护理学报 ›› 2019, Vol. 26 ›› Issue (4): 27-30.doi: 10.16460/j.issn1008-9969.2019.04.027
剖宫产后阴道试产产程观察与护理进展
张士琼, 刘书莲, 朱红艳
- 荆州市妇幼保健院 产科,湖北 荆州 434020
摘要： 目的 对剖宫产后阴道试产安全性评估、产程观察和护理进行综述,旨在为提高剖宫产后阴道试产的成功率提供一定的参考和依据。方法 通过查阅国内外相关文献,依据文献结果对剖宫产后再次妊娠阴道试产的产程观察和护理措施进行总结。结果 再次生育的孕产妇32.7%~50.0%为疤痕子宫,阴道试产成功率为60%~80%,剖宫产后阴道试产需根据孕产妇条件进行个性化评估,并结合超声测量子宫下段肌层厚度和子宫切口肌层的连续性,建立独立的评估表评估其分娩方式的安全性,并加强第一、第二、第三产程的监护和观察,在出现紧急情况下多学科能协助快速进行剖宫产,安全有效处理子宫破裂等并发症。结论 剖宫产后再次妊娠的孕产妇进行阴道试产是降低剖宫产率策略之一,加强对此类孕产妇安全有效的产程观察和护理,可提高阴道试产的成功率,降低再次剖宫产率。
中图分类号:
- R473.71
| [1] Hou L, Li G, Zou L, et al. Cesarean Delivery Rate and Indications in Mainland China: A Cross Sectional Study in 2011(in Chinese) China[J]. J Obstet Gynecol, 2014, 49(10):728-735. DOI:10.3760/cma.j.issn.0529-567x.2014.10.003. [2] Liu Y, Wang X, Zou L, et al.An Analysis of Variations of Indications and Maternal-fetal Prognosis for Caesarean Section in a Tertiary Hospital of Beijing: A Population-based Retrospective Cohort Study[J]. Medicine (Baltimore),2017, 96(7):e5509. DOI:10.1097/MD.0000000000005509. [3] Crowther C A, Dodd J M, Hiller J E, et al.Planned Vaginal Birth or Elective Repeat Caesarean Patient Preference Restricted Cohort with Nested Randomised Trial[J]. PLoS Med, 2012, 9(3):e1001192. DOI:10.1371/journal.pmed.1001192. [4] Spong C Y, Berghella V, Wenstrom K D, et al.Preventing the First Cesarean Delivery: Summary of a Joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-fetal Medicine, and American College of Obstetricians and Gynecologists Workshop[J]. Obstet Gynecol, 2013, 121(4):1181-1193.DOI:10.1097/AOG.0b013e31828a82b5. [5] Mone F, Harrity C, Toner B, et al.Predicting Why Women Have Elective Repeat Cesarean Deliveries and Predictors of Successful Vaginal Birth after Cesarean[J].Int J Gynecol Obstet, 2014, 126(1):67-69. DOI:10.1016/j.ijgo.2013.12.013. [6] Ling C, Zhao J, Qi X.Partial Molar Pregnancy in the Cesarean Scar: A Case Report and Literature Review[J]. Medicine (Baltimore), 2018, 97(26):11312-11317.DOI:10.1097/MD.0000000000013213. [7] 中华医学会妇产科学分会产科学会组. 剖宫产术后再次妊娠分娩管理的国家共识(2016)[J].中华妇产科杂志,2016, 51(8):561-563. DOI:10.3760/cma.j.issn.0529-567x.2016.08.001. [8] 何承晋,漆洪波.美国妇产科医师学会《前次剖宫产后阴道分娩指南》2015版要点解读[J]. 中国实用妇科与产科杂志, 2016, 32(11):1083-1084. DOI:10.7504/fk2016100114. [9] Branger B, Dochez V, Gervier S et al. Cesarean after Labor Induction: Risk Factors and Prediction Score[J]. Gynecol Obstet Fertil Senol, 2018,46(5):458-465.DOI:10.1016/j.gofs.2018.03.008. [10] Sentilhes L, yssière C, Beucher G, et al. Delivery for Women With a Previous Cesarean: Guidelines for Clinical Practice from the French College of Gynecologists and Obstetricians (CNGOF)[J]. Eur J Obstet Gynecol Reprod Biol, 2013, 170(1):25-32.DOI:10.1016/j.ejogrb.2013.05.015. [11] Grylka-Baeschlin S, Petersen A, Karch A, et al.Labour Duration and Timing of Interventions in Women Planning Vaginal Birth after Caesarean Section[J]. Midwifery, 2016, 34(5):221-229. DOI:10.1016/j.midw.2015.11.004. [12] Kalok A, Zabil S A, Jamil M A, et al.Antenatal Scoring System in Predicting the Success of Planned Vaginal Birth Following One Previous Caesarean Section[J]. J Obstet Gynaecol,2018,38(3):339-343.DOI:10.1080/01443615.2017.1355896. [13] Clark S M, Carver A R, HanKins G D. Vaginal Birth after Cesarean and Trial of Labor after Cesarean: What Should We be Recommending Relative to Maternal Risk: Benefit?[J]. Womens Health (Lond), 2012, 8(4):377-378. DOI:10.2217/whe.12.28. [14] Jordans I P, de Leeuw R, Stegwee S I, et al. A Practical Guideline for Examining a Uterine Niche Using Ultrasonography in Non-pregnant Women: A Modified Delphi Method Amongst European Experts[J]. Ultrasound Obstet Gynecol, 2018, 14(10):1909-1916. DOI:10.1002/uog.19049. [15] Hautakangas T, Palomäki O, Eidstø K, et al. Impact of Obesity and Other Risk Factors on Labor Dystocia in Term Primiparous Women: A Case Control Study[J]. BMC Pregnancy Childbirth,2018, 18(1):304.-306.DOI:10.1186/s12884-018-1938-3. [16] Landon M B, Leindecker S, Spong C Y, et al.The MFMU Cesarean Registry: Factors Affecting the Success of Trial of Labor after Previous Cesarean Delivery[J]. AM J Obstet Gynecol, 2005,193(5):1016-1023.DOI:10.1016/j.ajog.2005.05.066. [17] 郑媛媛,邹丽颖,范玲. 新产程标准实施后产程中剖宫产指征的变化及母儿预后分[J].中华妇产科杂志, 2016, 51(4):245-249. DOI:10.7620/zgfybj.j.issn.1001-4411.2018.13.25. [18] Kalok A, Zabil S A, Jamil M A, et al.Antenatal Scoring System in Predicting the Success of Planned Vaginal Birth Following One Previous Caesarean Section[J]. J Obstet Gynaecol, 2018,38(3):339-343. DOI:10.1186/s12884-018-1938-3. [19] 段然,漆洪波. ACOG剖宫产后阴道试产指南(2017版)解读[J].中国实用妇科与产科杂志, 2018, 34(5):537-541. DOI:10.19538/j.fk2018050115. [20] Royal College of Obstetricians and Gynecologists. Birth after Previous Cesarean Birth, in Green-top Guideline[M]. London: RCOG, 2007:1-17. [21] Ridgeway J J, Weyrich D L, Benedetti T J.Fetal Heart Rate Changes Associated with Uterine Rupture[J]. Obstet Gynecol,2004,103(3):506-512. DOI:10.1097/01.AOG.0000113619.67704.99. [22] King V J, Fontaine P L, Atwood L A, et al.Clinical Practice Guideline Executive Summary: Labor After Cesarean/Planned Vaginal Birth After Cesarean[J]. Ann Fam Med, 2015, 13(1):80-81. DOI:10.1370/afm.1738. [23] Grylka-Baeschlin S, Petersen A, Karch A, et al.Labour Duration and Timing of Interventions in Women Planning Vaginal Birth after Caesarean Section[J]. Midwifery, 2016, 34(5):221-229. DOI:10.1016/j.midw.2015.11.004. [24] Wu S W, Dian H, Zhang W Y. Labor Onset, Oxytocin Use,Epidural Anesthesia for Vaginal Birth after Cesarean Section and Associated Effects on Maternal and Neonatal Outcomes in a Tertiary Hospital in China: A Retrospective Study[J]. Chin Med J (Engl), 2018, 131(8):933-938. DOI: 10.4103/0366-6999.229897. [25] 赵原,朱丽红,刘慧. 瘢痕子宫再次妊娠孕妇阴道试产的风险分析及对策[J]. 护理学报, 2010, 17(12B):36-38.DOI:10.16460/j.issn1008-9969.2010.24.014. [26] Deruelle P, Lepage J, Depret S, et al.Induction of Labor and Intrapartum Management for Women with Uterine Scar[J]. J Gynecol Obstet Biol Reprod, 2012, 41(8):788-802. DOI:10.1016/j.jgyn.2012.09.030. [27] Elvander C, Ahlberg M, Edqvist M, et al.Severe Perineal Trauma among Women Undergoing Vaginal Birth after Cesarean Delivery: A Population-based Cohort Study[J].Birth,2018, 22:123-134. DOI:10.1111/birt.12402. [28] Elvander C, Ahlberg M, Thies-Lagergren L, et al.Birth Position and Obstetric Anal Sphincter Injury: A Population-based Study of 113 000 Spontaneous Births[J]. BMC Pregnancy Childbirth, 2015, 15(10):252-257. DOI:10.1186/s12884-015-0689-7. [29] 魏素花,叶晓东,郭梅. 129例剖宫产后再次妊娠经阴道分娩产妇的护理[J]. 护理学报, 2016, 23(7):64-66.DOI:10.16460/j.issn1008-9969.2016.07.064. [30] Calì G, Timor-Tritsch I E, Alacios-Jaraquemada J, et al. Outcome of Cesarean Scar Pregnancy Managed Expectantly: Systematic Review and Meta-analysis[J]. Ultrasound Obstet Gynecol, 2018, 51(2):169-175. DOI:10.1002/uog.17568. [31] Xu C, Fu Q, Tao H B.Effect of Cesarean Section on the Severity of Postpartum Hemorrhage in Chinese Women: The Shanxi Study[J]. Curr Med Sci, 2018, 38(4):618-625.DOI:10.1007/s11596-018-1922-1. Epub 2018 Aug 20. [32] 韩一栩,刘玉珠. 瘢痕子宫二次妊娠剖宫产术后并发症发生情况分析[J]. 中国妇幼保健, 2014, 29(20):3246-3248. DOI:10.7620/zgfybj.j.issn.1001-4411.2014.20.15. [33] 中华医学会麻醉学分会产科学组.分娩镇痛专家共识[J]. 临床麻醉学杂志, 2016, 32(8):816-818. [34] Salarian S, Fathi M, Farzanegan B.Efficacy and Safety of Sufentanil and Pethidine in Spinal Anesthesia for Painless Labor [J]. Drug Res (Stuttg), 2015, 65(7):344-346.DOI: 10.1055/s-0034-1372610. [35] Anim-Somuah M, Smyth R M,Cyna A M, et al.Epidural Versus Non-epidural or No Analgesia for Pain Management in Labour[J]. Cochrane Database Syst Rev, 2018, 21(5):5-9. DOI:10.1002/14651858.CD000331.pub4. [36] Grisaru-Granovsky S, Bas-Lando M, Drukker L, et al.Epidural Analgesia at Trial of Labor after Cesarean (TOLAC): A Significant Adjunct to Successful Vaginal Birth after Cesarean (VBAC)[J]. J Perinat Med, 2018, 46(3):261-269. DOI:10.1515/jpm-2016-0382. [37] 姜梅,庞汝彦. 助产士规范化培训教材[M].北京:人民卫生出版社,2018:13-14. [38] Ali H M, Wahdan A.Using Dexamethasone as an Adjuvantto Levobupivacaine in Epidural Anesthesia to Change the Pain Intensity and Duration in Painless Labor[J]. Saudi J Anaesth, 2018, 12(2):209-214.DOI:10.4103/sja.SJA_435_17. [39] Zhang Y, Qin Q R, Hui L T.Motor blocks and Operative Deliveries with Ropivacaine and Fentanyl for Labor Epidural Analgesia: A Meta-analysis[J]. J Obstet Gynaecol Res, 2018, 44(12):13772-13776. DOI:10.1111/jog.13772. [40] 何绍文,何电,张为远. 产时干预对剖宫产术后阴道分娩母婴结局的影响[J]. 中华医学杂志, 2017, 97(7):512-516. DOI:10.3760.cma.j.issn.0376.2491.2017.07.008. [41] Grisaru-Granovsky S, Bas-Lando M, Drukker L, et al.Epidural Analgesia at Trial of Labor after Cesarean (TOLAC): A Significant Adjunct to Successful Vaginal Birth after Cesarean (VBAC)[J]. J Perinat Med, 2018, 46(3):261-269. DOI:10.1515/jpm-2016-0382. [42] 陈丽玲,黄晓莉. 剖宫产术后再次妊娠阴道分娩产妇真实体验的质性研究[J]. 护理学报, 2017, 24(4):68-71. DOI:10.16460/j.issn1008-9969.2017.04.068. |
| [1] | 张静, 彭焕椽, 陈佳, 鲁永锦, 刘克玄, 侯晓敏. 成人体外循环心脏手术患者预防手术部位感染的最佳证据总结[J]. 护理学报, 2025, 32(4): 41-47. |
| [2] | 刘璐, 朱钰, 曹义, 张华, 彭玉娜. 腹腔热灌注化疗患者术中实施不同目标体温管理的效果观察[J]. 护理学报, 2025, 32(4): 59-63. |
| [3] | 李疆伟, 王树君, 李长仔, 胡宝山, 焦桂梅, 张卫红. 基于压力应对理论的护理干预对结直肠癌术后永久性肠造口患者心理压力、负性情绪及自我管理的影响[J]. 护理学报, 2025, 32(4): 64-69. |
| [4] | 龚祖华, 孙丽, 谭璇, 张悦, 施丹, 程娟娟. 肝胆外科术后患者基础体征采集-比对-识别隐匿型病情变化的效果观察[J]. 护理学报, 2025, 32(4): 74-78. |
| [5] | 李苗苗, 熊莉娟, 齐磊, 李敏, 向御婷. 基于Ridit分析法和秩和比法的疾病诊断相关分组在护理绩效管理中的应用[J]. 护理学报, 2025, 32(3): 22-26. |
| [6] | 焦雪萍, 王志稳, 韩舒羽. ICU老年患者躁动行为的干预研究进展[J]. 护理学报, 2025, 32(3): 38-42. |
| [7] | 李若雨, 刘鑫, 林萍, 陈丹, 林桦. 出院患者用药安全管理的最佳证据总结[J]. 护理学报, 2025, 32(3): 50-55. |
| [8] | 杨小娟, 毛孝容, 王静, 江华, 李蓉, 樊宇, 文青, 李林章, 陈晓容. 成人重度烧伤患者早期肠内营养管理的最佳证据总结[J]. 护理学报, 2025, 32(3): 56-61. |
| [9] | 朱天顺, 朱可可, 薛会元, 焦聪聪, 魏长慧, 王贺. 信息框架效应理论在健康管理领域应用的范围综述[J]. 护理学报, 2025, 32(2): 44-49. |
| [10] | 刘硕怡, 熊莉娟, 李凌, 王玉梅, 何嘉, 李鑫, 袁淑蕾, 郭雪琴, 王暘婧, 张慧娟. 老年住院患者衰弱预防及管理临床实践指南的质量评价及内容分析[J]. 护理学报, 2025, 32(2): 50-55. |
| [11] | 闫亚铃, 乐美妮, 姚桃琴, 王雪莲, 姜建玲, 辛艺. 老年胃肠肿瘤患者围手术期衰弱管理方案的构建[J]. 护理学报, 2025, 32(2): 74-78. |
| [12] | 顾妍鑫, 刘丽, 胡惠惠, 周芳, 杨怡, 高锐, 王培双. 以核心能力为导向的麻醉护理硕士专业学位研究生临床实践培养方案的构建[J]. 护理学报, 2025, 32(1): 7-12. |
| [13] | 孙娟, 李亚莉, 马安娜, 王华, 张会敏. 护理研究生对社区护理实践思政教学体验的质性研究[J]. 护理学报, 2025, 32(1): 19-23. |
| [14] | 李格格, 王婉儿, 蒲江锋, 谢章浩, 杨妞, 黄惠根. 基于熵权-TOPSIS结合RSR法广东省护理人力资源配置评价研究[J]. 护理学报, 2025, 32(1): 29-33. |
| [15] | 贺芳, 温秀兰, 林艳, 孙黎, 王晓杰, 余欣, 刘会, 郭晓萍, 周艳. 基于移动医疗的新生儿护理线上咨询门诊的建立与实施[J]. 护理学报, 2024, 31(9): 20-23. |
|
||