剖宫产术后再次妊娠的分娩方式分析

Study on delivery mode in patients with prior cesarean section

目的探讨剖宫产术后再次妊娠的最佳分娩方式。方法笔者所在医院自2005年1月～2008年12月收治剖宫产术后再次妊娠孕妇132例,对其分娩方式、分娩结局、母婴并发症及医疗费用进行回顾性分析。将其中再次剖宫产(RCS)96例与随机抽取同期首次剖宫产(PCS)96例进行对照;将其中剖宫产术后阴道分娩(VBAC)36例与随机抽取同期非瘢痕子宫阴道分娩(VBNC)36例进行对照。结果 132例中60例行阴道试产,36例试产成功,成功率60%;RCS 96例,手术产率72.2%。VBAC组新生儿窒息、产后出血量、先兆子宫破裂发生率与对照组比较差异均无统计学意义(P>0.05);RCS组产后出血量比VBAC组高,平均住院天数比VBAC组长,医疗费用高,产后出血、严重粘连发生率均较PCS组高,差异有统计学意义(P<0.05)。结论剖宫产术后再次妊娠分娩并非是剖宫产绝对指征。如无剖宫产指征,应给予试产,因为阴道分娩可以减少再次开腹手术给患者带来的各种危险和并发症,减少患者痛苦和经济负担。符合试产条件者,严密监护下阴道试产是安全的。

Objective To study the delivery way of the re - pregnant women after caesarean section. Methods Retrospectively analyze the ways of childbirth, the results of childbirth and the cost for 132 re -pregnant women after caesarean section between Jan. 2005 and Dec. 2008. At the same time , compare the 96 cases of a second caesarean section with the randomly chosen 96 cases of the first caesarean section （PCS） of the same period, and compare the 36 cases of vaginal delivery af- ter caesarean section with the randomly chosen 36 no - scar uterus vaginal birth of the same period. Results In 132 cases,60 cases adopted trial of vaginal labor, with 36 successful ones. The success rath was 60%. In 96 RCS cases, the success rath of caesarean section was 7：2.7%. There was no significant difference in neonatal asphyxia, postpartum hemorrhage and the in- cidence of uterine rupture threatened between VBAC and VBNC. The quantity of postpartum hemorrhage of RCS was more than of VBAC, and the average days of hospitalization were more and the cost higher. The rate of postpartum hemorrhage in RCS was higher than that of postpartum hemorrhage in PCS, with statistical significance（ P 〈 0.05 ）. Conclusion Caesarean birth history is not the absolute indication of a caesarean bieth. It is unreasonable for the casarean section history as the indica- tion of C. S. We should try the vaginal delivery is possible, which may reduce risks and complications, relieve patient from operative pain and economic burden. If you are fit for vaginal birth, vaginal birth is possible under intensive monitoring.