330例剖宫产术后再次妊娠孕妇分娩方式及结局分析

Analysis of 330 cases of re-pregnancy after caesarean section

目的：探讨剖宫产术后再次妊娠的分娩方式。方法回顾分析2012年1月到2012年12月云南省邵通市第一人民医院住院分娩的330例剖宫产术后再次妊娠孕妇的分娩方式及结局，其中经阴道试产组58例，剖宫产组272例。结果剖宫产术后再次妊娠330例孕妇中经阴道试产58例，成功经阴道分娩32例，失败26例，其中发生子宫先兆破裂改剖宫产3例，顺产死胎2例，子宫破裂致死胎1例，子宫破裂发生率1.7%；产后出血100~800ml，平均（300±50）ml；新生儿结局良好。剖宫产组272例，产后出血500~3000ml，平均（600±100）ml，因宫缩乏力行子宫切除1例，术中发现子宫不全破裂7例。结论剖宫产后通过认真评估可以进行阴道试产；加强产时监护，产妇和胎儿一旦发生危急症立即剖宫产结束分娩。

Objective To study the deliverymode of re-pregnancy after cesarean section. Method Retrospectively analyzed the delivery methods and the results of 330 re-pregnant women after cesarean section who were in hospital from January to December, 2012, all the re-pregnant women were divided into 2 groups:58 women were in vaginal birth after cesarean section group, 272 were in cesarean section group. Results Among 330 cases, 58 cases were tried to deliver through vagina, 32 succeeded and 26 failed, 3 were changed to cesarean section because of aura uterine rupture, 2 delivered stillbirth and 1 delivered stillbirth with uterine rupture in the course of delivery, the incidence of uterine rupture was 1.7%. The postpartum hemorrhage was 100~800ml and(300 ± 50)ml in average, and achieved good neonatal outcomes. 272 cases were delivered by cesarean section, the postpartum hemorrhage was 500~3000ml and (600 ± 100)ml in average, 1 case were conducted hysterectomy due to uterine inertia, 7 cases occurred incomplete uterine rupture during delivery. Conclusions The re-pregnant women pregnant after cesarean section can try to deliver through vagina after sufficient valuation by obstetrician. We should reinforce childbearing monitoring and the moment when the re-pregnant woman and the fetus are in danger, the vaginal delivery should stop and immediately operate cesarean section to end the delivery course.