摘要
目的探讨剖宫产后阴道分娩(VBAC)量化评分系统的拟定和应用。方法本次研究最终纳入2216例产妇作为研究对象,采集分析研究对象的人口统计学和产科资料。分析产妇分娩方式,比较剖宫产后阴道试产(TOLAC)成功与择期重复剖宫产(ERCS)产妇临床指标;对TOLAC成功的影响因素进行单因素及多因素Logistic回归分析,并进行验证;建立VBAC量化评分系统,并分析TOLAC产妇VBAC量化评分。结果2216例产妇,其中ERCS 1640例,占74.01%;TOLAC 576例,占25.99%。TOLAC中失败113例,失败后紧急行剖宫产;成功463例(80.38%),其中钳产24例,TOLAC钳产率为4.17%。TOLAC成功产妇的产后24 h出血量、住院天数均明显少于ERCS产妇,差异有统计学意义(P<0.05);而TOLAC成功与ERCS产妇并发症发生率、新生儿并发症发生率及新生儿出生5 min Apgar评分比较,差异均无统计学意义(P>0.05)。TOLAC成功产妇中宫颈Bishop评分≥7分、孕龄<38岁、孕周≤40周、前次剖宫产指征其他、新生儿体重<4000 g占比均高于TOLAC失败,差异有统计学意义(P<0.05)。TOLAC成功与TOLAC失败产妇有阴道分娩史、与前次剖宫产间隔时间比较差异无统计学意义(P>0.05)。多因素Logistic回归分析显示,宫颈Bishop评分≥7分、孕龄<38岁、孕周≤40周、前次剖宫产指征(其他)是TOLAC成功的影响因素(P<0.05)。随后利用单因素Logistic回归分析宫颈Bishop评分≥7分、孕龄<38岁、孕周≤40周、前次剖宫产指征(其他)对TOLAC成功的影响进行验证,差异均有统计学意义(P<0.05)。依据以上研究中各因素的OR、P值,并结合相关文献,对影响因素赋分值,制定VBAC量化评分系统,包括宫颈Bishop评分、孕龄、前次剖宫产指征、孕周4项,总分5分。576例TOLAC产妇中,VBAC量化评分≤2分产妇的TOLAC成功率64.35%明显低于总体成功率的80.38%,差异有统计学意义(P<0.05)。结论在严密监护下,TOLAC是安全的,且可获得母婴的利益最大化;据本研究拟定的VBAC量化评分系统,当量化评分≤2分时,产妇阴道试产的成功率明显降低,需谨慎试产。
Objective To discuss the development and application of quantitative scoring system for vaginal birth after cesarean(VBAC).Methods In this study,2216 cases of pregnant women were selected as the research subjects,and the demographic and obstetric data of the research subjects were collected and analyzed.The mode of delivery was analyzed,and the clinical indicators of trial of labor after cesarean delivery(TOLAC)and elective repeated cesarean section(ERCS)women was compared.The factors influencing the success of TOLAC were analyzed and verified by univariate and multivariate logistic regression.The quantitative scoring system for vaginal birth after cesarean(VBAC)was established,and the scores of TOLAC maternal VBAC quantitative score was analyzed.Results Among 2216 cases of maternal women,there were 1640 cases of ERCS,accounting for 74.01%;576 cases of TOLAC,accounting for 25.99%.113 cases failed in TOLAC,and emergency cesarean section was performed after failure;463 cases(80.38%)were successful,including 24 cases of forceps delivery,and the rate of TOLAC forceps delivery was 4.17%.The 24-h postpartum blood loss and the number of days of hospitalization of women with successful TOLAC were significantly less than those of ERCS women,and the difference was statistically significant(P<0.05);but there was no statistically significant difference in incidence of maternal complications,incidence of neonatal complications and Apgar score at 5 min after birth between women with successful TOLAC and ERCS(P>0.05).The proportion of cervical Bishop score≥7 points,gestational age<38 years,gestational age≤40 weeks,other indications for previous cesarean section,and neonatal weights<4000 g in women with successful TOLAC was higher than that of women with failed TOLAC,and the difference was statistically significant significance(P<0.05).There was no statistically significant difference in history of vaginal delivery and the interval between previous cesarean section between women with successful TOLAC and failed TOLAC(P>0.05).Multivariate logistic regression analysis showed that cervical Bishop score≥7 points,gestational age<38 years,gestational age≤40 weeks,and previous cesarean section indications(other)were influencing factors for TOLAC success(P<0.05).Subsequently,univariate Logistic regression was used to verify the impact of cervical Bishop score≥7 points,gestational age<38 years,gestational age≤40 weeks,and previous cesarean section indications(other)on the success of TOLAC,and the differences was statistically significant(P<0.05).According to the OR and P value of each factor in the above study,combined with relevant literature,the influencing factors were assigned scores,and the VBAC quantitative scoring system was established,including cervical Bishop score,gestational age,previous cesarean section indications and gestational week,with a total score of 5 points.Among 576 TOLAC women,the TOLAC success rate of women whose VBAC quantification table score≤2 points was 64.35%,which was significantly lower than the overall success rate of 80.38%,and the difference was statistically significant(P<0.05).Conclusion Under close monitoring,TOLAC is safe and can maximize the benefits of mother and baby.According to the VBAC quantitative scoring system developed in this study,when the quantitative score is≤2 points,the success rate of maternal vaginal trial delivery is significantly reduced,so it is necessary to be cautious.
作者
杨远强
黄碧云
黄雪萍
张群
YANG Yuan-qiang;HUANG B i-yun;HUANG Xue-ping(Department of Obstetrics,Jiangmen Central Hospital,Jiangmen 529000,China)
出处
《中国实用医药》
2021年第9期16-19,共4页
China Practical Medicine
关键词
剖宫产
阴道分娩
量化评分系统
应用
Cesarean section
Vaginal delivery
Quantitative scoring system
Application
