剖宫产术后再次妊娠分娩方式的临床探讨

Discussion on Clinical Pregnancy Delivery Modes after Cesarean Section

目的探讨剖宫产术后再次妊娠分娩方式的选择。方法对2005年1月至2010年12月在我院住院的150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104例剖宫产术后再次妊娠剖宫产(RCS组)及46例剖宫产术后再次妊娠阴道分娩(VBAC组),与同期104例首次剖宫产(PCS组)及46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Ap-gar评分以及住院时间等差异。结果 150例剖宫产术后再次妊娠者,再次剖宫产者104例(69.3%),阴道分娩者46例(30.7%)。VBAC组与RCS组比较,两组在产时出血量、新生儿Apgar评分以及住院时间方面均有统计学意义(P<0.05)。VBAC组与VBNC组相比较,两者在产程时间、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意义(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统计学意义(P<0.05),新生儿Apgar评分无统计学意义(P>0.05)。结论剖宫产术后再次妊娠分娩并非是剖宫产的绝对指征,符合试产条件者在严密监护下阴道试产是安全可行的,且能改善分娩结局。

Objective To discuss the selection of secondary delivery mode after cesarean section. Meth- ods A total of 150 cases of second pregnancy after cesarean delivery admitted in our hospital during Jan. 2005 to Dec. 2010 were reviewed, of which 104 cases underwent repeat cesarean section （RCS group） ,46 had vaginal birth after cesarean section（ VBAC group）. 104 corresponding cases that underwent first cesarean section（PCS） and 46 that had non-scarred uterus with vaginal delivery（VBNC） during the same period were also selected for comparison of delivery outcomes. Results Of the 150 cases, 104 （69.3 % ） had RCS, 46 （ 30.7 % ） had VBAC, and significant differences in blood loss volume, Apgar score, and hospital stay length were observed between the two groups （ P 〈 0.05 ）. No significant differences in labor time, intrapartum hem- orrhage, Apgar score, number of neonatal asphyxia and hospital stay length was observed between VBNC and VBAC group （P 〉 O. 05 ）. Significant differences in operation time, blood loss, postoperative abdominal adhe- sions and hospital stay were shown between RCS and PCS group （ P 〈 0.05 ） while Apgar score of neonatal was not significant different （ P 〉 0.05 ）. Conclusion Second time birth giving after a caesarean operation is not the absolute indication of a caesarean birth, in the case of fit for trial birth giving,it is safe to try vagina delivery under intensive care.which may imorove the delivery outcomes as well.