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目的探讨剖宫产术后再次妊娠分娩方式的选择与肥胖产妇自身因素的相关性。方法选取深圳市宝安区福永人民医院2015年12月-2016年11月收治的530例剖宫产术后再次妊娠的肥胖产妇资料进行回顾性分析,根据不同分娩方式分为剖宫产组与经阴道分娩组,分析对比选择两种不同分娩方式的肥胖产妇自身因素差异及分娩过程差异,汇总其影响因素为剖宫产术后再次妊娠分娩方式的选择提供依据。结果两组再次妊娠的肥胖产妇术前影响因素分析中,剖宫产组再次妊娠的肥胖产妇在上次分娩子宫切口愈合不良、具有重度子痫前期、经皮血氧饱和度低、胎盘附着位置异常与经阴道分娩组相比差异有统计学意义(P<0.05)。两组再次妊娠的肥胖产妇术中影响因素分析中,剖宫产组再次妊娠的肥胖产妇在术中出血量、最低平均动脉压、是否为急诊分娩与经阴道分娩组相比差异有统计学意义(P<0.05)。两组再次妊娠的肥胖产妇术后影响因素分析中,剖宫产组再次妊娠的肥胖产妇在机械通气时间、低氧血症、急性肾功能衰竭与经阴道分娩组相比差异有统计学意义(P<0.05)。再次妊娠的肥胖产妇初步筛选的影响因素应用回归分析结果可知,术前胎盘附着位置异常、子宫切口愈合不良、重度子痫前期是影响再次妊娠肥胖产妇发生术后谵妄的独立影响因素(P<0.05)。结论剖宫产术后再次妊娠的肥胖产妇进行不同术式的自身因素对比分析提示术前胎盘附着位置异常、子宫切口愈合不良、重度子痫前期为独立危险因素,应高度注意具有影响因素的产妇采取剖宫产术式,对于不具备高危因素的产妇可进行经阴道分娩。
Objective To explore the correlation between the choice of delivery mode after cesarean section and the self-obese mothers. Methods The data of 530 obese women who were re-pregnant after cesarean section were retrospectively analyzed in Fuyong People’s Hospital of Bao’an District, Shenzhen from December 2015 to November 2016. According to different modes of delivery, they were divided into cesarean section group Vaginal delivery group, analysis and comparison of two different delivery methods of choice of obese mothers differences in their own factors and differences in childbirth process, summarizes the influencing factors for cesarean section after pregnancy delivery mode of choice to provide the basis. Results In the analysis of preoperative influencing factors of re-pregnant obese women in the two groups, the obese women who were re-pregnant in the cesarean section had poor healing in the last delivery of uterine incision, severe preeclampsia, low percutaneous oxygen saturation, Abnormalities and vaginal delivery group compared with the difference was statistically significant (P <0.05). Two groups of obese women again pregnancy analysis of influencing factors, cesarean section again pregnant women obese women in the amount of intraoperative blood loss, the lowest mean arterial pressure, whether emergency delivery and vaginal delivery group compared with the difference was statistically significant (P <0.05). In the analysis of influencing factors of post-pregnancy obese women in two groups again, there was significant difference between the obese women in the cesarean section and those in the vaginal delivery group after mechanical ventilation, hypoxemia and acute renal failure P <0.05). According to the results of regression analysis, preoperative location of placenta attachment, poor healing of uterine incision and severe preeclampsia were independent influencing factors of postoperative delirium in re-pregnant pregnant women (P <0.05) ). Conclusion The comparative analysis of the self-factors of different surgical procedures of obese mothers after re-pregnancy after cesarean section suggest that there are abnormal placenta previa attachment, poor healing of uterine incision, and severe preeclampsia as independent risk factors. Pay attention to the influencing factors Cesarean section to take, for women who do not have the risk factors can be vaginal delivery.