剖宫产术后再次妊娠阴道分娩的临床效果及安全性评价被引量：55

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摘要目的探讨剖宫产术后再次妊娠阴道分娩(VBAC)的临床效果及安全性.方法回顾性分析2016年1月至2018年10月于首都医科大学附属北京友谊医院分娩的剖宫产术后再次妊娠孕妇的妊娠结局,探讨VABC的相关因素;并比较339例VBAC(VBAC组)与197例剖宫产术后再次妊娠阴道试产(TOLAC)失败中转剖宫产(TOLAC失败组)孕妇的围产结局.结果(1)1 388例剖宫产术后再次妊娠孕妇中,行选择性再次剖宫产者852例,TOLAC孕妇536例;536例TOLAC孕妇中,VBAC者339例,TOLAC失败中转剖宫产者197例.近3年总TOLAC率为(38.62%,536/1 388),2016年、2017年及2018年的TOLAC率分别为51.7%(195/377)、38.0%(208/548)、28.7%(133/463),呈逐年下降趋势;近3年总VBAC率为63.3%(339/536),2016年、2017年及2018年的VBAC率分别为59.0%(115/195)、66.7%(132/198)及69.2%(92/133),呈逐年上升趋势.无子宫破裂者,无孕产妇及新生儿死亡.(2)单因素分析显示,年龄<35岁、自然临产、子宫颈评分>6分及胎儿体重<3 500 g是VBAC的有利因素.多因素logistic分析显示,自然临产、子宫颈评分是VBAC与否的相关因素.(3)TOLAC失败中转剖宫产的指征中,前3位为引产失败、产程异常及先兆子宫破裂.TOLAC失败组孕妇产后出血的发生率高于VBAC组(分别为9.6%、5.1%),住院时间长于VBAC组[分别为(4.6±0.6)、(2.2±0.8)d],新生儿出生体重高于VBAC组[分别为(3 640±114)、(3 190±305)g],分别比较,差异均有统计学意义(P均<0.05);但两组孕妇的宫内感染、新生儿窒息、新生儿转新生儿ICU的发生率及脐血pH值无明显差异(P均>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,VBAC率在60%以上.自然临产、子宫颈评分高的孕妇VBAC率高.

作者韩肖燕杨桦

机构地区首都医科大学附属北京友谊医院妇产科

出处《中华妇产科杂志》 CAS CSCD 北大核心 2019年第6期411-414,共4页 Chinese Journal of Obstetrics and Gynecology

关键词剖宫产术后再次妊娠安全性评价阴道分娩临床效果多因素LOGISTIC分析先兆子宫破裂新生儿死亡 VBAC

分类号 R714.4 [医药卫生—妇产科学]

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1张为远.剖宫产术后再次妊娠阴道分娩管理的专家共识（2016）[J].中华妇产科杂志,2016,51(8):561-564. 被引量：336

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