中华围产医学杂志
中華圍產醫學雜誌
중화위산의학잡지
CHINESE JOURNAL OF PERINATAL MEDICINE
2014年
3期
164-168
,共5页
刘铭%刘丹%李婷%王伟琳%单震丽%盛丽丽%苏秀娟%周健%裘佳敏
劉銘%劉丹%李婷%王偉琳%單震麗%盛麗麗%囌秀娟%週健%裘佳敏
류명%류단%리정%왕위림%단진려%성려려%소수연%주건%구가민
剖宫产后阴道分娩%产后出血%子宫破裂%妊娠结局
剖宮產後陰道分娩%產後齣血%子宮破裂%妊娠結跼
부궁산후음도분면%산후출혈%자궁파렬%임신결국
Vaginal birth after cesarean%Postpartim hemorrhage%Uterine rupture%Pregnancy outcome
目的 探讨剖宫产术后阴道分娩(vaginal birth after cesarean,VBAC)的管理规范对安全开展和成功推行VBAC的指导意义. 方法 回顾性分析2009年1月至201 3年7月在同济大学附属第一妇婴保健院分娩的剖宫产术后再次妊娠的2 002例孕妇的资料,对本院VBAC管理规范实施前后试行VBAC的116例有1次剖宫产史的单胎孕妇进行比较,规范实施后的95例为研究组,规范实施前的21例为对照组.采用f或x2检验比较2组孕妇产后出血、子宫破裂、新生儿Apgar评分及入住新生儿病房等母儿结局. 结果 自2012年1月本院VBAC管理规范实施后,VBAC试产率从1.8％(21/1 147)增加至11.1％ (95/855),VBAC成功率达97.9％(93/95),仅2例因产时胎儿窘迫和活跃期停滞中转剖宫产终止妊娠.研究组孕妇产时出血[(246±127)ml]低于对照组[(260±35) ml](t=0.50,P＞0.05);产褥病率1例(1.0％),高于对照组[0(0.0％)](P＞0.05);产后住院(2.1±0.8)d,短于对照组[(2.1±0.5)d](t=0.22,P＞0.05),但差异均无统计学意义.研究组新生儿出生体重为(3 290±632)g,显著高于对照组[(2 837±1 057)g](t=2.59,P＜0.05);新生儿l min Apgar评分8～l0分88例(92.6％),4～7分7例(7.4％),对照组21例新生儿1 min Apgar评分均为8～l0分(100％),差异无统计学意义(x2=1.64,P＞0.05);研究组1 7例(1 7.9％)新生儿入住新生儿病房,显著低于对照组[8例(33.1％)](x2=4.15,P＜0,05).2组均无子宫破裂、全子宫切除或母儿死亡等严重并发症. 结论 VBAC管理规范对安全开展VBAC和提高VBAC成功率有指导意义,有利于保障母儿安全和降低VBAC失败带来的严重不良预后.
目的 探討剖宮產術後陰道分娩(vaginal birth after cesarean,VBAC)的管理規範對安全開展和成功推行VBAC的指導意義. 方法 迴顧性分析2009年1月至201 3年7月在同濟大學附屬第一婦嬰保健院分娩的剖宮產術後再次妊娠的2 002例孕婦的資料,對本院VBAC管理規範實施前後試行VBAC的116例有1次剖宮產史的單胎孕婦進行比較,規範實施後的95例為研究組,規範實施前的21例為對照組.採用f或x2檢驗比較2組孕婦產後齣血、子宮破裂、新生兒Apgar評分及入住新生兒病房等母兒結跼. 結果 自2012年1月本院VBAC管理規範實施後,VBAC試產率從1.8％(21/1 147)增加至11.1％ (95/855),VBAC成功率達97.9％(93/95),僅2例因產時胎兒窘迫和活躍期停滯中轉剖宮產終止妊娠.研究組孕婦產時齣血[(246±127)ml]低于對照組[(260±35) ml](t=0.50,P＞0.05);產褥病率1例(1.0％),高于對照組[0(0.0％)](P＞0.05);產後住院(2.1±0.8)d,短于對照組[(2.1±0.5)d](t=0.22,P＞0.05),但差異均無統計學意義.研究組新生兒齣生體重為(3 290±632)g,顯著高于對照組[(2 837±1 057)g](t=2.59,P＜0.05);新生兒l min Apgar評分8～l0分88例(92.6％),4～7分7例(7.4％),對照組21例新生兒1 min Apgar評分均為8～l0分(100％),差異無統計學意義(x2=1.64,P＞0.05);研究組1 7例(1 7.9％)新生兒入住新生兒病房,顯著低于對照組[8例(33.1％)](x2=4.15,P＜0,05).2組均無子宮破裂、全子宮切除或母兒死亡等嚴重併髮癥. 結論 VBAC管理規範對安全開展VBAC和提高VBAC成功率有指導意義,有利于保障母兒安全和降低VBAC失敗帶來的嚴重不良預後.
목적 탐토부궁산술후음도분면(vaginal birth after cesarean,VBAC)적관리규범대안전개전화성공추행VBAC적지도의의. 방법 회고성분석2009년1월지201 3년7월재동제대학부속제일부영보건원분면적부궁산술후재차임신적2 002례잉부적자료,대본원VBAC관리규범실시전후시행VBAC적116례유1차부궁산사적단태잉부진행비교,규범실시후적95례위연구조,규범실시전적21례위대조조.채용f혹x2검험비교2조잉부산후출혈、자궁파렬、신생인Apgar평분급입주신생인병방등모인결국. 결과 자2012년1월본원VBAC관리규범실시후,VBAC시산솔종1.8％(21/1 147)증가지11.1％ (95/855),VBAC성공솔체97.9％(93/95),부2례인산시태인군박화활약기정체중전부궁산종지임신.연구조잉부산시출혈[(246±127)ml]저우대조조[(260±35) ml](t=0.50,P＞0.05);산욕병솔1례(1.0％),고우대조조[0(0.0％)](P＞0.05);산후주원(2.1±0.8)d,단우대조조[(2.1±0.5)d](t=0.22,P＞0.05),단차이균무통계학의의.연구조신생인출생체중위(3 290±632)g,현저고우대조조[(2 837±1 057)g](t=2.59,P＜0.05);신생인l min Apgar평분8～l0분88례(92.6％),4～7분7례(7.4％),대조조21례신생인1 min Apgar평분균위8～l0분(100％),차이무통계학의의(x2=1.64,P＞0.05);연구조1 7례(1 7.9％)신생인입주신생인병방,현저저우대조조[8례(33.1％)](x2=4.15,P＜0,05).2조균무자궁파렬、전자궁절제혹모인사망등엄중병발증. 결론 VBAC관리규범대안전개전VBAC화제고VBAC성공솔유지도의의,유리우보장모인안전화강저VBAC실패대래적엄중불량예후.
Objective To assess the value of clinical guidelines for safe and successful implementation of vaginal birth after cesarean (VBAC).Methods A retrospective study was conducted,which included 2 002 cases with prior cesarean delivery in the First Maternity and Infant Hospital Affiliated to Tongji University,from January 2009 to July 2013.A total of 116 women with singleton live births and one prior cesarean delivery who attempted VBAC were included.The cases were divided into two groups according to the time of implementation of the VBAC guidelines of our hospital:the research group (n=95) and the control group (n=21).Pregnancy outcomes were evaluated according to whether the VBAC guidelines were implemented.Main outcome measures included the rates of attempting VBAC,postpartum hemorrhage,uterine rupture,neonatal Apgar score and admittance to neonatal unit.Chi-square or t-test were used to analyze the data.Results Following implementation of the VBAC guidelines from January 2012,the rate of trial labor increased to 11.1％ (95/855),compared to 1.8％ (21/1 147) before implementation of the VBAC guidelines.In the research group,93 cases (97.9％,93/95) were successful in VBAC and only two cases failed due to fetal distress or a protracted active phase.The mean intrapartum blood loss in the research group was (246± 127) ml,which was lower than that in the control group [(260±35) ml,t=0.50,P＞0.05].Puerperal morbidity occurred in one patient (1.0％) in the research group,which was higher than that in the control group [0 (0.0％)] (P＞0.05).The length of hospitalization in the research group was (2.1 ±0.8) d,which was longer than that in the control group [(2.1-±-0.5) d,t=0.22,P＞0.05].The neonatal 1 min Apgar score was 8-10 in 88 cases (92.6％) and 4-7 in seven cases (7.4％) in the research group; while the 1 min Apgar score in the control group was 8-10 in all 21 cases (100％) (x2=1.64,P＞0.05).None of the above showed significant difference between the two groups.The mean neonatal birth weight in the research group was (3 290± 632) g,which was higher than that in the control group [(2 837±1 057) g,t=-2.59,P＜0.05].Seventeen neonates (17.9％) in the research group were admitted to neonatal units,which was lower than that in the control group [8 (33.1％),x2=4.15,P＜0.05].There were no serious complications such as uterine rupture,hysterectomy or maternal death in the two groups.Conclusions The value of VBAC guidelines for the safe and successful implementation of VBAC is significant.These guidelines help to ensure maternal and fetal safety,and reduce serious complications caused by failed VBAC.
