[1]陈震宇,孙静莉*,陈晓明,等.剖宫产术后再次妊娠阴道分娩的妊娠结局[J].中国计划生育和妇产科,2020,(5):58-63,68.
　CHEN Zhenyu,SUN Jingli*,CHEN Xiaoming,et al.Pregnant outcome of vaginal birth after cesarean[J].Chinese Journal of Family Planning & Gynecotokology,2020,(5):58-63,68.
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剖宫产术后再次妊娠阴道分娩的妊娠结局
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《中国计划生育和妇产科》[ISSN:1674-4020/CN:51-1708/R]

卷:
期数:
2020年5期
页码:
58-63,68
栏目:
论著与临床
出版日期:
2020-05-25

文章信息/Info

Title:
Pregnant outcome of vaginal birth after cesarean
作者:
陈震宇; 孙静莉*; 陈晓明; 仲莞; 金珈汐
北部战区总医院和平院区妇产科
Author(s):
CHEN Zhenyu;  SUN Jingli*;  CHEN Xiaoming;  ZHONG Wan;  JIN Jiaxi
Department of Obstetrics and Gynecology, General Hospital of Northern Theatre Command (Heping Campus), Shenyang Liaoning 110003, P.R.China
关键词:
剖宫产后阴道分娩; 妊娠结局; 产程
Keywords:
vaginal birth after cesarean;  pregnancy outcome;  labor
分类号:
R 7144
摘要:
目的分析剖宫产术后阴道分娩（vaginal birth after cesarean, VBAC）产妇的产时特点及妊娠结局。方法选取2015年1月至2019年6月在北部战区总医院和平院区VBAC的122例产妇为研究对象（VBAC组），按1∶2配对病例对照设计，选择与VBAC产妇同时期分娩的重复性剖宫产（elective repeat cesarean section, ERCS）产妇244例（ERCS组）及经阴道分娩的初产妇244例（对照组），比较3组产妇的母婴结局，分析VBAC组的产时特点。结果① ERCS组年龄最大、孕次最多，对照组年龄最小、孕次最少；对照组受教育程度高于其他两组；ERCS组孕前体质量指数（body mass index, BMI）及分娩前BMI高于其他两组；VBAC组孕期增重低于其他两组，入院时宫颈Bishop评分最高，差异均有统计学意义（P＜005）。② VBAC组分娩孕周（3847±182）周，低于对照组（P＜005）；VBAC组早产发生率最高、新生儿体重最低、巨大儿发生率最低（P＜005）；VBAC组产后出血量最多，对照组次之，ERCS组最少（P＜005），VBAC组及对照组产后出血发生率高于ERCS组（P＜005）；VBAC组、对照组住院天数和住院费用均少于ERCS组（P＜005）；3组新生儿Apgar评分、转入NICU率、输血率、产褥病率比较，差异均无统计学意义（P＞005）； 3组中均无产妇及新生儿死亡。③ VABC组中自然临产率、阴道助产率、会阴侧切率高于对照组，引产率、分娩镇痛率、产程中应用缩宫素比例低于对照组，第一、二产程及总产程时间短于对照组，差异均有统计学意义（P＜005）。结论控制体重，降低新生儿出生体重，更好地理解剖宫产术后阴道试产（trial of labor after cesarean delivery, TOLAC）产程特点，加强监测，有助于降低TOALC的风险，提高VBAC成功率，改善妊娠结局。
Abstract:
Objective To analyze the labor characteristics and pregnant outcome of vaginal birth after cesarean (VBAC) . Methods122 cases with VBAC in General Hospital of Northern Theatre Command (Heping Campus) from January 2015 to June 2019 were studied and set as VBAC group. In a 1∶2 matched casecontrol study, 244 cases of elective repeat cesarean section (ERCS group) and 244 primiparas of vaginal delivery (control group) who delivered during the same time were selected. The maternal and infant outcomes of the three groups of women were compared and the labor characteristics of the VBAC group were analyzed. Results① The ERCS group was the oldest and had the most pregnany times, the control group was the youngest and the pregnancy times was the least; the control group was more educated than the other two groups; the body mass index (BMI) before pregnancy and BMI before delivery were higher in the ERCS group than the other two groups. The VBAC group had lower weight gain during pregnancy than the other two groups. The cervical Bishop score was the highest at admission in the VBAC group,and the differences were statistically significant (P<005). ② The gestational weeks of the VBAC group ［(38.47±1.82) weeks］ was smaller than the control group (P<005). The incidence of preterm birth was the highest in the VBAC group, the lowest in the newborn weight and the incidence of macrosomia (P<005). The VBAC group had the highest postpartum hemorrhage, followed by the control group, and the ERCS group had the lowest postpartum hemorrhage (P<005). The incidence of postpartum hemorrhage in VBAC group and control group was higher than that in ERCS group (P<005). The hospitalization days and hospitalization expenses of VBAC group and control group were lower than those of ERCS group (P<005). There were no significant differences in Apgar score, NICU rate, blood transfusion rate and puerperal rate between the three groups (P>005). There were no maternal and neonatal deaths in the three groups.③ Spontaneous labor rate, operative vaginal delivery rate and episiotomy rate were higher in VBAC group than those in control group ，the rate of inducing labor, requiring spinal analgesia and using oxytocin during labor were lower in VBAC group than those in control group， the duration of the first stage, second stage and total labor stage in VBAC group were shorter than those in control group，the differences were statistically significant (P<005). ConclusionWeight control, reducing birth weight, better understanding of the characteristics of TOLAC labor, and strengthen monitoring will help to reduce the risk of TOLAC, increase the success of VBAC and improve pregnant outcomes.

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备注/Memo

备注/Memo:
辽宁省自然科学基金指导计划（项目编号：20180551133）
更新日期/Last Update: 2020-05-25