剖宫产术后再次妊娠阴道分娩与初产妇阴道分娩产程特征的比较分析

摘要
图/表
参考文献(21)
相关文章 (15)

全文: PDF (0 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的比较分析新生儿结局良好的剖宫产术后再次妊娠阴道分娩（VBAC）与初产妇阴道分娩的产程特征。方法回顾性分析2017年1～12月于苏州市立医院本部成功阴道分娩并且新生儿结局良好（5 min Apgar 评分≥8分）的单胎足月产妇的临床资料，包括290例无阴道分娩史的VBAC 产妇，作为VBAC组；抽取同期经阴道分娩的311例初产妇，作为初产组。比较两组间总产程、不同阶段产程以及采取干预措施时的产程差异。结果 VBAC组的总产程、第一产程宫口扩张2～10 cm 阶段和第二产程均短于初产组[455.0（340.0，652.5）vs.530.0（380.0，733.0）min；100.0（60.0，190.0） vs.130.0（80.0，220.0）min；31.0（20.0，47.0） vs.43.0（28.0，69.0）min]，差异有统计学意义（P＜0.05）。两组的第三产程比较，差异无统计学意义（P>0.05）。VBAC组中自然分娩产妇的总产程、第一产程宫口扩张＜2 cm 阶段、宫口扩张2～10 cm 阶段以及第二产程均短于初产妇自然分娩产妇[420.0（315.0，560.0） vs.487.5（371.3，646.3）min；300.0（180.0，408.8） vs.337.5（210.0，480.0）min；80.0（50.0，116.3） vs.109.0（60.0，150.0）min；28.0（18.0，45.0） vs.37.5（28.0，54.3）min]，差异有统计学意义（P＜0.05）。VBAC组与初产组中采取缩宫素、人工破膜和镇痛等干预措施产妇的总产程比较，差异无统计学意义（P＞0.05）。结论与初产妇相比，自然分娩的VBAC 产妇产程更短。因此，对剖宫产术后再次妊娠的孕妇，条件许可者可推荐尝试VBAC。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	贾月改
	吴晓
	柴利强
	康苏娅

关键词 ：剖宫产术后再次妊娠阴道分娩, 产程, 初产妇, 回顾性分析

Abstract：Objective To compare and analyze the labor characteristics of vaginal delivery after cesarean section(VBAC) and vaginal delivery of nulliparas with good outcome.Methods The clinical data of single-term full-term maternal women who had successful vaginal delivery and normal neonatal outcomes (5-minute Apgar score ≥7 points)from January to December 2017 in Headquarter of Suzhou Municipal Hospital were retrospectively analyzed,including 290 women undergoing VBAC as VBAC group,and 311 women with vaginal delivery at the same time were selected as the nulliparas group.Comparison of total labor duration and labor duration at different stages between two groups with or without interventions were performed.Results The total labor duration,the 2-10 cm period of the uterine dilation in the first labor stage,and the second labor stage in the VBAC group were shorter than those in the nulliparas group (455.0 [340.0,652.5]vs.530.0 [380.0,733.0]min;100.0 [60.0,190.0]vs.130.0 [80.0,220.0]min;31.0 [20.0,47.0]vs.43.0 [28.0,69.0]min),the differences were statistically significant (P＜0.05).There was no statistically significant difference in the third stage of labor between the two groups (P＞0.05).The total labor duration,＜2 cm and 2-10 cm period of the uterine dilation in the first stage of labor,and the second stage of labor in the VBAC group with natural delivery were shorter than those in the nulliparas group with natural delivery (420.0 [315.0,560.0]vs.487.5 [371.3,646.3]min;300.0 [180.0,408.8]vs.337.5[210.0,480.0]min;80.0 [50.0,116.3]vs.109.0 [60.0,150.0]min;28.0 [18.0,45.0]vs.37.5 [28.0,54.3]min),the differences were statistically significant (P＜0.05).For women who took interventions such as Oxytocin,artificial rupture of membranes,and epidual analgesia,the total labor duration of the VBAC group was similar to that of the nulliparas group (P>0.05).Conclusion Compared with nulliparas,VBAC women with natural delivery has a shorter labor duration.Therefore,for pregnant women who are pregnant again after cesarean section,VBAC can be recommended to those who meet the indications.

Key words： Vaginal delivery after cesarean section Labor duration Nulliparas Retrospective analysis

基金资助:江苏省苏州市科技发展计划项目（SYSD2018210）

通讯作者: 康苏娅（1981-），女，硕士，副主任医师，主要研究方向：高危妊娠及剖宫产后再次阴道分娩的发病特点和机制，擅长妊娠合并内分泌疾病的诊疗、剖宫产后再次阴道分娩的评估及临床处理

作者简介: 贾月改（1983-），女，硕士，主治医师，主要从事妊娠高血压相关的临床和科研工作

引用本文:

贾月改；吴晓；柴利强；康苏娅. 剖宫产术后再次妊娠阴道分娩与初产妇阴道分娩产程特征的比较分析[J]. 中国当代医药, 2020, 27(35): 20-24.
JIA Yue-gai；WU Xiao；CHAI Li-qiang； KANG Su-ya. Comparative analysis of labor pattern of vaginal delivery after cesarean section and vaginal delivery of nulliparas. 中国当代医药, 2020, 27(35): 20-24.

链接本文:

https://www.dangdaiyiyao.com/CN/ 或 https://www.dangdaiyiyao.com/CN/Y2020/V27/I35/20

	ing a trial of labor after cesarean.Do they have their own rules?[J].Acta Obstet Gynecol Scand，2011，90 （12）：1386-1392.
[8]	Grantz KL，Gonzalez-Quintero V，Troendle J，et al.Labor pat
	terns in women attempting vaginal birth after cesarean with normal neonatal outcomes[J].Am J Obstet Gynecol，2015，213（2）：226.e1-6.
[9]	Graseck AS，Odibo AO，Tuuli M，et al.Normal first stage of
	labor in women undergoing trial of labor after cesarean de
	livery[J].Obstet Gynecol，2012，119（4）：732-736.
[10]	Lindblad Wollmann C，Ahlberg M，Saltvedt S，et al.Risk of repeat cesarean delivery in women undergoing trial of labor：A population-based cohort study[J].Acta Obstet Gynecol Scand，2018，97（12）：1524-1529.
[14]	Zhang L，Troendle J，Branch DW，et al.The expected labor progression after labor augmentation with oxytocin：A retrospective cohort study[J].PLoS One，2018，13（10）：e0205735.
[15]	Balki M，Ronayne M，Davies S，et al.Minimum oxytocin dose requirement after cesarean delivery for labor arrest[J].Obstet Gynecol，2006，107（1）：45-50.
[4]	中华医学会妇产科学分会产科学组.剖宫产术后再次妊娠阴道分娩管理的专家共识（2016）[J].中华妇产科杂志，2016，51（8）：561-564.
[5]	American College of Obstetricians and Gynecologists′ Committee on Practice Bulletins—Obstetrics.ACOG Practice Bul
	letin No.205：Vaginal Birth After Cesarean Delivery[J].Obstet Gynecol，2019，133（2）：e110-e127.
[6]	Tsakiridis I，Mamopoulos A，Athanasiadis A，et al.Vaginal Birth After Previous Cesarean Birth：A Comparison of 3 Na
[1]	Li HT，Luo S，Trasande L，et al.Geographic Variations and Temporal Trends in Cesarean Delivery Rates in China，2008-2014[J].JAMA，2017，317（1）：69-76.
[2]	Betrán AP，Ye J，Moller AB，et al.The Increasing Trend in Caesarean Section Rates：Global，Regional and National Estimates：1990-2014[J].PLoS One，2016，11（2）：e0148343.
[3]	Liang J，Mu Y，Li X，et al.Relaxation of the one child policy and trends in caesarean section rates and birth outcomes in China between 2012 and 2016：observational study of nearly seven million health facility births[J].BMJ，2018，360：k817.
	tional Guidelines[J].Obstet Gynecol Surv，2018，73（9）：537-543.
[11]	Thapsamuthdechakorn A，Sekararithi R，Tongsong T.Factors Associated with Successful Trial of Labor after Cesarean Section：A Retrospective Cohort Study[J].J Pregnancy，2018，2018：6140982.
[12]	Grylka-Baeschlin S，Clarke M，Begley C，et al.Labour characteristics of women achieving successful vaginal birth after caesarean section in three European countries[J].Midwifery，2019，74：36-43.
[13]	Anim-Somuah M，Smyth RM，Cyna AM，et al.Epidural versus non-epidural or no analgesia for pain management in labour[J].Cochrane Database Syst Rev，2018，5（5）：CD000 331.
[16]	Lavoie A，McCarthy RJ，Wong CA.The ED90 of prophylactic oxytocin infusion after delivery of the placenta during cesarean delivery in laboring compared with nonlaboring women：an up-down sequential allocation dose-response study[J].Anesth Analg，2015，121（1）：159-164.
[17]	Miller N，Pelleg M，Hag-Yahia N，et al.Labor progression of women attempting vaginal birth after previous cesarean delivery with or without epidural analgesia[J].Arch Gynecol Obstet，2019，299（1）：129-134.
[7]	Faranesh R，Salim R.Labor progress among women attempt
[20]	陈凤兰，颜建英.产程时限研究进展及适宜的产程干预时机选择[J].国际妇产科学杂志，2017，44（5）：539-542.
[21]	李剑红，吴晓玲.瘢痕子宫产妇再次妊娠行阴道试产的可行性及影响因素[J].中国现代医生，2019，57（17）：63-66.
[18]	Sun J，Yan X，Yuan A，et al.Effect of epidural analgesia in trial of labor after cesarean on maternal and neonatal outcomes in China：a multicenter，prospective cohort study[J].BMC Pregnancy Childbirth，2019，19（1）：498.
[19]	Leighton BL，Halpern SH.The effects of epidural analgesia on labor，maternal，and neonatal outcomes：a systematic review[J].Am J Obstet Gynecol，2002，186（5 Suppl Nature）：S69-77.