剖宫产术后再次妊娠阴道分娩可行性分析

Vaginal Delivery Feasibility Analysis of Re-pregnancy after Cesarean Section

目的探讨剖宫产术后再次妊娠经阴道分娩的可行性。方法将2017年5月至2019年6月我院妇产科收治的剖宫产术后再次足月妊娠的124例孕妇为研究对象,其中51例符合阴道试产适应征,且孕妇及家属同意行阴道试产,51例中38例成功阴道试产,作为实验组,其余86例再次剖宫产作为对照组。比较两组产妇的住院总费用、产后(经阴或剖宫产)24小时出血量、新生儿窒息、产褥(产褥感染、泌尿系感染、乳腺炎、上呼吸道感染等)等各方面的发生率。结果在51例符合经阴道试产且征得孕妇及家属同意进行阴道试产的产妇中,有38例阴道试产成功(74.5%),生产过程中未发生子宫破裂、大出血等棘手情况。住院费用实验组产妇明显低于对照组,两者之间的差异具有统计学意义(P<0.05);实验组产后24小时出血量、产褥病发生率明显低于对照组,差异有统计学意义(P<0.05)。在新生儿窒息的发生率方面两组产妇比较差异无统计学意义(P>0.05)。结论在充分做好产妇及其家属思想工作的前提下,严格把握好剖宫产术后再次妊娠经阴道试产的适应征、禁忌征、注意事项等情况下,对符合经阴道试产条件的产妇进行进行阴道分娩,可大大降低住院患者的总费用,减少并发症的发生,值得妇产科医生推广应用。

Objective To explore vaginal delivery feasibility of re-pregnancy after cesarean section.Methods A total of 124 pregnant women who had a full-term pregnancy after cesarean section admitted to our department of gynaecology and obstetrics from May 2017 to June 2019 were objects of study.Among them,51 women met the indications of vaginal trial,and the pregnant women and their families agreed vaginal trial production.38 of the 51 women had successful vaginal trial production,as the experimental group.The remaining 86 cases of cesarean section again were control group.Compare the total hospitalization costs of the two groups of women,incidences of 24 hours postpartum hemorrhage,neonatal asphyxia,puerperium(puerperal infection,urinary system infection,mastitis,upper respiratory infection,etc).Results Of the 51 women who met the vaginal trial and pregnant women and their families agreed for vaginal trial production,38 had a successful vaginal trial production(74.5%).No thorny situations like hysterorrhexis or massive hemorrhage occurred during the production process.The hospitalization cost of the experimental group was obviously lower than that of the control group,the differences between the two have statistically significance(P<0.05);the incidences of 24 hours postpartum hemorrhage,puerperium of experimental group was obviously lower than the control group,the differences have statistically significance(P<0.05).There was no significant differences of the incidences of neonatal asphyxia between the two groups(P>0.05).Conclusion Under the premise of fully doing the ideological work of pregnant women and their family members,strictly controlling the indications,contraindications,precautions,etc.of the vaginal trial of re-pregnancy after cesarean section,and meeting the conditions of vaginal trial production,vaginal delivery can obviously reduce the total cost of hospitalization of patients and reduce the incidences of complications,which is worthy of promotion and application by obstetricians and gynecologists.