Abstract:Objective: To investigate the influencing factors and predictive value of vaginal delivery in scarred uterus re-pregnancy. Methods: A retrospective study was conducted on 109 pregnant women with scarred uterus re-pregnancy who were admitted to the First People's Hospital of Bengbu from January 2021 to June 2023. According to the delivery outcome, they were divided into two groups: vaginal delivery success group (n=78) and failure group (n=31). The baseline data and late pregnancy myometrial thickness of the pregnant women in the two groups were compared. Logistic regression analysis was used to analyze the influencing factors of vaginal delivery in scarred uterus re-pregnancy, and the receiver operating characteristic (ROC) curve was used to analyze the predictive value of the influencing factors for vaginal delivery in scarred uterus re-pregnancy. Results: There was no significant difference in age, gestational week, parity, interval from previous cesarean section, estimated fetal weight before delivery, admission in labor, and education level between the two groups (P>0.05). The pre-pregnancy body mass index (BMI), cervical Bishop score, and myometrial thickness were significantly different between the two groups (P<0.05). Logistic regression analysis showed that pre-pregnancy BMI, cervical Bishop score, and myometrial thickness were the influencing factors of delivery outcome in scarred uterus re-pregnancy (P<0.05). The ROC curve analysis showed that the areas under the curve (AUC) of pre-pregnancy BMI, cervical Bishop score, and myometrial thickness for predicting vaginal delivery in scarred uterus re-pregnancy were 0.669, 0.691, and 0.670, respectively. The AUC of the combined prediction of the three indicators was 0.806, which was significantly higher than that of the single indicators (Z=2.885, 3.604, 3.296, P=0.004, <0.001, 0.001). The sensitivity was 90.32%, and the specificity was 61.54%. Conclusion: Pre-pregnancy BMI, cervical Bishop score, and myometrial thickness are the influencing factors of vaginal delivery outcome in scarred uterus re-pregnancy and can be used as predictive indicators of vaginal delivery outcome.
马晓丹, 刘洋, 吴云, 高宇洁, 马铟. 疤痕子宫再妊娠经阴道分娩的影响因素及预测价值分析[J]. 河北医学, 2024, 30(4): 646-650.
MA Xiaodan, LIU Yang, WU Yun, et al. Analysis of Influencing Factors and Predictive Value of Vaginal Delivery in Scarred Uterus Re-Pregnancy. HeBei Med, 2024, 30(4): 646-650.
[1] Colomar M,Colistro V,Sosa C,et al.Cesarean section in Uruguay from 2008 to 2018:country analysis based on the robson classification.An observational study[J].BMC Pregnancy Childbirth,2022,22(1):471. [2] 王雪茵,张小松.剖宫产率的趋势和预测:基于全球和地区估计[J].中华围产医学杂志,2021,24(10):788. [3] 水杰,顾似铱,陈轩,等.剖宫产术后瘢痕子宫再次妊娠经阴道分娩可行性的预测模型构建[J].中国计划生育和妇产科,2022,14(3):74-78. [4] Attanasio LB,Paterno MT,Kjerulff KH.Factors associated with labor after cesarean in a prospective cohort[J].Birth,2022,49(4):833-842. [5] Setubal A,Alves J,Osorio F,et al.Demonstration of isthmocele surgical repair[J].Minim Invasive Gynecol,2021,28(3):389-390. [6] Biel F,Darney B,Caughey A,et al.Medical indications for primary cesarean delivery in women with and without disabilities[J].Matern Fetal Neonatal Med,2020,33(20):3391-3398. [7] Carbonnel M,Brot D,Benedetti C,et al.Risks factors FOR wound complications after cesarean section[J].Gynecol Obstet Hum Reprod,2021,50(7):101987. [8] Wellmann S,Manegold-Brauer G,Fischer T,et al.Improving neonatal and maternal outcome by inducing mild labor before elective cesarean section:the lacarus randomized controlled trial[J].Neonatology,2021,118(1):116-121. [9] Regmi DR,Dangal G,Silwal A,et al.Repeat cesarean section among pregnant women in a tertiary center of nepal:a descriptive cross-sectional study[J].JNMA Nepal Med Assoc,2022,60(245):6-11. [10] Lazarou A,Oestergaard M,Netzl J,et al.Vaginal birth after cesarean (VBAC):fear it or dare it an evaluation of potential risk factors[J].Perinat Med,2021,49(7):773-782. [11] 李奕,晋兴林,蒋玉芬.瘢痕子宫再次妊娠产妇经阴道分娩试产失败因素分析[J].中国医药导报,2022,19(14):28-31. [12] 陈燕,李玉林,陈蓉.产前超声联用宫颈Bishop评分对瘢痕足月妊娠阴道分娩结局及新生儿评分的影响[J].武警后勤学院学报:医学版,2021,30(7):38-40. [13] 韩艳,刘志红.超声测量子宫瘢痕前壁下段厚度与阴道分娩妊娠结局分析[J].医学影像学杂志,2020,30(5):810-813,818.