尤海英 刘银春 郭晓燕 张晓萍

【摘要】 目的：探究剖宮产术后再次妊娠阴道试产失败的影响因素。方法：选取2016年1月-2019年6月本院收治的500例剖宫产术后再次妊娠阴道试产孕妇的临床资料进行回顾性分析。根据阴道试产成功与失败的结局，比较入组患者的年龄、孕周、胎儿体重、阴道试产史、孕前体质量指数（BMI）、入院时宫颈Bishop评分子宫下段厚度，分析可能影响阴道试产失败的危险因素。结果：在500例孕妇中，有395例阴道试产成功（占79.0%），105例试产失败中转剖宫产。两组年龄、孕周、胎儿体重、阴道试产史、孕前体质量指数（BMI）、入院时宫颈Bishop评分的比较，差异均有统计学意义（P<0.05），子宫下段肌层厚度比较，差异无统计学意义（P>0.05）。经多因素logistic回归分析，产妇的年龄、孕前BMI、胎儿体重、阴道试产史及入院时宫颈Bishop评分均是影响阴道试产失败的独立影响因素（P<0.05）。结论：影响剖宫产术后再次妊娠经阴道分娩失败的因素较多，产前可根据相关影响因素及产妇的身体状况进行全面评估，指导其正确选择分娩方式。

【关键词】 瘢痕子宫 阴道试产 宫颈Bishop评分

Study on the Influencing Factors on the Failure of Vaginal Trial Delivery of Scar Uterus Pregnancy after Cesarean Section/YOU Haiying， LIU Yinchun， GUO Xiaoyan， ZHANG Xiaoping. //Medical Innovation of China， 2021， 18（01）： -171

[Abstract] Objective： To study the influencing factors of the failure of vaginal trial delivery after cesarean section in scarred uterus pregnancy. Method： A total of 500 re-pregnant women undergoing vaginal trial delivery after cesarean section treated in our hospital from January 2016 to June 2019 were conducted on the clinical data of retrospective analysis. According to the successful and failed outcomes of vaginal trial， the enrolled patients of differences age， gestational week， fetal weight， history of vaginal trial delivery， pre-pregnancy body mass index （BMI）， cervical Bishop score on admission and thickness on the inferior segment of the uterus were compared， the risk factors that may influence the failure of vaginal trial delivery. Result： Among the 500 pregnant women， 395 （79.0%） were successful in vaginal trial delivery， 105 were unsuccessful in cesarean section delivery. There were statistically significant differences between the two groups in age， gestational week， fetal weight， history of vaginal trial delivery， pre-pregnancy body mass index （BMI）， and cervical Bishop score on admission （P<0.05）， while there was no statistically significant difference in the thickness of the inferior segment of the uterus （P>0.05）. According to multivariate logistic regression analysis， age， pre-pregnancy BMI， fetal weight， history of vaginal trial delivery and Bishop score at admission were independent factors influencing the failure of vaginal trial delivery （P<0.05）. Conclusion： There are many factors that affect the failure of the second pregnancy after cesarean section in vaginal delivery， prenatal evaluation can be conducted according to the relevant factors and maternal physical conditions to guide the correct choice of delivery.

[Key words] Scarred uterus Vaginal trial delivery Cervical Bishop score

First-authors address： Qingyuan Womens and Childrens Hospital， Qingyuan 511500， China

doi：10.3969/j.issn.1674-4985.2021.01.041

随着2016年我国二孩政策全面开放，剖宫产术后再次妊娠的比例和数量随之增加，剖宫产后再次妊娠分娩方式的选择在国内外得到广泛关注。研究显示，与选择性重复剖宫产（planned repeat cesarean delivery，PRCD）分娩相比，剖宫产后阴道分娩（vaginal birth after cesarean section，VBAC）的并发症相对较少，而阴道试产失败后剖宫产的并发症相对增加[1]。由此可见，剖宫产术后再次妊娠分娩的产妇其并发症发生率与阴道试产成功率有关。而在临床工作中对于瘢痕子宫选择分娩方式存在一定的困难，主要是由于分娩过程容易受到各种危险因素的影响，导致阴道试产失败[2]。所以了解是否存在阴道试产失败的影响因素，选择安全生产方式对保护剖宫产术后再次妊娠产妇的安全具有重要作用[3]。……