剖宫产后再次分娩阴道试产失败的影响因素

doi:10.20223/j.cnki.1000-8535.2025.03.020

摘要/Abstract

摘要： 目的探讨剖宫产后再次分娩阴道试产失败的影响因素。方法选取2021年5月—2024年5月在枣庄市妇幼保健院分娩的138例有剖宫产手术史的足月妊娠产妇进行回顾性分析。所有产妇依照其阴道试产结果将成功阴道分娩的35例产妇分为成功组,将阴道试产失败中转剖宫产的103例产妇分为失败组。对比两组产妇的妊娠结局、孕期情况及围产期情况,最后采用多因素Logistic回归分析法分析剖宫产后再次分娩阴道试产失败的影响因素。结果两组产妇子宫破裂、胎儿窘迫、产褥感染及产后出血等妊娠不良结局总发生率对比差异无统计学意义（11.43% vs 6.80%,χ²=0.760,P=0.382>0.05）;通过对比两组产妇孕期情况发现,失败组与成功组孕妇年龄、孕次、身高、孕前体质量、妊娠期合并症、分娩前体质量指数（BMI）比较差异无统计学意义（P>0.05）,失败组与成功组孕妇孕期体质量增长[（4.56±2.56）kg vs （12.45±3.24）kg]、分娩孕周[（39.46±1.25）周 vs（37.95±1.37）周]、阴道分娩史（8.57% vs 26.21%）、妊娠间隔时间[（2.74±0.35）年 vs（3.37±0.57）年]及瘢痕厚度[（4.51±0.56）mm vs（5.42±0.38）mm],对比差异有统计学意义（t=3.497,P<0.001;t=5.755,P<0.001;χ²=4.780,P=0.029;t=6.148,P<0.001;t=10.764,P<0.001）;通过对比两组产妇围产期情况发现,失败组与成功组新生儿性别、是否镇痛比例比较差异无统计学意义（P>0.05）,失败组与成功组孕妇产前新生儿估重[（3352.31±153.67）g vs（3046.25±141.68）g]、是否引产[60.00% vs 52.43%]、胎膜早破[11.43% vs 35.92%]、入院时是否临产[857% vs 27.18%],对比差异有统计学意义（t=10.805,P<0.001;χ²=7.330,P=0.007;χ²=7.500,P=0.006;χ²=5.200,P=0.023）;以阴道试产情况作为因变量（失败=1,成功=0）纳入Logistic回归模型,结果显示,分娩孕周过晚、产前新生儿估重过高、引产及入院时未临产为剖宫产后再次分娩阴道试产失败的影响因素（P<0.05）。结论分娩孕周过高、产前新生儿估重过高、引产及入院时未临产为剖宫产后再次分娩阴道试产失败的独立影响因素,需针对分娩孕周、产前新生儿估重过高的剖宫产后再次分娩阴道试产产妇给予高度关注并采取相应措施进行干预,同时自然临产能够降低阴道试产失败风险,但针对具有引产指征的产妇,依然需要及时引产。

关键词: 剖宫产, 再次分娩, 阴道试产, 中转剖宫产, 影响因素, 试产失败

Abstract: Objective To explore the influencing factors of vaginal trial delivery failure after cesarean section．Methods A retrospective analysis was conducted on 138 full-term pregnant women with a history of cesarean section who gave birth in our hospital from May 2021 to May 2024．All women were divided into two groups according to the results of their vaginal trial delivery．Based on their vaginal trial results,35 parturients who successfully delivered were divided into the successful group,and 103 parturients who failed vaginal trial delivery and transitioned to cesarean section were divided into the failed group．The pregnancy outcomes of postpartum women and the pregnancy and perinatal conditions were compared between the two groups,and multivariate Logistic regression analysis was used to analyze the independent influencing factors of vaginal trial delivery failure after cesarean section．Results There was no significant difference in the total incidence of adverse pregnancy outcomes such as uterine rupture,fetal distress,postpartum infection,and postpartum hemorrhage between the two groups of parturients （P>0.05）．By comparing the pregnancy status of two groups of pregnant women,it was found that there was no difference （P>0.05）．The average weight gain during pregnancy of failure and successful group,gestational age,cases with vaginal delivery history,interval between pregnancy and scar thickness,the contrast difference was significant （all P<0.05）．By comparing the perinatal situation of the two groups,there was no difference in the sex of fetus and analgesia receiving of parturients between the failed group and the successful group （P>0.05）,while there is difference in weight estimation,whether induced labour,premature rupture of fetal membrane,whether admitted to hospital （all P<0.05）．Vaginal trial delivery was set as the dependent variable （failure=1,success=0） and it was incorporated into the Logistic regression model．The results showed that high gestational age during delivery,high estimated weight of fetus before delivery,induction of labor,and non-labor upon admission were independent influencing factors for vaginal trial delivery failure after cesarean section （P<0.05）．Conclusions Excessive gestational age,high estimated weight of fetus before delivery,induced labor,and non-labor upon admission were independent influencing factors for the failure of vaginal trial delivery after cesarean section．It is necessary to pay high attention and take corresponding measures to intervene in women who have undergone vaginal trial delivery after cesarean section due to excessive gestational age and high estimated weight of fetus before delivery．At the same time,spontaneous labour can reduce the risk of vaginal trial delivery failure．However,for women with indications for induced labor,timely induction is still necessary．

Key words: cesarean section, giving birth again, vaginal trial delivery, transfer to cesarean section, influencing factors, trial production failed

王新, 石丹丹, 张爽, 王青, 张亚莉. 剖宫产后再次分娩阴道试产失败的影响因素[J]. 广州医药, 2025, 56(3): 410-415.

WANG Xin, SHI Dandan, ZHANG Shuang, WANG Qing, ZHANG Yali. The influencing factors of failed vaginal trial delivery after cesarean section[J]. Guangzhou Medical Journal, 2025, 56(3): 410-415.

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