摘要
目的探讨不同分娩孕周对剖宫产术后阴道试产(TOLAC)的围生期结局的影响。方法对491例TOLAC孕产妇按不同分娩孕周分为3组,A组:39周≤孕周<40周共276例;B组:40周≤孕周<41周共182例;C组:41周≤孕周<42周共33例。比较其产后出血、子宫破裂、剖宫产术后阴道分娩(VBAC)率、中转剖宫产情况及新生儿结局等。结果3组的产程管理在产程时限、阴道助产使用率及会阴侧切率差异无统计学意义(P>0.05);而3组间产程中的人工破膜率和缩宫素使用率差异有统计学意义[37例(13.4%)vs.15例(8.24%)vs.0例(0.00),(P<0.05)]。491例TOLAC孕产妇中,产后出血率和会阴裂伤率与孕周相关[11例(3.99%)vs.11例(6.04%)vs.6例(18.18%);89例(32.25%)vs.57例(31.33%)vs.19例(57.58%),P<0.05]。子宫破裂4例。总VBAC率为68.23%(335/491),随着孕周的增加,VBAC率增高,中转剖宫产率下降,3组间差异无统计学意义(P>0.05)。(P>0.05)。中转剖宫产主要原因有:疑诊先兆子宫破裂、胎儿窘迫及产程异常(P>0.05)。新生儿平均出生体质量、羊水粪染率与孕周相关(P<0.05)。3组新生儿窒息发生率随孕周增加而下降,但差异无统计学意义(P>0.05)。结论对自然临产并分娩孕周为39~42周的TOLAC者,随着孕周的增加,VBAC率是升高的,同时由于产程干预的降低,围生期的不良结局将有所降低。
Objective To explore the Influence of different delivery gestational age for trial of labor after cesarean on perinatal outcomes.Methods Retrospective descriptive study was conducted on clinical data of 491 trial of labor after cesarean cases with spontaneous labor betwen 39~42 gestational age from The Third Affiliated Hospital of Guangzhou Medical University from January 2009 to December 2017.The cases of patients were divided into 3 groups:group A with 276 cases(39≤gestational age<40),group B with 182 cases(40≤gestational age<41),group C with 33 cases(41≤gestational age<42).Results The labor managements including labor time,operative vaginal delivery usage,episiotomy,the rate of each group showed no significant difference(P>0.05);while the rate of artificial rupture of membrances and oxytocin usage among the three groups were statistically significant[37 cases(13.4%)vs.15 cases(8.24%)vs.0 cases(0.00),(P<0.05)].Among the 491 pregnant woman,both the rate of postpartum hemorrhage and perineal laceration increased with the increasing of gestational age at delivery,and the differences were statistically significant[11 cases(3.99%)vs.11 cases(6.04%)vs.6 cases(18.18%);89 cases(32.25%)vs.57 cases(31.33%)vs.19 cases(57.58%),P<0.05].There were 4 cases of uterine rupture(respectively 1,3,0).The total rate of VBAC was 68.23%(335/491),all the three groups increased with the increasing of gestational week at delivery the transfer rate of cesarean of the three groups is decreasing,the differences were not statistically significant(P>0.05).The factors of the transfer of cesarean were analyzed,the top three reasons were impending uterine rupture(diagnosed),fatal distress,labor abnormalities.The differences of surgical indications of the three groups were not statistically significant(P>0.05).The mean birth weight of newborns of the three groups and the rate of meconium stained amniotic fluid of the three groups were increased with the increasing of gestational week at delivery,and the differences were statistically significant(P<0.05).While the rate of neonatal asphyxia of the three groups decreased with the increasing of gestational week at delivery,the differences were not statistically significant(P>0.05).Conclusion To the trial of labor after cesarean paient with spontaneous labor betwen 39 and 42 gestation age,with the increasing of gestational week at delivery,the rate of vaginal birth after cesarean increases,meanwhile because of the reduction of labor interventions,the adverse perinatal period outcomes decreases.
作者
张丽清
钟柳英
林嘉恒
杨媛婷
薛家健
王建华
郑蔚晗
邓雯锋
ZHANG Li-Qing;ZHONG Liu-Ying;LIN Jia-Heng(The Third Affiliated Hospital of Guangzhou Medical University,the Key Laboratory for Major Obstetric Diseases of Guangdong Province,Guangzhou Guangdong 510150,China)
出处
《中国妇幼保健》
CAS
2021年第15期3429-3432,共4页
Maternal and Child Health Care of China
基金
广州医科大学国家级、省级大学生创新创业训练计划立项项目(201810570059)
广州医科大学大学生实验室开放项目(24)
广州医科大学第三临床学院大学生科研项目(10)。
