剖宫产后再次妊娠分娩方式的结果分析

Analysis of the delivery mode results of repregnancy after cesarean section

目的 探讨剖宫产术后再次妊娠分娩方式的最佳选择。方法 将剖宫产术后再次妊娠孕妇312例按分娩方式不同分为再次剖宫产组（RCS组）210例和剖宫产术后再次妊娠阴道分娩组（VBAC组）102例,另外选择同期210例首次剖宫产者为PCS组。观察产妇的分娩方式和结局,并比较三组相关情况（产后出血、平均住院天数及住院费用等）。结果 312例产妇,试产144例,阴道分娩102例,成功率为70.83%;168例直接行剖宫产,占53.85%。RCS组产后出血（310.5±30.2）ml明显高于VBAC组的（143.5±25.2）ml（U=7.55,P〈0.01）和PCS组的（244.2±28.3）ml（U=20.40,P〈0.01）;RCS组平均住院天数（7.5±0.2）d明显多于VBAC组的（3.0±0.3）d（U=25.50,P〈0.01）和PCS组的（6.6±0.6）d（U=16.70,P〈0.01）;RCS组住院费用（4 451.5±62.4）元明显多于VBAC组的（1 223.6±12.3）元（U=71.50,P〈0.01）和PCS组的（3 756.4±54.6）d（U=25.20,P〈0.01）。结论 剖宫产术后再次妊娠并非是剖宫产绝对指征,只要在医务人员严密监护下,阴道分娩是安全可行,可有效降低剖宫产率。

Objective To explore the best choice mode of repregnancy after cesarean section.Methods 312 cases with repregnancy after cesarean section were divided into the repeat cesarean section（RCS） group （210 cases）,vaginal birth after cesarean（VBAC） group （102 cases）, and the first time cesarean（PCS）group（210 cases）.The maternity delivery mode and outcome were observed and the relevant conditions（postpartum hemorrhage,the average length of hospital stay and hospital costs,etc.）were compared among the three groups.Results The trial production was in 144 cases,and vaginal delivery in 102 cases,the success rate was 70.83%.168 cases with direct vaginal delivery,the success rate was 53.85%. The postpartum hemorrhage of RCS group[（310.5± 30.2）ml] was significantly higher than that of VBAC group[（143.5±25.2）ml]（U=7.55,P〈0.01） and PCS group[（244.2±28.3）ml]（U=20.4,P〈0.05）. The hospital stay time of RCS group[（7.5± 0.2）d]was significantly more than that of VBAC group[（3.0±0.3）d]（U=25.50,P〈0.01）and PCS group[（6.6±0.6）d]（U=16.7,P〈0.05）. The hospitalization costs of RCS group[（4 451.5±62.4）yuan]was significantly higher than that of VBAC group[（1 223.6±12.3）yuan]（U=71.5,P〈0.01） and PCS group[（3 756.4± 54.6）d]（U=25.2,P〈0.01）.Conclusion Repregnancy after cesarean section is not absolute indications for cesarean section,vaginal birth is safe and feasible as long as the medical intensive care effectively,and it can reduce the rate of cesarean section.