剖宫产后再次妊娠116例分娩方式的临床研究

Clinical research of the delivery modes of 116 cases of repregnancies after cesarean sections

目的:探讨剖宫产后再次妊娠的最佳分娩方式,降低剖宫产率、孕产妇及围产儿的病死率。方法:选取我科收治的剖宫产后再次妊娠孕妇116例临床资料进行回顾性分析,将68例剖宫产术后阴道分娩(VBAC)与同期非瘢痕子宫阴道分娩(VBNC)68例进行对照分析;将再次剖宫产(RCS)48例与随机抽取的同期首次剖宫产(PCS)48例的相关资料进行比较。结果:116例剖宫产后再次妊娠孕妇中有70例行阴道试产,试产成功68例,试产成功率97.14%,再次剖宫产48例,手术产率41.38%。VBAC组与VBNC组的各项指标比较,无显著性差异(P>0.05);RCS组比VBAC组产后出血量高,平均住院天数多,医疗费用高(P<0.05,P<0.01);RCS组产后出血量明显高于PCS组(P<0.01)。结论:剖宫产后再次妊娠分娩并不是行剖宫产术的绝对指征,若无阴道试产禁忌者可在严密监护下行阴道试产,大部分孕妇都能安全通过阴道分娩。

Objective： To discuss the best delivery mode of repregnancy after cesarean section, so that it can reduce the cesarean rate and maternal and the perinatal mortality rate. Methods： Clinical data of 116 cases of secondary pregnancy after cesarean section in my department were retrospectively analyzed. 68 cases of vaginal birth after cesarean section （VBAC） and 68 cases of vaginal birth after no-scar cesarean section （VBNC） the corresponding period were compared; at the same time, the related data of 48 cases of repeat cesarean section （RCS） and 48 ramdomized cases of the first cesarean section （PCS） at the same period were compared. Results： Of the 116 repregnant women after cesarean section, 70M chose vaginal deliveries with the success rate of 97.14%; 48 cases repeated cesarean sections with the operation rate of 41.38%. Compared the indicators in VBAC group with VBNC group, there were no significant difference （P〉0.05）; the amount of postpartum bleeding in RCS group was higher than VBAC group, the average hospital day was longer and hospitalization costs was higher （P〈0.05, P〈0.01） ; the amount of postpartum bleeding in RCS group was obviously higher than that in PCS group （P〈0. 01）. Conclusion. The delivery for repregnancies after cesarean section is not the absolute indication to perform cesarean section, if no vaginal delivery contraindication, repregnant women can choose vaginal delivery under the close ward, and more pregnant women can safely deliver through the vaginas.