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目的:分析有试产指征的一次剖宫产后产妇阴道分娩的影响因素,提高试产的成功率和安全性,保障母儿健康。方法:对2013年1~10月全部一次剖宫产术后有试产指征的产妇进行对照分析。查阅病历记录,获得年龄、孕周、分娩结局等指标。比较试产成功者与再次剖宫产者的母儿结局。进行单因素分析和多因素回归分析,寻找影响试产成功的危险因素。结果:261例符合试产条件的瘢痕子宫患者,共成功阴道分娩39例(14.94%)(试产成功组),未发生子宫破裂,其中产钳助产9例(23.08%),全部实施了会阴侧切术;再次剖宫产222例(再次剖宫产组)。两组均无新生儿窒息发生,全部新生儿存活。试产成功组与再次剖宫产组母儿结局比较差异均无统计学意义(P>0.05)。试产成功组有31例测量子宫下段厚度,为1.90~3.20 mm,均值(2.438 7±0.349)mm,<3 mm 29例(93.53%);再次剖宫产组有123例测量子宫下段厚度,为1.60~3.60 mm,均值(2.594 3±0.463)mm,<3 mm 100例(81.30%)。Logistic回归分析显示:胎儿体重和子宫下段厚度是剖宫产的危险因素,胎儿体重越大,子宫下段厚度越厚,剖宫产率越高。结论:在严格的临床管理下,有试产指征的一次剖宫产产妇再次阴道分娩是相对安全的,应当给予试产机会。大部分产妇子宫下段厚度<3 mm,提示以子宫下段厚度>3 mm作为试产指征存在着不确定性。应以临床评估观察为主,保障母儿安全。
OBJECTIVE: To analyze the influencing factors of vaginal delivery after a cesarean section with pilot indications, to improve the success rate and safety of trial production and to ensure the health of both mother and child. Methods: All the women who had indications for trial after one cesarean section from January to October in 2013 were analyzed. Access to medical records, access to age, gestational age, delivery outcome and other indicators. Comparison of trial-run success and cesarean section again mother and child outcomes. Univariate analysis and multivariate regression analysis were conducted to find the risk factors that influence the trial success. Results: Among 261 patients with scar uterus that meet the requirements of trial production, 39 cases (14.94%) were successful vaginal delivery (successful trial), no rupture of uterus occurred, and 9 cases (23.08% Lateral incision; cesarean section again 222 cases (cesarean section again). Neonatal asphyxia occurred in both groups and all newborns survived. There was no significant difference in the results of maternal and child outcomes between the successful trial group and the second cesarean section group (P> 0.05). In the successful trial, 31 cases measured the thickness of the lower uterine segment, ranging from 1.90 to 3.20 mm (mean, 2.438 7 ± 0.349) mm, and 29 cases (93.53%) <3 mm. In the second cesarean section, 123 cases measured the thickness of the lower uterine segment, 1.60 ~ 3.60 mm, mean (2.594 3 ± 0.463) mm, <3 mm 100 cases (81.30%). Logistic regression analysis showed that fetal weight and lower uterine segment thickness were the risk factors of cesarean section. The larger the fetus weight, the thicker the lower uterine segment, the higher the cesarean section rate. CONCLUSIONS: Under strict clinical management, a vaginal delivery of a cesarean section with indications for trial production is relatively safe and trial production should be given. The majority of maternal uterine segment thickness <3 mm, suggesting that the thickness of the lower uterine segment> 3 mm as the pilot indications there is uncertainty. Clinical evaluation should be based mainly to protect the safety of mother and child.