehiscence. Conclusions: The lower uterine scar thickness could be a useful tool to predict scar rupture. This could aid in making decisions regarding induction of labour with oxytocin in women with previous cesarean section.
文摘目的探讨孕产妇首次剖宫术后再次妊娠经阴道试产(trial of labor after previous cesarean delivery,TOLAC)引起子宫破裂的重要因素及预防。方法选取2015-10至2017-10剖宫产术后再次妊娠,在孕30周首次筛查符合阴道试产条件的,无试产绝对禁忌证者共412例,分析样本的分娩方式及导致子宫破裂重要因素。结果经过回顾性分析得出,共有215例进行了TOLAC,试产阴道分娩(vaginal birth after cesarean,VBAC)成功率为72.56%(156/215),剖宫产率为27.44%(59/215),完全子宫破裂发生率仅为0.47%(1/215)。根据试产结局将样本分为两组,阴道分娩组及再次剖宫产组,其中阴道分娩组的产后出血量明显低于再次剖宫产组(P<0.01);对13例发生子宫破裂的孕产妇样本数据进行比对,探究共同特征,得出胎心及宫缩异常等指标是共性因素。结论 TOLAC绝对危险性很小,产妇年龄、巨大儿及瘢痕厚度等均不是绝对禁忌证,但在做最后决策时,必须考虑本文推断出的共性因素,即胎心和宫缩情况,以提高TOLAC的成功率,降低子宫破裂发生率。
文摘Background: Cesarean delivery has become the most common major surgical procedure in many parts of the world. Induction of labor in women with prior cesarean delivery is an alternative to mitigate the rising cesarean rates. Objectives: To compare the VBAC success rate between two vaginal forms of dinoprostone for labor induction in women with prior cesarean section. Material and Methods: A pilot study was conducted at a large Governmental Hospital, Dhahran, Saudi Arabia, including 200 women with prior cesarean section and planned for labor induction. Participants were randomly allocated into two groups. Group A (n = 100) received dinoprostone 1.5 mg vaginal tablet. Group B (n = 100) received 10 mg dinoprostone sustained release vaginal pessary. Primary outcome was vaginal delivery rate. Secondary outcomes included maternal and neonatal outcomes. Results: The dinoprostone vaginal tablet and dinoprostone vaginal pessary had a comparable vaginal delivery rate (67% and 64%, respectively;p = 0.78). The median patient satisfaction with the birth process was superior in the dinoprostone vaginal pessary group (p = 0.04). Maternal and neonatal outcomes were similar in both groups. Conclusion: Both forms of dinoprostone were effective methods for labor induction in women with prior cesarean section. However, the patient satisfaction with the birth process was in favor of the dinoprostone sustained release vaginal pessary.
文摘Background: Trial of labor after cesarean delivery (TOLAC) has long been accepted as a safe option for women with previous cesarean delivery. Previous efforts have been exerted in trials to predict the success rates of TOLAC according to specific parameters related to previous cesarean section and before TOLAC. We aimed to investigate the different indications of previous cesarean delivery as independent predictors for successful vaginal birth. Methods: A retrospective study was conducted in Armed Forces Hospitals of the Southern Region between December 15, 2019, and July 1, 2020. The included 566 patients with previous cesarean section who were willing to undergo a trial of labor were divided into two groups according to the success of vaginal birth (VBAC). Results: The nonrecurring indications for previous cesarean delivery were higher in the successful group (fetal distress 54.7% vs 41.1%, malpresentation 26% vs 21.4%, multifetal pregnancy 3.8% vs 2.7%). Additionally, the successful VBAC group had a significantly higher percentage of previous successful VBAC (47.7% vs 21.9%) and prior vaginal deliveries (58.5% vs 44.2%) and less coincidence of medical disorders and meconium-stained liquor (18.1% vs 26.3% and 3.2% vs 8.2%, respectively) than the unsuccessful group. Conclusion: During counseling regarding trial of labor after cesarean section, indications for previous cesarean section not related to arrest of labor can predict higher success of VBAC. Moreover, previous successful vaginal delivery or VBAC improves the success rates.
文摘目的探讨剖宫产术后阴道试产(trial of labor after cesarean delivery,TOLAC)过程中完全性子宫破裂及不完全性子宫破裂的临床表现及胎心监护特点,以期早期识别。方法收集2016年1月1日至2019年12月31日北京和睦家医院进行TOLAC过程中子宫破裂孕产妇的临床资料,分为完全性子宫破裂组及不完全性子宫破裂组,比较两组临床资料、分娩前2 h胎心监护结果及分娩结局。结果TOLAC孕产妇共486例,TOLAC过程中发生子宫破裂13例,发生率为2.67%,其中完全性子宫破裂5例,发生率为1.03%;不完全性子宫破裂8例,发生率为1.65%。完全性子宫破裂组与不完全性子宫破裂组孕产妇年龄、BMI、孕次、距前次剖宫产时间、分娩孕周、孕期体质量增加、合并妊娠糖尿病情况、临产方式、临产后试产时间、决定剖宫产时宫口、决定剖宫产时胎先露位置、新生儿体质量、5 min Apgar评分、脐血pH值及碱剩余、产后出血量比较,差异均无统计学意义(P>0.05),仅决定剖宫产至胎儿娩出时间完全性子宫破裂组显著短于不完全性子宫破裂组[(26.4±9.0)min比(57.8±27.8)min,P=0.035]。分娩前2 h胎心监护比较发现,分娩前20 min,完全性子宫破裂组全部病例均为Ⅱ类胎心监护(2例,40%)和Ⅲ类胎心监护(3例,60%);不完全性子宫破裂组有3例(37.5%)为Ⅰ类胎心监护,3例(37.5%)为Ⅱ类胎心监护,2例(25%)出现Ⅲ类胎心监护。完全性子宫破裂组中可见宫缩模式改变,即宫缩强度递减,随后胎心减速。结论对TOLAC产程中持续胎心监护,尽量做到子宫破裂的早期识别及快速反应,尽量缩短决定剖宫产至胎儿娩出时间,是减少TOLAC子宫破裂导致的母体及新生儿严重并发症的有效保障。
