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目的研究影响剖宫产后阴道分娩成败的因素。方法回顾性分析2012年10月-2013年7月间80例自愿要求经阴道试产的既往有剖宫产手术史的单胎孕妇资料,按照最终阴道分娩成败分为剖宫产后阴道分娩(VBAC)组(n=40)和重复剖宫产(RCS)组(n=40),对其一般资料进行比较,并作多因素相关分析。同时随机选取同时期40例既往有阴道分娩史,此次再行阴道分娩的患者作为对照组,记录VBAC组与对照组产后出血量、总产程的时间、会阴情况。结果既往前次剖宫产指征为产程停滞[OR=1.601,95%CI(1.025,2.469),P=0.04]、宫颈Bishop评分<7分[OR=3.757,95%CI(1.437,8.772),P=0.01]及新生儿体质量大[OR=1.391,95%CI(1.124,2.583),P=0.03]与VBAC失败有关。VBAC组总产程时间为(6.71±2.94)h,对照组为(5.88±2.47)h,差异无统计学意义(P=0.176);VBAC组产后出血量为(259.13±75.31)m L,对照组为(230.36±67.44)m L,差异无统计学意义(P=0.076)。结论 VBAC术后恢复快,住院时间短,但需把握合适的指征以保证母婴安全。
Objective To study the factors affecting the success or failure of vaginal delivery after cesarean section. Methods A retrospective analysis of 80 cases of single-fetus pregnant women with previous history of cesarean section who were asked to undergo vaginal trial voluntarily between October 2012 and July 2013 was divided into vaginal delivery after cesarean section according to the results of the final vaginal delivery VBAC group (n = 40) and repeated cesarean section (RCS) group (n = 40). The general data were compared and analyzed by multivariate analysis. At the same time, 40 patients with previous history of vaginal delivery during the same period were randomly selected as the control group. The postpartum hemorrhage volume, the duration of labor and the perineal condition were recorded in VBAC group and control group. Results The previous cesarean section indications for labor stagnation [OR = 1.601,95% CI (1.025,2.469, P = 0.04], cervical Bishop score <7 points [OR = 3.757,95% CI (1.437,8.772) , P = 0.01] and neonatal body mass [OR = 1.391, 95% CI (1.124, 2.583), P = 0.03] were associated with failure of VBAC. The total labor duration was (6.71 ± 2.94) h in VBAC group and (5.88 ± 2.47) h in control group, the difference was not statistically significant (P = 0.176); the amount of postpartum hemorrhage in VBAC group was (259.13 ± 75.31) (230.36 ± 67.44) m L, the difference was not statistically significant (P = 0.076). Conclusion VBAC has faster recovery and shorter hospital stay, but it is necessary to grasp the appropriate indications to ensure the safety of mother and infant.