剖宫产术后再次妊娠经阴道分娩的成败因素探索

Study of Key Success Factors About Vaginal Delivery With Repeated Pregnancy After Cesarean Section

目的探讨剖宫产术后再次妊娠的分娩方式,分析经阴道分娩的可能性。方法采取回顾性分析法,对2009年3月至2011年12月在南京迈皋桥医院既往有剖宫产史再次分娩的116例孕妇为研究对象,对其进行剖宫产后再次妊娠经阴道分娩(VBAC)的可能性分析(本研究遵循的程序符合南京迈皋桥医院人体试验委员会所制定的伦理学标准,得到该委员会批准,并与之签署临床研究知情同意书)。结果 116例孕妇中,仅15例(12.9%)接受经阴道试产,10例(66.6%,10/15)阴道分娩成功,106例(91.4%)再次剖宫产分娩终止妊娠。本组具备阴道试产条件但选择择期剖宫产术终止妊娠的孕妇为27例(23.3%);因既往病史不清选择再次剖宫产术分娩的为13例(11.2%)。本组实际剖宫产率显著高于有明确剖宫产指针的剖宫产率,且差异有统计学意义(P<0.05)。结论剖宫产术后再次妊娠分娩并非剖宫产的绝对指征,对符合条件的孕妇可以在严密监护下阴道试产。

Objective To investigate the delivery of repeated pregnancy after cesarean section. Evaluate the likelihood of vaginal birth after caesarean（VBAC）. Methods There were 116 pregnant women with previous cesarean section delivery who would delivery again from March 2009 to December 2011 in Nanjing Maigaoqiao Hospital.Their outcomes were analyzed by retrospective analysis method. Informed consent was obtained from all participants. Results Among 116 pregnant women of 15 cases （12.9%）of vaginal trial production,10 cases（66.6%,10/15） were successful. Once again the cesarean section rate was 91.4%（106/116）.There were 27 cases（23.3%） who had vaginal production conditions but chose elective cesarean section. Formerly medical history of previous cesarean section delivery were not clear of 13 cases （11.2%） who also chose elective cesarean section . There had significance difference between actual cesarean section rate and indication for caesarean section rate（P0.05）. Conclusions Repeated pregnancy after cesarean section delivery is not absolute indications for cesarean section .To meet the requirements of the pregnant women can vaginal delivery in intensive care.