بررسی مقایسه‌ای پیامدهای مادری و جنینی در "زایمان طبیعی" یا "سزارین تکراری" در مادران بلافاصله پس از دو سزارین قبلی

نوع مقاله : اصیل پژوهشی

نویسندگان

1 دانشیار گروه زنان و زایمان، هسته تحقیقاتی حمایت از خانواده و جوانی جمعیت، دانشکده پزشکی، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

2 متخصص زنان، دانشکده پزشکی، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

3 متخصص زنان و زایمان، هسته تحقیقاتی حمایت از خانواده و جوانی جمعیت، دانشکده پزشکی، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

4 دانشجوی دکترای آمار زیستی، گروه اپیدمیولوژی و آمار زیستی، دانشکده بهداشت، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

5 استادیار گروه زنان و زایمان، هسته تحقیقاتی حمایت از خانواده و جوانی جمعیت، دانشکده پزشکی، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

10.22038/ijogi.2025.87454.6420

چکیده

مقدمه: با توجه به مزایای بالقوه زایمان طبیعی برای مادر و نوزاد و توجه نهادهای نظارتی بر کاهش تعداد سزارین‌های غیر ضروری، مطالعه حاضر با هدف بررسی عوارض مادری و جنینی زایمان طبیعی در افراد با سابقه 2 بار سزارین قبلی و مقایسه آنها با گروه سزارین تکراری انجام شد.
روش‌کار: این مطالعه نیمه‌تجربی طی سال‌های 1400-1398 بر روی 100 نفر از زنان باردار با سابقه 2 بار سزارین قبلی مراجعه کننده به بیمارستان‌های امام رضا (ع) و ام‌البنین (س) مشهد انجام شد. شرکت‌کنندگان به یکی از دو گروه کاندیدای زایمان طبیعی و یا انجام سزارین ارجاع و عواقب مادری و نوزادی در دو گروه مقایسه شد. تجزیه و تحلیل داده‌ها با استفاده از نرم‌افزار آماری SPSS (نسخه 24) و آزمون‌های‌ تی مستقل، کای دو و فیشر انجام گرفت. میزان p کمتر از 05/0 معنی‌دار در نظر گرفته شد.
یافته ­ها: میانگین بارداری­ ها در دو گروه تفاوت معنی‌داری نداشت (1/0<p). در گروه سزارین تکراری (RCD) میزان دیابت، پره‌اکلامپسی و فشارخون مزمن (001/0>p)، انتقال خون و خونریزی پس از زایمان (009/0=p) و بستری شدن در NICU (12%) (001/0=p) بیشتر بود. رضایت از زایمان در گروه زایمان طبیعی (96%) به‌طور معنی‌داری بیشتر بود (001/0>p).
نتیجه ­گیری: با توجه به افزایش عوارض بعد از سزارین تکراری از جمله میزان خونریزی پس از زایمان، نیاز به تزریق خون و همچنین رضایت کمتر مادر از زایمان RCD، باید زایمان طبیعی بعد از سزارین (VBACs) را به‌عنوان روشی مطمئن برای مادران واجد شرایط ارائه کرد.

کلیدواژه‌ها

موضوعات

عنوان مقاله [English]

Maternal and Fetal Outcomes of Vaginal Delivery or Repeat Cesarean in Mothers with Two Previous Cesarean Sections

نویسندگان [English]

  • Malihe Afiat 1
  • Seyede Houra Mousavi Vahed 1
  • Neda Davaryari 2
  • Leila Pourali 1
  • Farzaneh Afshar Delkhah 3
  • Fatemeh Zamaninasab 4
  • Ezat Hajmollarezaei 5
1 Associate Professor, Department of Obstetrics and Gynecology, Supporting the Family and the Youth of Population Research Core, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran.
2 Gynecologist, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran.
3 Gynecologist, Department of Obstetrics and Gynecology, Supporting the Family and the Youth of Population Research Core, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran.
4 PhD Student in Biostatistics, Department of Epidemiology and Biostatistics, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
5 Assistant Professor, Department of Obstetrics and Gynecology, Supporting the Family and the Youth of Population Research Core, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran.
چکیده [English]

Introduction: Considering to the potential benefits of vaginal delivery (VD) for mothers and infants, and the attention of regulatory organizations to reduce the number of unnecessary cesareans, this study was conducted with aim to examine maternal and fetal complications of VD in individuals with a history of two previous cesareans (VBAC) and compare them with the repeat cesarean group.
Methods: This semi-experimental study was conducted in 2019 to 2021 on 100 pregnant women with a history of two previous cesareans visiting Imam Reza & Omolbanin Hospitals. Participants were referred to two groups: candidates for VBAC or cesarean delivery. Maternal and neonatal outcomes were compared in both groups. Data were analyzed using SPSS (version 24) and independent t, Chi-square, and Fisher tests. P<0.05 was considered significant.
Results: The mean number of pregnancies did not differ in the two groups (P>0.1). In the RCD group, the underlying diseases (diabetes, preeclampsia, and chronic hypertension) (P<0.001), blood transfusion and postpartum hemorrhage (P=0.009), admission to the NICU (12%) (P=0.001) were higher than the VBAC group. Satisfaction with delivery was significantly higher in VBAC group (96%) (P<0.001).
Conclusion: Given the increased complications after repeat cesarean, including postpartum hemorrhage rates, the need for blood transfusions, and lower maternal satisfaction with RCD, VBAC should be presented as a safe method for qualified mothers.

کلیدواژه‌ها [English]

  • Cesarean Incision
  • Postpartum Hemorrhage
  • Vaginal Birth after Cesarean

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مجله زنان، مامایی و نازایی ایران
دوره 28، شماره 8
آبان 1404
صفحه 1-9

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