引产对剖宫产后经阴道分娩妊娠结局的影响

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摘要目的探讨引产是否增加剖宫产后阴道试产（TOLAC）的母婴并发症，以及不同引产方法对TOLAC 的影响。方法选取2015年1月～2017年12月于江门市中心医院产科住院的2292 例孕妇资料进行回顾性分析，依据是否接受引产，将孕妇分为引产组与自然临产组。分析比较引产组与自然临产组孕产妇的一般情况和妊娠结局，了解引产是否增加TOLAC 的母婴风险。依据引产方式的不同，将引产组孕妇分为催产素引产组和球囊引产组，分析比较催产素引产组和球囊引产组孕妇的一般情况和妊娠结局，了解不同引产方式对剖宫产后经阴道分娩（VBAC）的影响。结果 TOLAC 孕妇共576 例，引产组有56 例，自然临产组有520 例。引产组中，催产素引产组有37 例和球囊引产组有19 例。引产组的年龄和分娩孕龄大于自然临产组，试产成功率低于自然临产组，产后24 h出血量多于自然临产组，住院时间长于自然临产组，差异有统计学意义（P＜0.05）；而引产组、自然临产组的钳产率、孕产妇并发症发生率、新生儿并发症发生率比较，差异无统计学意义（P＞0.05）；催产素引产组的年龄大于球囊引产组，住院时间短于球囊引产组，差异有统计学意义（P＜0.05）；而催产素引产组、球囊引产组的分娩孕龄、试产成功率、钳产率、产后24 h 出血量、孕产妇并发症发生率、新生儿并发症发生率比较，差异无统计学意义（P＞0.05）。结论在严密的监护下，在TOLAC 过程中引产是安全有效的，但引产降低了VBAC 的成功率，应严格掌握引产的适应证和禁忌证。小剂量缩宫素引产和球囊引产在引产效果及可能引起的母婴并发症方面无明显差异，不同方法的选择主要取决于孕妇的宫颈成熟度。

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关键词 ：剖宫产后经阴道分娩, 剖宫产后阴道试产, 引产, 缩宫素, 宫颈扩张球囊

Abstract：Objective To investigate whether induction of labor increases the complications of trial of labor after cesarean (TOLAC) section and the impact of different methods of induction on TOLAC. Methods Data of 2292 pregnant women who were hospitalized in the Department of Obstetrics in Jiangmen Central Hospital from January 2015 to December 2017 were retrospectively analyzed. According to whether they received labor induction or not, pregnant women were divided into labor induction group and natural labor group. The general conditions and pregnancy outcomes of pregnant women in the induced labor group and the natural labor group were analyzed and compared to understand whether the induced labor increased the maternal and infant risk of TOLAC. According to the different methods of labor induction, the pregnant women in the labor induction group were divided into the Oxytocin labor induction group and the balloon labor induction group. The general situation and pregnancy outcome of the pregnant women in the Oxytocin labor induction group and the balloon labor induction group were analyzed and compared, so as to understand the influence of different methods of labor induction on vaginal birth after cesarean (VBAC). Results There were 576 pregnant women with TOLAC, 56 in induced labor group and 520 in natural labor group. In the labor induction group, 37 were in the Oxytocin group and 19 in the balloon group. The age and gestational age of labor induction group were higher than those of natural labor group, the success rate of trial labor was lower than that of natural labor group, the amount of postpartum blood loss at 24 h was more than that of natural labor group, and the length of hospital stay was longer than that of natural labor group, the differences were statistically significant (P＜0.05). There were no significant differences in the rate of forceps delivery, the incidence of maternal complications and neonatal complications between the induced labor group and the natural labor group (P＞0.05). The age of the Oxytocin induced labor group was higher than that of the balloon induced labor group, and the length of hospital stay was shorter than that of the balloon induced labor group, the differences were statistically significant (P＜0.05). However, there were no significant differences in gestational age, success rate of trial labor, forceps delivery rate, postpartum blood loss at 24 h, incidence of maternal complications and neonatal complications between the Oxytocin induced labor group and the balloon induced labor group(P＞0.05). Conclusion Under strict supervision, the induction of labor during TOLAC is safe and effective, but the induction of labor reduces the success rate of VBAC, and the indications and contraindications of labor induction should be strictly controlled. There is no significant difference between low-dose Oxytocin induction and balloon induction in terms of the effect of labor induction and the possible complications of mother and infant. The choice of different methods mainly depends on the pregnant women′s cervical maturity.

Key words： Vaginal delivery after cesarean section Trial of labor after cesarean section Labor induction Oxytocin;Cervical dilation balloon

收稿日期: 2020-06-16

基金资助:广东省江门市医疗卫生科技计划项目（2019A114）

引用本文:

杨远强；黄雪萍. 引产对剖宫产后经阴道分娩妊娠结局的影响[J]. 中国当代医药, 2021, 28(12): 119-122.
YANG Yuan-qiang HUANG Xue-ping. Influence of induction of labor on pregnancy outcome of vaginal birth after cesarean section. 中国当代医药, 2021, 28(12): 119-122.

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http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2021/V28/I12/119

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