论文部分内容阅读
目的:分析剖宫产术后阴道分娩(VBAC)的影响因素。方法:选取剖宫产术后阴道试产(TOLAC)的114例孕妇。超声测定其宫颈长度,根据最终是否成功VBAC分为成功组和失败组,采用单因素和多因素Logistic回归分析影响VBAC的因素,观察宫颈长度是否是影响VBAC的独立因素。结果:TOLAC成功率为46.49%。单因素分析显示,成功组和失败者的年龄、出血量、孕产次、距上次剖宫产时间、上次是否进入产程、分娩孕周、阴道分娩史等比较,差异均无统计学意义(均P>0.05);成功组的自然临产率和分娩镇痛率均较失败组高(均P<0.05),新生儿体重低于失败组(P<0.05)。Logistics多因素分析显示,自然临产和宫颈长度为VBAC的独立影响因素,自然临产(B=3.014,P<0.001,OR=20.372)为TOLAC成功的保护因素,宫颈长度为TOLAC成功的危险因素(B=-0.091,P<0.05,OR=0.913)。成功组的平均宫颈长度(19.86±11.05)mm,明显短于失败组[(28.61±7.75)mm](P<0.01)。宫颈长度每减少1mm对TOLAC成功的优势比为1.095。结论:自然临产是TOLAC成功的有利因素,超声测量的宫颈长度为TOLAC成功率的独立影响因素。
Objective: To analyze the influencing factors of vaginal delivery after cesarean section (VBAC). Methods: One hundred and seventy pregnant women who underwent vaginal trial (TOLAC) after cesarean section were selected. The cervical length was measured by ultrasound. According to whether VBAC was successful or not, the factors influencing VBAC were analyzed by single factor and multivariate Logistic regression, and whether cervical length was an independent factor influencing VBAC was observed. Results: The success rate of TOLAC was 46.49%. Univariate analysis showed that there was no significant difference in the age, amount of bleeding, pregnancy and childbirth between the successful group and the loser, the time from last cesarean section, the time of entering the labor process, the birth gestational age and vaginal delivery history (All P> 0.05). The rates of spontaneous labor and labor analgesia in the successful group were higher than those in the failed group (all P <0.05). The newborn’s body weight was lower than that of the failed group (P <0.05). Logistics multivariate analysis showed that spontaneous labor and cervical length were independent factors of VBAC. Natural labor (B = 3.014, P <0.001, OR = 20.372) was the protective factor of TOLAC success. Cervical length was the risk factor of TOLAC success (B = -0.091, P <0.05, OR = 0.913). The mean cervical length of the successful group (19.86 ± 11.05) mm was significantly shorter than that of the failed group (28.61 ± 7.75 mm) (P <0.01). For every 1 mm reduction in cervical length, the odds ratio for successful TOLAC was 1.095. CONCLUSION: Spontaneous labor is a favorable factor for the success of TOLAC. The length of cervix measured by ultrasound is an independent factor affecting the success rate of TOLAC.