剖宫产术后再次妊娠分娩方式的探讨与分析

Choice of secondary delivery mode after cesarean section

目的:探讨剖宫产术后再次妊娠分娩方式的选择,从而提高分娩质量。方法:对81例剖宫产术后再次妊娠分娩者的临床资料进行回顾性分析,并将其中62例剖宫产术后再次妊娠剖宫产(RCS组)及19例剖宫产术后再次妊娠阴道分娩(VBAC组)与同期62例首次剖宫产(PCS组)及19例非瘢痕子宫阴道分娩(VBNC组)比较,分析各组分娩结局、新生儿Apgar评分以及住院时间等差异。结果:81例剖宫产术后再次妊娠者,再次剖宫产者62例(76.5%),阴道分娩者19例(23.5%)。VBAC组与RCS组比较,二组在产时出血量、新生儿Apgar评分以及住院时间方面均有明显差异(P<0.05)。VBAC组与VBNC组相比较,二者在产程时间、产时出血量、新生儿Apgar评分、新生儿窒息数及住院时间方面均无统计学差异(P>0.05)。RCS组与PCS组相比较,在手术时间、产时出血量、术后腹腔粘连及住院时间方面均有明显差异(P<0.05),新生儿Apgar评分无明显差异(P>0.05)。结论:剖宫产术后再次妊娠,如无剖宫产指征且符合阴道分娩条件,应首选阴道试产,以改善分娩结局,提高分娩质量。

Objective： To discuss the selection of secondary delivery mode after cesarean section in order to improve delivery outcomes.Methods： A total of 81 cases of second term pregnancy after cesarean delivery,of which 62 cases underwent repeat cesarean section（RCS group）,19 had vaginal birth after cesarean section（VBAC group）.62 corresponding cases that underwent first cesarean section（PCS） and 19 that had non-scarred uterus with vaginal delivery（VBNC） during the same period were also selected for comparison of delivery outcomes.Results： Of the 81 cases,62（76.5%） had RCS,19（23.5%） had VBAC,and significant differences in blood loss volume,Apgar score,and hospital stay length were observed between the two groups（P0.05）.No significantl differences in labor time,intrapartum hemorrhage,Apgar score,number of neonatal asphyxia and hospital stay length was observed between VBNC and VBAC group（P0.05）.Significant differences in operation time,blood loss,postoperative abdominal adhesions and hospital stay were shown between RCS and PCS group（P0.05） while Apgar score of neonatal was not significant different（P0.05）.Conclusion： In order to improve the delivery outcomes,VBAC is proposed for women that had second term pregnancy after cesarean delivery if no high risk factors existe.