بررسی عوارض نوزادی و مادری زایمان طبیعی متعاقب سزارین در سال های 1398 و 1399 در بیمارستان خاتم الانبیا

نوع مقاله : کاربردی

نویسندگان

1 دانشکده پزشکی، دانشگاه شاهد، تهران، ایران

2 گروه زنان، دانشکده پزشکی، دانشگاه شاهد، تهران، ایران

3 گروه بهداشت و پزشکی اجتماعی، دانشکده پزشکی، دانشگاه شاهد، تهران، ایران

چکیده

مقدمه و هدف: زایمان واژینال پس سزارین (vaginal birth after cesarean) از استراتژی‌های توسعه یافته برای کنترل سیر صعودی موارد سزارین و افزایش فرزندآوری  است و کماکان در دست بررسی است. در این مطالعه به تعیین عوارض نوزادی و مادری زایمان طبیعی متعاقب سزارین پرداخته شد.
مواد و روش ها: در این مطالعه مقطعی تمام زنان باردار با سابقه یک بار سزارین که در سال 1398 و 1399 تصمیم به انجام زایمان واژینال پس از سزارین داشتد وارد مطالعه شدند. اطلاعات دموگرافیک و پیامدهای بعد از زایمان شامل میزان موفقیت زایمان واژینال پس از سزارین، عوارض مادری و جنینی و علت شکست زایمان واژینال پس از سزارین مورد بررسی قرار گرفت.
نتایج: 255 خانم باردار با میانگین سنی 95/31 سال و شاخص توده ی بدنی 98/39 kg/m2  حضور داشتند. میانگین زمان سپری شده از آخرین زایمان، 5.57 سال بود. زایمان واژینال پس از سزارین در 6/77% موارد موفق بوده است و عدم پیشرفت زایمان و عدم پاسخ به اینداکشن در مجموع علت 5/85% موارد شکست بودند. VBAC در 97% زنان و 5/95% نوزادان بدون عارضه بود. میانگین آپگار دقیقه اول و پنجم نوزاد به ترتیب 99/8 و10 بود. شایعترین عارضه مادر خونریزی (2%) و شایعترین عارضه نوزادی  RDS(3%) بود. هیچ مورد مورتالیتی یا پارگی رحم مشاهده نشد.
نتیجه‌گیری: VBAC در 6/77% موارد موفق بوده و در موارد ناموفق، عدم پیشرفت زایمان و عدم پاسخ به اینداکشن علل شکست هستند. همچنین نوازادان حاصل از زایمان واژینال پس از سزارین دارای نمره آپگار و آنالیز گازهای خونی مطلوب هستند و در بیش از 95% موارد عوارض مادری یا نوزادی وجود وجود ندارد.

کلیدواژه‌ها

عنوان مقاله [English]

Neonatal and maternal complications of vaginal birth after cesarean in Khatam Al-Anbia hospital in 2019-2020

نویسندگان [English]

  • Horiyeh Epakchi 1
  • Farahnaz Torkestani 2
  • Nafiseh Zafarghandi 2
  • Ashraf Pirasteh 3
1 Faculty of Medicine, Shahed University, Tehran, Iran
2 Department of Gynecology and Obstetrics, Faculty of Medicine, Shahed University, Tehran, Iran
3 Department of Health and Social Medicine, Shahed University, Tehran, Iran
چکیده [English]

Background and Objective: Vaginal birth after cesarean (VBAC) is one of the strategies developed to control the growing number of cesarean sections and is still under investigation. In this study, we investigated the neonatal and maternal complications of VBAC.
 
Materials and Methods: In this cross-sectional study, all pregnant women with a history of cesarean section who decided to have VBAC from 2019 to 2020 were included in the study. Demographic information and postpartum outcomes including success rate of VBAC, its maternal and neonatal complications, and causes of VBAC failure were assessed.
 
Results: 255 pregnant women with a mean age of 31.95 years and BMI of 29.98 kg/m2 were present on study. The mean time elapsed since the last delivery was 5.57 years. VBAC was successful in 77.6% of cases and  lack of delivery progress and lack of response to induction  were the cause of 85.5% of failures. VBAC was uncomplicated in 97% of  mothers and 95.5% of neonates. The average Apgar score of the first and fifth minutes was 8.99 and 10, respectively. The most common maternal complication was bleeding (2%) and the most common neonatal complication was RDS (3%). No case of mortality or uterine rupture was observed.
 
Conclusion: VBAC is successful in 77.6% of cases and in unsuccessful cases, decline FHR and failure to descent are the most common causes of failure. Also, VBAC-born neonates have a favorable Apgar score and blood gas analysis, and in more than 95% of cases, there are no maternal or neonatal complications.
 

کلیدواژه‌ها [English]

  • Vaginal birth
  • Cesarean section
  • Maternal complications
  • Neonatal complications

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دانشور پزشکی
دوره 29، شماره 6 - شماره پیاپی 157
بهمن و اسفند 1400
صفحه 24-33

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