目的 研究二次剖宫产后续妊娠的分娩方式。方法 选取广州市妇女儿童医疗中心2015年8月1日—2017年12月31日的第三次及以上妊娠孕妇资料,要求前两次均为剖宫产,本次妊娠为头位单胎。分析本次妊娠相关因素及最终分娩方式、妊娠结局及围产儿情况。结果 二次剖宫产后阴道分娩与急诊、择期剖宫产相比,三组子宫破裂、新生儿窒息等的发生率差异无统计学意义。成功阴道分娩者本次均为自然临产。结论 二次剖宫产后,第三次妊娠分娩方式的选择包括顺产及剖宫产,在妊娠结局、母儿并发症方面差异无统计学意义,有阴道试产史是成功阴道分娩的有利因素。孕妇尤其是自然临产孕妇可在严密监护下选择阴道试产。

Objective To study the delivery mode after two previous cesareans. Methods We selected pregnant women, single cephalic, following two previous cesareans in Guangzhou Women and Children Medical Center, from August 1, 2015 to December 31, 2017. Analysis of this pregnancy related factors and final delivery mode, the maternal and fetal morbidities were studied. Results There wasn't statistical significance in the incidence of uterine rupture, neonatal asphyxia among vaginal birth after two previous cesareans, selected cesarean section and emergency cesarean section. And the success cases of vaginal delivery are natural labor. Conclusion The delivery modes after two previous cesareans include vaginal delivery and cesarean section. There are no statistical significance in pregnancy outcomes. Vaginal trial history are the favorable factors of successful vaginal delivery. Especially in pregnant women with natural vaginal labor we can choose vaginal delievery under intensive care.

目的 探讨分娩前后母体血浆D-二聚体的变化及其在预测和预防静脉血栓栓塞症的临床意义。方法 回顾性分析2015年5月在东莞市长安医院分娩的、产前与产后均进行了D-二聚体检测,产前与产后均未使用抗凝药物并产后随访6周的102例产妇的临床资料。结果 分娩后48~72小时,75.5%的产妇血浆D-二聚体水平下降,24.5%的产妇血浆D-二聚体水平升高。血浆D-二聚体水平升高的产妇60%存在发生VTE的高危因素,经积极预防,无静脉血栓栓塞症病例发生。结论 比较分娩前后母体血浆D-二聚体水平是有临床意义的。对分娩后母体血浆D-二聚体水平升高者,尤其是存在血栓高危因素者应高度重视,积极预防静脉血栓栓塞症。

目的 观察联合缩宫素与间苯三酚在基层医院分娩中疗效。方法 选用高明区人民医院2013年8月—2014年10月要求自然分娩的初产妇200例,随机分成两组,孕妇进入临产时,观察组予双管输液,予缩宫素2.5U+5%葡萄糖注射液静滴,另一静脉通路5%葡萄糖注射液250 mL+间苯三120 mg静滴;对照组仅予缩宫素2.5U+5%葡萄糖注射液静滴。比较两组产妇各产程时间、分娩方式、新生儿情况、产后出血量。结果 观察组第一产程、第二产程、第三产程时间均短于对照组(P＜0.01),剖宫产率3%及新生儿窒息率3%均低于对照组21%,和13%;P＜0.01;产后2小时出血量较对照组少(109.38±16.13)mL vs(185.00±30.71)mL, P＜0.01。结论 临产孕妇联合间苯三酚与缩宫素,可缩短产程,降低剖宫产率,降低新生儿窒息发生率,减少产后出血量,推荐基层医院使用。

Objective To investigate the effect of oxytocin combined with phloroglucinol in childbirth in primary hospital. Methods A total of 200 primiparas admitted to department of obstetrics in Gaoming people's hospital from August 2013 to October 2014　were selected as study subjects. The cases were randomly divided into observation group (100 cases) and control group (100 cases). In labor, cases in control group were given oxytocin 2.5 U and 5% glucose injection 500 mL, and were given 5% glucose injection 250 mL and phloroglucinol 120 mg by double tube intravenous infusion. Cases in observation group were only given oxytocin 2.5 U and 5% glucose injection 500 mL intravenous infusion. The duration of delivery、delivery mode、the condition of newborn and volume of bleeding after labor were compared between two groups. Results For the first、second and third stages of labor, duration of delivery in observation group were significantly shorter than that in control group (P＜0.01), Both cesarean delivery rate [3%(3/100)] and the incidence of neonatal asphyxia[3%(3/100)] in observation group were significantly lower than that in control group 21%(21/100)and 13%(13/100;P＜0.01). The volume of bleeding during two hours after labor in observation group was less than that in control group (109.38±16.13)mL vs 185.00±30.71 mL, P＜0.01. Conclusion In the stages of labor, the use of oxytocin combined with phloroglucinol can shorten the duration of delivery, reduce the cesarean delivery rate and the incidence of neonatal asphyxia and reduce the volume of bleeding after labor. It is worth recommending to use in primary hospital.

       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%，χ ² =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；χ ² =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；χ ² =7.330，P=0.007；χ ² =7.500，P=0.006；χ ² =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。

       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，intervalbetween 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．

       目的   探讨阴道分娩后尿失禁患者疾病应对方式的影响因素。方法   选取2022年1月—2023年1月医院收治的阴道分娩后尿失禁患者78例，评估所有患者的应对方式，根据结果分为积极应对组与消极应对组，设计基线资料调查表，详细统计两组患者的基线资料并比较，重点分析阴道分娩后尿失禁患者疾病应对方式的影响因素。结果   经评估，78例阴道分娩后尿失禁患者疾病消极应对有40例，占比51.28%；积极应对组与消极应对组患者的产次（χ ² =4.110，P=0.043）、文化水平（Z=2.094，P=0.036）、家庭关怀度（Z=2.069，P=0.040）与自我效能（Z=2.249，P=0.025）比较差异有统计学意义，组间年龄（t=0.096，P=0.924）、孕次（t=1.257，P=0.212）、体质指数（BMI）（t=0.125，P=0.901）、工作（χ ² =0.778，P=0.378）、家庭月人均收入（χ ² =0.044，P=0.834）、漏尿（χ ² =0.040，P=0.842）比较差异无统计学意义；经回归分析发现，家庭关怀度低（OR=1.799，P=0.041）、自我效能低（OR=1.942，P=0.026）、经产妇（OR=2.554，P=0.045）及文化水平低（OR=1.837，P=0.038）均是阴道分娩后尿失禁患者疾病应对方式的影响因素。结论   阴道分娩后尿失禁患者疾病消极应对风险高，可能与产次、文化水平、家庭关怀度及自我效能有关。

       Objective To explore the influencing factors of disease coping strategies in patients with urinary incontinence after vaginal delivery．Methods A total of 78 patients with urinary incontinence after vaginal delivery admitted to the hospital from January 2022 to January 2023 were selected．The coping strategies of all patients were evaluated，and they were divided into a positive coping group and a negative coping group based on the results．A baseline data questionnaire was designed，and the baseline data of the two groups of patients were compared in detail．The focus was on analyzing the factors influencing the disease coping strategies of patients with urinary incontinence after vaginal delivery．Results After evaluation，40 out of 78 patients with urinary incontinence after vaginal delivery had negative coping strategies，accounting for 51.28%．The parity of patients in the positive and negative coping groups（χ ² =4.110，P=0.043），educational level（Z=2.094，P=0.036），family care（Z=2.069，P=0.040），and self-efficacy（Z=2.249，P=0.025）among the groups were different．Age between groups（t=0.096，P=0.924），gestational age（t=1.257，P=0.212），body mass index（t=0.125，P=0.901），and work experience（χ ² =0.778，P=0.378），monthly per capita income of households（χ ² =0.044，P=0.834），urinary leakage（χ 2 =0.040，P=0.842）had no statistically significant difference in comparison．Through regression analysis，it was found that low family care（OR=1.799，P=0.041），low self-efficacy（OR=1.942，P=0.026），postpartum women（OR=2.554，P=0.045），and low educational level（OR=1.837，P=0.038）were all influencing factors on the disease coping strategies of patients with urinary incontinence after vaginal delivery．Conclusions  Patients with urinary incontinence after vaginal delivery have a higher risk of negative coping with the disease，which may be related to parity，educational level，family care and self-efficacy．