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与第一次阴道分娩相比,剖腹产后阴道分娩中产妇关节损伤的风险指标
J van Bavel1, A C J Ravelli2, J P W R Roovers3
1Department of Obstetrics and Gynaecology, Amphia Hospital Breda, The Netherlands.
概括
与第一次阴道分娩相比,经过剖腹产后阴道分娩 (VBAC) 的女性患产科关节损伤 (OASI) 的风险更高. 诸如手术性阴道分娩和更长的分娩第二阶段等因素在VBAC中增加了OASI风险.
科学领域:
- 产科和妇科 产科和妇科
- 产周研究 产周研究
- 孕产妇健康 孕产妇健康
背景情况:
- 产妇关节损伤 (OASI) 是阴道分娩的一个重要并发症.
- 剖腹产后阴道分娩 (VBAC) 越来越常见,需要了解与之相关的风险.
- 真正无产妇的妇女代表了在不同分娩场景中比较OASI率的基线.
研究的目的:
- 为了比较OASI的发病率在妇女接受了他们的第一个VBAC对比真正的无孕妇女与阴道分娩.
- 在VBAC群体中识别与OASI相关的风险指标.
主要方法:
- 分析了来自荷兰围产阶级登记的大量数据集,其中包括28535名第一次VBAC的妇女和275,439名未婚妇女.
- 使用单变量和多变量逻辑回归分析来比较OASI率并评估风险因素.
- 数据包括分娩类型,先前剖腹产的指示,以及各种母亲和胎儿特征.
主要成果:
- 在VBAC组中,OASI率为5.2%,而在无双组中为4.0%.
- 选择性剖腹产后的阴道分娩显示,与紧急剖腹产后的阴道分娩相比,OASI的调整几率比率 (aOR 1.34) 更高 (aOR 1.16).
- 在VBAC中增加OASI的风险因素包括妊娠年龄≥42周,出生体重≥3500克,手术性阴道分娩和第二阶段的分娩≥60分钟. 中侧表皮切割,较低的出生体重 (<3000g) 和较年轻的母亲年龄 (<25岁) 与较低的OASI率有关.
结论:
- 与第一次阴道分娩的女性相比,患有VBAC的女性的OASI发生率更高,除了那些因怀疑胎儿痛苦而进行紧急剖腹产的女性.
- 特定因素,如中侧表皮切割,25岁以下的母亲年龄和3000克以下的出生体重,与VBAC中OASI风险降低有关.
- 怀孕年龄,高出生体重,手术性阴道分娩和延长的分娩第二阶段是试图VBAC的女性OASI的重要危险因素.
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