剖宫产术后再次分娩方式探讨

Secondary Delivery after Cesarean Section

近年来剖宫产率有上升的趋势，其重要因素是首次剖宫产指征的放宽及再次剖宫产的增加。如何降低重复剖宫产率是产科领域的重要问题。本文对９３例前次剖宫产后再次妊娠的孕妇进行阴道试产的前瞻性研究。结果：８１例试产成功并经阴道分娩（占８７．１％），试产失败再次剖宫产分娩１２例（占１２．９％）。先兆子宫破裂２例（占２．１％）。无１例孕产妇死亡。９３例新生儿出生后１分钟Ａｐｇａｒ评分≤７分者５例（其中１例早产儿死亡）。提示：恰当的选择有剖宫产史者试产，阴道分娩的成功率高且对母婴预后无不良影响。

The number of cesarean section is rising in recent years.The main causes are that,the obstetric demands are relaxed for the first time and the increase of secondary cesarean section.It is an important subject in obstetric practice that how to decrease the percentage of secondary cesarean section.The author has prospectively studied 93 cases of secondary pregnancy after cesarean section,and applied vaginal trail-delivery.Results are:81 cases have succeeded(87.1%),12 cases failed and applied secondary cesarean section(12.9%).There are two cases threatened rupture ofuterus(2.1%).No maternal death occured.According to Apgar scores,among 93 cases newborn in one minutes after delivery,there are 5 cases less than 7 points(I case prematrue infant dead).These results indicate that:doctors may apply vaginal trail-delivery under intensive observation;the succesive rate is high under this situation;vaginal trail-delivery will not cause severe injure to motheres and infants.