剖宫产术后再次妊娠产妇的分娩方式选择逐步判别的临床分析

目的探讨CS风险系数表用于剖宫产后再次妊娠产妇分娩方式的选择及其判别中的价值。方法对某院97例剖宫产史足月分娩产妇采用CS风险系数表进行阴道分娩风险值预测,观察不同预测值下阴道试产的结局。结果 (1)分娩前胎儿性别全部按照男性计算,风险值﹤20%阴道试产成功率100.00%,20%～40%阴道试产成功率86.36%,﹥40%阴道试产成功率56.25%;分娩后根据实际新生儿性别矫正CS风险值,﹤20%阴道试产成功率100.00%,20%～40%阴道试产成功率89.74%,﹥40%阴道试产成功率50.00%;(2)试产失败组与试产成功组在胎儿窘迫、新生儿窒息发生率方面差异无统计学意义(P﹥0.05),出血量、住院天数、住院费用方面差异有统计学意义(P﹤0.05);(3)阴道试产失败产妇剖宫产原因胎儿窘迫占23.08%,滞产占69.23%,先兆子宫破裂占7.69%。结论利用CS风险系数表预测有剖宫产史再次妊娠产妇阴道试产风险,风险值﹤20%阴道试产基本均可成功,﹥40%阴道分娩成功率非常小,不建议考虑阴道试产。

Clinical analysis of stepwise discriminant on delivery mode of subsequent pregnancy after cesarean section

OBJECTIVE To investigate the CS risk factor table value in the selection and discrimination on delivery mode of subsequent pregnancy after cesarean section.METHODS 97 cases of cesarean section delivery at term women in our hospital completed CS risk factor table to predict the risk value of vaginal delivery,the outcomes of vaginal delivery under different predicted values were observed.RESULTS(1)The ante partum fetus were all calculated as boys,when the risk value was ﹤20%,the vaginal delivery success rate was 100.00%,when the risk value was 20%-40%,the vaginal delivery success rate was 86.36%,when the risk value was ﹥40%,the vaginal delivery success rate was 56.25%.After the delivery,the sex of neonates were relied on to correct the CS risk values,when the risk value was ﹤20%,the vaginal delivery success rate was 100.00%,when the risk value was 20%-40%,the vaginal delivery success rate was 89.74%,when the risk value was ﹥40%,the vaginal delivery success rate was 50.00%.(2)There were no obvious differences among the fetal distress,neonatal asphyxia rate of trial failed group and trial successful group(P﹥0.05),while there were obvious differences among the blood loss,hospital stay,hospital charges.(3)Fetal distress by cesarean section of vaginal delivery failure accounted for 23.08%,prolonged labor accounted for 69.23%,threatened uterine rupture accounted for 69.23%,foreboding hysterorrhexis accounted for 7.69%.CONCLUSION Using CS risk factor table to predict the vaginal delivery risks of subsequent pregnancy after cesarean section,when risk value is﹤20%,the vaginal deliveries are basically succeeding,﹥40%,the success rate is very low and not recommended to consider vaginal trial delivery.