168例剖宫产术后再次妊娠分娩方式分析

Delivery mode analysis of secondary pregnancy after cesarean delivery in 168 cases

目的探讨剖宫产术后再次妊娠的最佳分娩方式。方法对168例剖宫产术后再次妊娠孕妇分娩方式、分娩结局进行回顾性分析。将其中剖宫产术后阴道分娩（VBAC）23例与同期非瘢痕子宫阴道分娩（VBNC）23例进行对照分析，再次剖宫产（RCS）145例与同期首次剖宫产（PCS）145例进行对照分析。结果36例孕妇阴道试产，23例试产成功，成功率63．89％；选择RCS145例，手术产率86．31％。VBAC组新生儿窒息率、产时出血量与对照组比较，差异均无显著性差异（t=1．524，P〉0．05）：RCS组较VBAC组出血量大（195．9±4．6）mL、（165．7±13．6）mL，有极显著性差异（t=10．552，P〈0．01）；RCS与PCS两组术中出血量比较差异无统计学意义（t=1．069，P〉0．05）。结论剖宫产史作为再次妊娠剖宫产的指征是不合理的，如无剖宫产指征，应在严密监护下阴道试产。

Objective To discuss the best delivery mode of secondary pregnancy after cesarean section. Methods The delivery mode and outcomes of 168 cases of secondary pregnancy after cesarean section were retrospectively analyzed. Among the 168 cases, 23 eases of vaginal birth after cesarean delivery （VBAC） and 23 cases of vaginal birth with non-scarred cesarean delivery （VBNC） over the same period were compared and analyzed, and the rest 145 cases of repeat cesarean section （RCS） were compared with 145 cases of primary cesarean section （PCS） over the same period. Results Among the 36 cases of vaginal trial production, 23 cases were successful and the success rate was 63.89%. RCS was selected by 145 cases and the surgical delivery rate was 86.31%. The neonatal asphyxia rate and the intrapartum hemorrhage volume of VBAC group were not significantly different from those of control group （ t = 1. 524, P 〉 0.05 ）. The hemorrhage volume of RCS group was more than that in VBAC group [ （ 195.9 ± 4.6 ） mL, （ 165.7 ±13.8 ） mL] and the difference was statistically significant （t = 10. 552 ,P 〈 0.01 ）. The hemorrhage volume of RCS group and PCS group was not significantly different （t = 1. 069, P 〉 0.05 ）. Conclusion It is not reasonable to take the history of cesarean section as an indication of secondary pregnancy cesarean section, so if there is no indication of cesarean section, vaginal trial production should be encouraged under intensive monitoring.