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目的探讨剖宫产术后再次妊娠阴道试产成功的影响因素。方法回顾性分析福建省妇幼保健院2013年11月至2014年12月住院分娩的181例既往有1次剖宫产史的单胎、头位、足月妊娠、阴道试产病例的临床资料。将剖宫产后阴道分娩的病例作为观察组A,阴道试产失败改行再次剖宫产的病例作为观察组B。用非条件logistic回归分析孕前及分娩前体质指数(BMI)、定期产前检查、孕周、导乐陪伴分娩、新生儿体重等与阴道试产成功的关系。结果阴道试产成功151例,失败30例,成功率83.4%。孕前BMI≤24.9、定期产前检查、导乐陪伴分娩为阴道试产成功的保护因素;分娩前BMI≥30、新生儿出生体重>3.5kg、孕周≥40周为危险因素。结论定期产前检查、良好的体重管理、病情需要时引产及加速产程、导乐陪伴分娩可提高剖宫产术后再次妊娠阴道试产成功率。
Objective To explore the influencing factors of successful vaginal trial after cesarean section. Methods The clinical data of 181 pregnant women with single fetus, head position, full-term pregnancy and vaginal trial who had a previous history of cesarean section from November 2013 to December 2014 in Fujian MCH were retrospectively analyzed. The case of vaginal delivery after cesarean section as observation group A, vaginal trial failed to divert cesarean section again as the observation group B. Non-conditional logistic regression analysis was used to analyze the relationship between BMI, prenatal care, gestational age, accompanied douche, weight of neonates, and vaginal trial production before pregnancy and before delivery. Results 151 cases of vaginal trial success, failure in 30 cases, the success rate of 83.4%. Pre-pregnancy BMI ≤ 24.9, regular prenatal care, doula accompany childbirth for vaginal trial production of successful protective factors; pre-delivery BMI ≥ 30, newborn birth weight> 3.5kg, gestational age ≥ 40 weeks as a risk factor. Conclusions Regular prenatal examination, good weight management, induction of labor when needed, and accelerated labor, doula with childbirth can improve the success rate of pregnancy after vaginal delivery of cesarean section again.