張雅娟

[摘要] 目的 探討剖宮產(chǎn)術(shù)后再次妊娠經(jīng)陰道分娩成功的影響因素，并對產(chǎn)后母嬰結(jié)局進(jìn)行分析。 方法 選取2013年3月～2015年11月本院產(chǎn)科收治的剖宮產(chǎn)術(shù)后再次妊娠行陰道試產(chǎn)的125例產(chǎn)婦，其中成功陰道分娩65例，選取60例作為觀察組，試產(chǎn)失敗行剖宮產(chǎn)分娩60例作為對照組，經(jīng)單因素和多因素Logistic回歸分析比較兩組研究因素的差異，并對兩組母嬰結(jié)局進(jìn)行對比分析。 結(jié)果 單因素分析顯示兩組在家屬態(tài)度、孕周、有否胎膜破裂、宮高、胎兒腹圍及雙頂徑、胎頭方位、Bishop宮頸成熟度評分、兩次妊娠間隔時間、陰道分娩史方面差異有統(tǒng)計學(xué)意義（P<0.05）；多因素Logistic回歸分析顯示孕周、胎兒腹圍、Bishop評分及胎頭方位四個因素方面差異有統(tǒng)計學(xué)意義（P<0.05）；兩組產(chǎn)后2 h及24 h出血量、產(chǎn)后住院時間方面差異有統(tǒng)計學(xué)意義（P<0.05），兩組子宮破裂率差異無統(tǒng)計學(xué)意義（P>0.05）；兩組新生兒在窒息率、新生兒Apgar評分、住院率方面無顯著差異（P>0.05）。 結(jié)論 對剖宮產(chǎn)術(shù)后再次妊娠的孕婦進(jìn)行產(chǎn)前能否經(jīng)陰道分娩的評估，若孕婦未出現(xiàn)剖宮產(chǎn)指征，可在嚴(yán)密監(jiān)護(hù)和多次評估后，指導(dǎo)產(chǎn)婦進(jìn)行陰道分娩，以降低對母嬰身心健康的影響，提升母嬰生存質(zhì)量。

[關(guān)鍵詞] 剖宮產(chǎn)術(shù)；再次妊娠；陰道分娩；成功因素；母嬰結(jié)局

[中圖分類號] R719.8 [文獻(xiàn)標(biāo)識碼] B [文章編號] 1673-9701（2016）35-0047-04

Analysis of factors influencing the success of vaginal delivery on the second pregnant after cesarean section and maternal-infant outcome

ZHANG Yajuan

Department of Obstetrics and Gynecology， Mindong Hospital Affiliated to Fujian Medical University， Fuan 355000， China

[Abstract] Objective To explore the factors of successful vaginal delivery on the second pregnant after cesarean section， and to analyze the outcome of mother and child after delivery. Methods A total of 125 puerperant who had undergone vaginal trial on the second pregnant after cesarean section in our hospital from March 2013 to November 2015 were chosen in the study including 65 cases of successful vaginal delivery， and 60 cases were selected as observation group， with 60 cases of cesarean delivery after failure of vaginal trial production as the control group. Univariate analysis and multivariate Logistic regression analysis were used to compare the differences between the two groups， and the results of mother and child were analyzed. Results Univariate analysis showed that there were statistically significant differences in attitudes of the relatives， gestational age， fetal rupture， uterine height， fetal abdominal circumference and biparietal diameter， fetal head orientation， Bishop cervical maturity score， time between two pregnancies， vaginal delivery history（P<0.05）. Multivariate Logistic regression analysis showed that the gestational age， fetal abdominal circumference， Bishop score and fetal head orientation were statistically significant （P<0.05）. Postpartum 2 h and 24 h hemorrhage and postpartum hospital stay between the two groups were statistically significant（P<0.05）. There was no significant difference in uterine rupture rate between the two groups（P>0.05）. There were no significant differences between the two groups in terms of asphyxia rate， neonatal Apgar score and hospital stay rate（P>0.05）. Conclusion Pregnant women on second pregnancy after cesarean section can be assessed in prenatal for vaginal delivery. If pregnant women do not have indications for cesarean section， the puerperant can be guided to have a vaginal birth after closely monitored and repeated assessment， can reduce the effect on the mother and infants physical and mental health， improve the life quality of maternal and child.