引产对剖宫产后经阴道分娩妊娠结局的影响

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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

Received: 16 June 2020

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