本文選題：剖宮產(chǎn)術(shù)后再次妊娠陰道分娩 + 產(chǎn)程特點　； 參考：《延邊大學(xué)》2017年碩士論文

【摘要】：目的分析瘢痕子宮再次妊娠陰道分娩(VBAC)的產(chǎn)程特點和分娩成功的相關(guān)因素,為臨床正確處理瘢痕子宮再次妊娠陰道分娩提供參考依據(jù)。方法收集2014年1月至2016年12月在本院婦產(chǎn)科住院孕產(chǎn)婦資料230例(包含瘢痕子宮陰道分娩分娩失敗23例),分為VBAC 67例(觀察組),對照組A組同期足月經(jīng)陰道分娩初產(chǎn)產(chǎn)婦70例,對照組B組足月再次經(jīng)陰道分娩經(jīng)產(chǎn)產(chǎn)婦70例。記錄①孕產(chǎn)婦年齡、孕周、孕產(chǎn)史、身體一般狀況、妊娠期合并癥、胎位等產(chǎn)科一般住院檢查;②與前次剖宮產(chǎn)間隔時間;③第一產(chǎn)程、第二產(chǎn)程、第三產(chǎn)程的產(chǎn)程時間;④分娩時相關(guān)并發(fā)癥;⑤新生兒出生后1分鐘及5分鐘的APgar評分及并發(fā)癥記錄。通過上述檢測項目分析:①各分組的總產(chǎn)程、第一產(chǎn)程、第二產(chǎn)程時間長度分別比較,明確是否存在差異,并分析和與前次剖宮產(chǎn)間隔時間有無關(guān)系;②分析各組分娩時并發(fā)癥(胎盤黏連、產(chǎn)后出血、子宮破裂),新生兒APgar評分并判定是否存在新生兒窒息。結(jié)果1.觀察組VBAC平均總產(chǎn)程(7.444±2.585小時)小于對照組A組總產(chǎn)程(11.39±1.674小時,P0.05);大于對照組B組經(jīng)產(chǎn)婦總產(chǎn)程(6.372±3.150小時,P0.05),有統(tǒng)計學(xué)差異。2.觀察組VBAC產(chǎn)婦平均第一產(chǎn)程(6.960±2.178小時)小于對照組A組10.74±1.579小時,P0.01);大于對照組B組(5.988±3.077小時,P0.05),有統(tǒng)計學(xué)差異。3.觀察組VBAC產(chǎn)婦平均第二產(chǎn)程(0.3510±0.3810小時小于對照組A組(0.5058±0.3124小時,P0.01);大于對照組B組(0.2370±0.1737小時,P0.05)。4.VBAC經(jīng)產(chǎn)婦與前次剖宮產(chǎn)間隔時間3-12年,平均7.444±2.585(小時),總產(chǎn)程和與前次剖宮產(chǎn)間隔時間成負相關(guān)(Y=-0.5.144x+10.123,r2=0.3629,P0.01)。5.各組比較分娩時出血量新生兒5分鐘APgar評分、相關(guān)分娩并發(fā)癥無統(tǒng)計學(xué)差異。6.TOLAC失敗組新生兒體重(3748±1223g)高于VBAC組(3318±756.3g),產(chǎn)婦宮頸 BishoP 評分(6.652±1.201)低于 VBAC 組(9.090±3.073,P0.05)。瘢痕子宮陰道分娩失敗病例中胎兒宮內(nèi)窘迫4例,潛伏期試產(chǎn)6小時無進展4例,活躍期停滯3例,胎位異常10例,產(chǎn)婦放棄2例。結(jié)論1.分析觀察組與對照組的產(chǎn)程時限,VBAC產(chǎn)婦總產(chǎn)程介于初產(chǎn)婦與經(jīng)產(chǎn)婦之間,距前次剖宮產(chǎn)間隔時間是影響產(chǎn)程的重要因素,在臨床處理瘢痕子宮陰道分娩患者時需考慮其特殊產(chǎn)程特點,嚴(yán)密觀察產(chǎn)程進展及是否需要干預(yù)2.胎兒體重、宮頸評分是影響瘢痕子宮陰道分娩成功的重要因素3.瘢痕子宮陰道分娩并不增加產(chǎn)后并發(fā)癥的發(fā)生率,因此在符合試產(chǎn)條件時充分試產(chǎn),降低剖宮產(chǎn)率、提高母兒健康
[Abstract]:Objective to analyze the characteristics of the vaginal delivery of scar uterus and the related factors of successful delivery, and to provide a reference for the clinical treatment of the vaginal delivery of the scar uterus. Methods from January 2014 to December 2016, the data of 230 pregnant and lying-in women in our hospital were collected, including 23 cases of scar uterus and vaginal delivery failure, which were divided into VBAC 67 cases (observation group) and control group A (70 cases of first parturient delivered through vagina during the same period). In group B, 70 cases of parturient were delivered again through vagina. 1 Maternal age, gestational week, history of pregnancy, general condition of pregnancy, complications of pregnancy, gestational position and other obstetrical examinations were recorded. The first stage of labor, the second stage of labor, and the time of the third stage of labor were recorded during the interval between the previous cesarean section and other obstetrical examinations. 4 APgar score and complication record of 1 and 5 minutes after birth. By analyzing the total labor process, the first stage of labor and the second stage of labor, the length of time of the first stage of labor and the second stage of labor were compared to determine whether there were any differences, and whether there was any relationship with the interval time between the previous cesarean section and the previous cesarean section. 2 complications during delivery (placental adhesion, postpartum hemorrhage, uterine rupture, neonatal APgar score and asphyxia neonatorum) were analyzed. Result 1. The average total VBAC of the observation group was 7.444 鹵2.585 hours, which was lower than that of the control group A (11.39 鹵1.674 hours), and was higher than that of the control group B (6.372 鹵3.150 hours) (P 0.05). The average first stage of labor in the observation group was 6.960 鹵2.178 hours, which was lower than that in the control group A (10.74 鹵1.579 hours), and was higher than that in the control group (5.988 鹵3.077 hours) (P 0.05). The average second stage of labor in the observation group was 0.3510 鹵0.3810 hours, which was less than that in the control group A (0.5058 鹵0.3124 hours), and the interval between the parturient and the previous cesarean section was 3-12 years, which was larger than that in the control group B (0.2370 鹵0.1737 hours). The average value was 7.444 鹵2.585. the total labor process and the interval time of the previous cesarean section were negatively correlated with that of the previous cesarean section. There was no significant difference in birth complications among all groups. 6. The weight of newborns in TOLAC failure group (3748 鹵1223g) was higher than that in VBAC group (3318 鹵756.3 g), and the cervical BishoP score of puerpera (6.652 鹵1.201) was lower than that of VBAC group (9.090 鹵3.073g, P 0.05). There were 4 cases of fetal distress, 4 cases of no progress in 6 hours of incubation period, 3 cases of active stagnation, 10 cases of abnormal fetal position and 2 cases of abandonment of parturient. Conclusion 1. The duration of labor and VBAC in the observation group and the control group were between primipara and transpartum, and the interval between the previous cesarean section was an important factor affecting the labor process. In clinical treatment of cicatricial uterus and vagina delivery, it is necessary to consider the special characteristics of labor process, closely observe the progress of labor process and whether intervention is necessary. 2. Fetal weight and cervix score are important factors influencing the success of scar uterus and vagina delivery. Cicatricial uterus and vagina delivery does not increase the incidence of postpartum complications. Therefore, full trial labor can reduce the rate of cesarean section and improve the health of mother and child when it meets the conditions of trial delivery.
【學(xué)位授予單位】：延邊大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.4
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本文編號：1846899