ارزیابی عوارض مادری و جنینی در زایمان طبیعی بعد از سزارین

ﻣﻘﺪﻣﻪ: از روش ﻫﺎی ﻣﻮرد اﺳﺘﻔﺎده در ﺟﻬﺖ ﮐﺎﻫﺶ آﻣﺎر روزاﻓﺰون ﺳﺰارﯾﻦ، اﺳﺘﻔﺎده از زاﯾﻤﺎن ﻃﺒﯿﻌﯽ ﺑﻌﺪ از ﺳﺰارﯾﻦ اﺳﺖ. ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﺑﺎ ﻫﺪف ارزﯾﺎﺑﯽ ﻋﻮارض ﻣﺎدری و ﺟﻨﯿﻨﯽ در اﻓﺮادی ﮐﻪ زاﯾﻤﺎن ﻃﺒﯿﻌﯽ ﻣﻮﻓﻖ ﺑﻌﺪ از ﺳﺰارﯾﻦ داﺷﺘﻨﺪ، اﻧﺠﺎم ﺷﺪ. روشﮐﺎر: اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﮔﺬﺷﺘﻪ ﻧﮕﺮ ﺑﺮ روی 160 زن ﻣﺘﻘﺎﺿﯽ زاﯾﻤﺎن واژﯾﻨﺎل ﺑﻌﺪ از ﯾﮏ ﻧﻮﺑﺖ ﺳﺰارﯾﻦ ﺑﺎ ﺑﺮش ﻋﺮﺿﯽ ﺑﺮ روی رﺣﻢ در ﻓﺎﺻﻠﻪ ﺳﺎلﻫﺎی 1395-97 در ﺑﯿﻤﺎرﺳﺘﺎن ام اﻟﺒﻨﯿﻦ (س) ﻣﺸﻬﺪ اﻧﺠﺎم ﺷﺪ. اﻃﻼﻋﺎت دﻣﻮﮔﺮاﻓﯿﮏ و ﻣﺮﺗﺒﻂ ﺑﺎ زاﯾﻤﺎن ﺑﯿﻤﺎران و ﻫﻤﭽﻨﯿﻦ اﻃﻼﻋﺎت ﻣﺮﺑﻮط ﺑﻪ ﻧﻮزادان از ﭘﺮوﻧﺪه ﺑﯿﻤﺎران ﺟﻤﻊ آوری ﺷﺪ. ﺗﺠﺰﯾﻪ و ﺗﺤﻠﯿﻞ داده ﻫﺎ ﺑﺎ اﺳﺘﻔﺎده از ﻧﺮم اﻓﺰار آﻣﺎری spss (ﻧﺴﺨﻪ 11) و آزﻣﻮن ﻫﺎی ﮐﻮﻟﻤﻮﮔﺮوف اﺳﻤﯿﺮﻧﻮف، ﮐﺎی اﺳﮑﻮﺋﺮ و ﺗﯽ ﺗﺴﺖ اﻧﺠﺎم ﺷﺪ. ﻣﯿﺰان p ﮐﻤﺘﺮ از 0/05 ﻣﻌﻨﯽ دار در ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪ. ﯾﺎﻓﺘﻪﻫﺎ: از 160 ﺑﯿﻤﺎر، 141 ﻧﻔﺮ (88/12%) ﻣﻮﻓﻖ ﺑﻪ زاﯾﻤﺎن ﻃﺒﯿﻌﯽ ﺷﺪه و در 19 ﻧﻔﺮ (11/88%) ﺳﺰارﯾﻦ اﻧﺠﺎم ﺷﺪ. دو ﮔﺮوه ﻣﻮﻓﻘﯿﺖ و ﺷﮑﺴﺖ زاﯾﻤﺎن ﻃﺒﯿﻌﯽ ﺑﻌﺪ از ﺳﺰارﯾﻦ، از ﻧﻈﺮ ﻣﯿﺎﻧﮕﯿﻦ ﺳﻦ ﻣﺎدر (0/18=p)، ﻣﺘﻮﺳﻂ ﺗﻮده ﺑﺪﻧﯽ (0/07=p)، ﻣﺘﻮﺳﻂ ﺳﻦ ﺣﺎﻣﻠﮕﯽ (0/15=p) و ﻓﺎﺻﻠﻪ از ﺳﺰارﯾﻦ ﻗﺒﻠﯽ (0/07=p) ﺗﻔﺎوت ﻣﻌﻨﺎداری ﺑﺎ ﯾﮑﺪﯾﮕﺮ ﻧﺪاﺷﺘﻨﺪ. ﺑﯿﺸﺎب اﺳﮑﻮر ﮐﻤﺘﺮ از 6 در ﮔﺮوه ﺷﮑﺴﺖ ﻧﺴﺒﺖ ﺑﻪ ﮔﺮوه ﻣﻮﻓﻘﯿﺖ ﺑﻪﻃﻮر ﻣﻌﻨﺎداری ﺑﯿﺸﺘﺮ ﺑﻮد (0/02=p). در ﮔﺮوه ﺷﮑﺴﺖ، ﺧﻮﻧﺮﯾﺰی ﺑﻌﺪ از زاﯾﻤﺎن (0/03)=p و ﺑﺴﺘﺮی ﻧﻮزاد در ﺑﺨﺶ ﻣﺮاﻗﺒﺖﻫﺎی وﯾﮋه (0/001

Maternal and fetal complications in vaginal birth after cesarean

Introduction: Vaginal birth after cesarean is one of the methods used to reduce the increasing number of cesarean sections. This study was performed with aim to evaluate maternal and fetal complications in women who had successful vaginal delivery after cesarean. Methods: This retrospective study was performed on 160 women who had successful vaginal delivery after one cesarean section with transverse uterine incision at Mashhad Omolbanin hospital in 20162018. Demographic data related to delivery and the infants’ data were collected from the patients’ records. Data was analyzed by SPSS software (version 11) KolmogrovSmirnov, Chisquare and ttest. p < 0.05 was considered statistically significant. Results: Among 160 patients, 141 cases (88.12%) had successful normal vaginal delivery and 19 cases (11.88%) had cesarean section. The two groups of success and failure of normal delivery after cesarean section had no significant difference in terms of mean maternal age (p= 0.18), body mass (p=0.07), gestational age (p= 0.15) and distance from previous cesarean section (p=0.07). The bishop score less than 6 was significantly higher in the failure group than in the success group (p=0.02). In the failure group, postpartum hemorrhage (p= 0.03) and NICU admission (p=<0.001) were significantly higher. Conclusion: Vaginal delivery after cesarean is a safe delivery method and reduces maternal and fetal risks caused by repeated cesarean section.