瘢痕子宫再次妊娠阴道分娩的产程特点和分娩成功的相关因素

发布时间：2018-05-05 08:08

  本文选题：剖宫产术后再次妊娠阴道分娩 + 产程特点　； 参考：《延边大学》2017年硕士论文

【摘要】：目的分析瘢痕子宫再次妊娠阴道分娩(VBAC)的产程特点和分娩成功的相关因素,为临床正确处理瘢痕子宫再次妊娠阴道分娩提供参考依据。方法收集2014年1月至2016年12月在本院妇产科住院孕产妇资料230例(包含瘢痕子宫阴道分娩分娩失败23例),分为VBAC 67例(观察组),对照组A组同期足月经阴道分娩初产产妇70例,对照组B组足月再次经阴道分娩经产产妇70例。记录①孕产妇年龄、孕周、孕产史、身体一般状况、妊娠期合并症、胎位等产科一般住院检查;②与前次剖宫产间隔时间;③第一产程、第二产程、第三产程的产程时间;④分娩时相关并发症;⑤新生儿出生后1分钟及5分钟的APgar评分及并发症记录。通过上述检测项目分析:①各分组的总产程、第一产程、第二产程时间长度分别比较,明确是否存在差异,并分析和与前次剖宫产间隔时间有无关系;②分析各组分娩时并发症(胎盘黏连、产后出血、子宫破裂),新生儿APgar评分并判定是否存在新生儿窒息。结果1.观察组VBAC平均总产程(7.444±2.585小时)小于对照组A组总产程(11.39±1.674小时,P0.05);大于对照组B组经产妇总产程(6.372±3.150小时,P0.05),有统计学差异。2.观察组VBAC产妇平均第一产程(6.960±2.178小时)小于对照组A组10.74±1.579小时,P0.01);大于对照组B组(5.988±3.077小时,P0.05),有统计学差异。3.观察组VBAC产妇平均第二产程(0.3510±0.3810小时小于对照组A组(0.5058±0.3124小时,P0.01);大于对照组B组(0.2370±0.1737小时,P0.05)。4.VBAC经产妇与前次剖宫产间隔时间3-12年,平均7.444±2.585(小时),总产程和与前次剖宫产间隔时间成负相关(Y=-0.5.144x+10.123,r2=0.3629,P0.01)。5.各组比较分娩时出血量新生儿5分钟APgar评分、相关分娩并发症无统计学差异。6.TOLAC失败组新生儿体重(3748±1223g)高于VBAC组(3318±756.3g),产妇宫颈 BishoP 评分(6.652±1.201)低于 VBAC 组(9.090±3.073,P0.05)。瘢痕子宫阴道分娩失败病例中胎儿宫内窘迫4例,潜伏期试产6小时无进展4例,活跃期停滞3例,胎位异常10例,产妇放弃2例。结论1.分析观察组与对照组的产程时限,VBAC产妇总产程介于初产妇与经产妇之间,距前次剖宫产间隔时间是影响产程的重要因素,在临床处理瘢痕子宫阴道分娩患者时需考虑其特殊产程特点,严密观察产程进展及是否需要干预2.胎儿体重、宫颈评分是影响瘢痕子宫阴道分娩成功的重要因素3.瘢痕子宫阴道分娩并不增加产后并发症的发生率,因此在符合试产条件时充分试产,降低剖宫产率、提高母儿健康
[Abstract]:Objective to analyze the characteristics of the vaginal delivery of scar uterus and the related factors of successful delivery, and to provide a reference for the clinical treatment of the vaginal delivery of the scar uterus. Methods from January 2014 to December 2016, the data of 230 pregnant and lying-in women in our hospital were collected, including 23 cases of scar uterus and vaginal delivery failure, which were divided into VBAC 67 cases (observation group) and control group A (70 cases of first parturient delivered through vagina during the same period). In group B, 70 cases of parturient were delivered again through vagina. 1 Maternal age, gestational week, history of pregnancy, general condition of pregnancy, complications of pregnancy, gestational position and other obstetrical examinations were recorded. The first stage of labor, the second stage of labor, and the time of the third stage of labor were recorded during the interval between the previous cesarean section and other obstetrical examinations. 4 APgar score and complication record of 1 and 5 minutes after birth. By analyzing the total labor process, the first stage of labor and the second stage of labor, the length of time of the first stage of labor and the second stage of labor were compared to determine whether there were any differences, and whether there was any relationship with the interval time between the previous cesarean section and the previous cesarean section. 2 complications during delivery (placental adhesion, postpartum hemorrhage, uterine rupture, neonatal APgar score and asphyxia neonatorum) were analyzed. Result 1. The average total VBAC of the observation group was 7.444 卤2.585 hours, which was lower than that of the control group A (11.39 卤1.674 hours), and was higher than that of the control group B (6.372 卤3.150 hours) (P 0.05). The average first stage of labor in the observation group was 6.960 卤2.178 hours, which was lower than that in the control group A (10.74 卤1.579 hours), and was higher than that in the control group (5.988 卤3.077 hours) (P 0.05). The average second stage of labor in the observation group was 0.3510 卤0.3810 hours, which was less than that in the control group A (0.5058 卤0.3124 hours), and the interval between the parturient and the previous cesarean section was 3-12 years, which was larger than that in the control group B (0.2370 卤0.1737 hours). The average value was 7.444 卤2.585. the total labor process and the interval time of the previous cesarean section were negatively correlated with that of the previous cesarean section. There was no significant difference in birth complications among all groups. 6. The weight of newborns in TOLAC failure group (3748 卤1223g) was higher than that in VBAC group (3318 卤756.3 g), and the cervical BishoP score of puerpera (6.652 卤1.201) was lower than that of VBAC group (9.090 卤3.073g, P 0.05). There were 4 cases of fetal distress, 4 cases of no progress in 6 hours of incubation period, 3 cases of active stagnation, 10 cases of abnormal fetal position and 2 cases of abandonment of parturient. Conclusion 1. The duration of labor and VBAC in the observation group and the control group were between primipara and transpartum, and the interval between the previous cesarean section was an important factor affecting the labor process. In clinical treatment of cicatricial uterus and vagina delivery, it is necessary to consider the special characteristics of labor process, closely observe the progress of labor process and whether intervention is necessary. 2. Fetal weight and cervix score are important factors influencing the success of scar uterus and vagina delivery. Cicatricial uterus and vagina delivery does not increase the incidence of postpartum complications. Therefore, full trial labor can reduce the rate of cesarean section and improve the health of mother and child when it meets the conditions of trial delivery.
【学位授予单位】：延边大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.4
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本文编号：1846899