孟亚娟 吴朝勇 陆文兰 沈叶琴

    [摘要] 目的 探讨瘢痕子宫产妇阴道分娩失败的危险因素及其对母婴妊娠结局的影响。方法 选取2018年1月至2020年10月绍兴市柯桥区妇幼保健院妇产科收治的379例瘢痕子宫产妇进行调查，根据其阴道试产是否成功将其分为失败组(n=107)和成功组(n=272);比较两组一般资料的差异性，采用逐步logistic回归法筛选瘢痕子宫产妇阴道分娩失败的危险因素。结果 瘢痕子宫产妇阴道分娩失败率高达28.23%;影响瘢痕子宫产妇阴道分娩失败的危险因素包含高龄(OR=3.238)、产前体质量指数(BMI)(OR=2.588)、胎儿宫内窘迫(OR=3.504)、宫缩乏力(OR=4.233)、产程停滞(OR=5.403)等，而子宫下段厚度(OR=0.221)、使用宫缩剂(OR=0.482)则为保护因素;失败组的产后出血、产褥感染、胎儿窘迫、新生儿窒息等发生率均高于成功组(P<0.01)。结论? 瘢痕子宫产妇阴道分娩失败率仍然较高，且影响阴道试产失败的高危因素较多，而且阴道试产失败对母婴妊娠结局产生较大影响。

    [关键词] 瘢痕子宫;阴道分娩;危险因素;妊娠结局

    [中图分类号] R714.2? ? ? ? ? [文献标识码] B? ? ? ? ? [文章编号] 1673-9701(2022)12-0047-03

    [Abstract] Objective To investigate the risk factors of vaginal delivery failure in puerperas with scarred uterus and the influence of vaginal delivery failure on maternal and fetal pregnancy outcomes. Methods A total of 379 puerperas with scarred uterus admitted to the Department of Obstetrics and Gynecology in Shaoxing Keqiao Maternal and Child Health Care Hospital from January 2018 to October 2020 were selected and divided into failure group (n=107) and success group (n=272) according to whether their vaginal trial of labor was successful. The differences in the general data between the two groups were compared. The risk factors for vaginal delivery failure in puerperas with scarred uterus were screened by stepwise logistic regression. Results The failure rate of vaginal delivery in puerperas with scarred uterus was as high as 28.23%. The risk factors affecting vaginal delivery failure in puerperas with scarred uterus included advanced age (OR=3.238) ......