剖宫产后疤痕子宫再次妊娠分娩方式的临床探讨

The Mode of Delivery of Secondary Pregnancy after Cesarean Section of Scar Uterus

目的:探讨剖宫产后疤痕子宫再次妊娠分娩方式的合理选择。方法:回顾性分析我院在2008年6月至2012年6月期间的120例剖宫产术后再次妊娠孕妇的临床资料;其中78例孕妇的二次生产方式为剖宫产,将其视为观察组A(n=78),其余42例孕妇的二次生产方式为阴道分娩,将其视为观察组B(n=42);选择同时期的78例首次剖宫产孕妇作为对照组A(n=78),42例同期非疤痕子宫阴道分娩孕妇作为对照组B(n=42);对比分析观察组A、对照组A、观察组B、对照组B的分娩结局及母婴并发症。结果:120例剖宫产术后再次妊娠孕妇中共有59例行阴道试产,其中成功42例(71.2%);再次剖宫产孕妇78例,手术率65.0%;在产后出血量、重度粘连、切口乙级愈合发生率方面,观察组A和对照组A差异显著(P<0.05),具有统计学意义;在产后出血量、平均住院时间方面,观察组A和观察组B差异显著(P<0.05),具有统计学意义;在产后出血量、新生儿窒息、先兆子宫破裂发生率方面,观察组B和对照组B的差异不显著(P>0.05),不具有统计学意义。结论:疤痕子宫再次妊娠分娩并非剖宫产绝对指征,但是仍然以手术为主;符合试产条件下的阴道试产具有较高的安全性与可行性,但是为了确保母婴平安,需要高度关注子宫破裂问题。

Objective： To explore the reasonable choice on the mode of delivery of secondary pregnancy after cesarean section of scar uterus. Method：Clinical data of 120 cases secondary pregnant women after cesarean section in our hospital from Jun. 2008 to Jun. 2012 was retrospectively analyzed ; Of which two production of 78 pregnant women with cesarean section, were regarded as the observation group A （ n = 78 }, modes of two production in other 42 cases pregnant women with vagina delivery, were regarded as the obser- vation group B { n = 42） ; 78 cases of the same period of cesarean section for the first time pregnant women were selected as control group A { n = 78 } , 42 patients with non scar uterus vaginal delivery pregnant women as control group B （ n = 42 ） ; Birth outcomes and complications of mother and infant for observation group A, control group A, observation group B,control group B were compared ~ Result： There were 59 cases of vagi- nal delivery in 120 cases of pregnant women with pregnancy after cesarean section , which was successful in 42 cases { 71.2% ） ; 78 cases of pregnant women were cesarean section again, operation rate was 65% ;there were significant difference between the observation group A and control group A about the amount of postpar- tum hemorrhage, severe adhesions, incision healing rate of occurrence （ P 〈 0.05 ）, There＇s statistical sig- nificance; about postpartum hemorrhage volume, average hospitalization time, group A and group B were ob- served to be different significantly { P〈0.05 ）, with statistical significance ; There＇s differences in the amount of postpartum bleeding, neonatal asphyxia, the rate of occurrence of threatened uterine rupture, between ob- servation group B and the control group B （ P 〉 0.05 ）. Conclusion： Uterine scar pregnancy, childbirth is not the absolute indication of the cesarean section, but stil~ in operation; vaginal delivery with trial production conditions has high safety and feasibility , but in order to ensure the safety of mother and baby, the issue of uterine rupture should be paid more attention to.