剖宫产术后瘢痕子宫再次妊娠行阴道试产的临床可行性分析

Analysis of clinical feasibility of vaginal trial of labor in second pregnancy with scarred uterus after cesarean section

目的 研究剖宫产术后瘢痕子宫再次妊娠行阴道试产的临床可行性。方法 选择剖宫产术后再次妊娠行阴道试产的66例产妇作为瘢痕组,另选择同期非瘢痕子宫妊娠行阴道试产的66例产妇作为非瘢痕组。比较两组阴道试产结果,阴道试产成功产妇产程,产后出血量、住院时间及产后胎盘残留发生情况,不良妊娠结局发生情况,新生儿Apgar评分。结果 瘢痕组与非瘢痕组的阴道试产成功率(78.79%VS 84.85%)、转剖宫产率(21.21%VS 15.15%)比较,差异无统计学意义(P>0.05)。瘢痕组阴道试产成功产妇第一、二、三产程及总产程时间与非瘢痕组比较,差异无统计学意义(P>0.05)。瘢痕组产后出血量(210.28±56.36)ml、住院时间(3.69±1.62)d和产后胎盘残留发生率12.12%与非瘢痕组的(205.17±49.69)ml、(3.71±1.59)d、7.58%(5/66)比较,差异无统计学意义(P>0.05)。瘢痕组不良妊娠结局发生率(13.64%)与非瘢痕组(10.61%)比较,差异无统计学意义(P>0.05)。瘢痕组出生后1、5、10 min的新生儿Apgar评分比较,差异无统计学意义(P>0.05)。两组新生儿预后良好,无转入新生儿科记录。结论 剖宫产术后瘢痕子宫再次妊娠产妇的阴道试产成功率与非瘢痕子宫妊娠产妇基本一致,且未增加产程时间及产后出血量,不良妊娠结局发生率无明显升高,临床应用安全性可靠,证实该类产妇经阴道分娩的可行性较强,对提升阴道分娩率及降低剖宫产率具有重要应用价值。

Objective To study the clinical feasibility of vaginal trial of labor in second pregnancy with scarred uterus after cesarean section.Methods 66 women who underwent vaginal trial of labor for a second pregnancy after cesarean section were selected as the scarred group,and 66 women who underwent vaginal trial of labor for a non-scarred uterine pregnancy during the same period were selected as the non-scarred group.Comparison was made on outcome of vaginal trial of labor,duration of labor in women with successful vaginal trial of labor,postpartum hemorrhage,length of hospital stay,occurrence of postpartum residue placenta,occurrence of adverse pregnancy outcomes,and neonatal Apgar score between the two groups.Results There was no statistically significant difference in the success rate of vaginal trial of labor(78.79% VS 84.85%) and cesarean section(21.21% VS 15.15%) between scarred group and non-scarred group(P>0.05).There was no significant difference in the comparison of duration of first,second and third stages of labor and total labor time between the scarred group and the non-scarred group of women who had a successful vaginal trial of labor(P>0.05).In the scarred group,the incidence of postpartum hemorrhage was(210.28±56.36) ml,the length of hospital stay was(3.69±1.62) d and the incidence of postpartum residue placenta was 12.12%,which were not statistically significant when compared with(205.17±49.69) ml,(3.71±1.59) d,and 7.58%(5/66) in the non-scarred group(P>0.05).There was no statistically significant difference in the incidence of adverse pregnancy outcomes between the scarred group(13.64%) and the non-scarred group(10.61%)(P>0.05).Comparison of neonatal Apgar scores at 1,5,and 10 min after birth in the scarred group showed no statistically significant difference(P>0.05).The prognosis of neonates in both groups was good,and no transfer to the neonatal unit was recorded.Conclusion The success rate of vaginal delivery in post-cesarean section pregnant women with scarred uterus is basically the same as that of non-scarred uterus pregnant women,and there is no increase in the duration of labor,postpartum hemorrhage,and the incidence of adverse pregnancy outcomes.It is safe and reliable,which confirms the strong feasibility of vaginal delivery in such women,and has important application value in improving vaginal delivery rate and reducing cesarean section rate.