剖宫产术后再次妊娠150例分娩方式的选择

Ways of delivery for pregnant after caesarean:a report of 150 cases

目的:探讨剖宫产术后再次妊娠的分娩方式选择及对母儿结局的影响。方法:对150例剖宫产术后再次妊娠孕妇的分娩方式、分娩结局及母婴并发症进行回顾性分析。其中再次剖宫产(RCS)132例,剖宫产术后阴道分娩(VBAC)18例;并随机抽取同期首次剖宫产(PCS)132例,非瘢痕子宫阴道分娩(VBNC)18例进行对照。结果:(1)150例剖宫产术后再次妊娠者24例阴道试产,其中18例试产成功,成功率75%;手术产率88%。(2)VBAC组新生儿窒息率、产后出血量、先兆子宫破裂发生率与VBNC相比较,差异无显著性。(3)RCS组较VBAC组产后出血量高,严重粘连的发生率9%,平均住院天数均高于VBAC组,RCS组产后出血率较PCS组高,差异均有显著性(P<0.05)。结论:剖宫产术后(瘢痕子宫)再次妊娠阴道分娩不增加母儿不良结局的发生;瘢痕子宫妊娠再次剖宫产可明显增加产后出血量。

Objective：To investigate the delivery ways of once more pregnant childbirth after a caesarean operation. Methods ：We retrospective analyse 150 cases of once more caesarean birth, the results of childbirth and the complicating disease of the mother and baby for pregnant women of once more pregnant childbirth,in which there are the 132 cases of once more caesarean birth, the 18 cases of VBAC. By the way of comparing the 132 cases of those with the 132 randomly selected cases of the same time caesarean birth PCS for the first time,at the same time comparing the 18 cases of VBAC with 18 randomly selected cases of vagina delivery with Non-uterine scar. Results： The 24 vagina trial-birthgivings out of 150 cases, 18 cases are successful. The success ratio is 75% ,the success ratio of birthgiving by operation is 88%. There is no different marked significance according to the comparision between the newborn suffocating, the quantity of postpartum hemorrhage and the sub-bursting rate of the threatened rupture of uterus in VBAC group and comparative group. The quantity of postpartum hemorrhage of RCA is higher than that of VBAC, the rate of severe adhesion is 9%, and the equally hospitalized days of severe adhesion are more. The ration of postpartum hemorrhage in RCS group is higher than that of postpartam hemorrhage in PCS. The difference of them has a striking meaning （P〈0. 05）. Conclusion：The way of vaginal delivery which is once more pregnant childbirth after caesarean operation would not add the chance of the women and children accident, but the caesarean operation on which is uterine scar can lead the more amount of bleeding.