疤痕子宫足月妊娠经阴道试产产程特点及临床结局

Birth process feature and clinical outcome of vaginal trial parturition in uterogestation cases with scar uterus

目的：观察疤痕子宫足月妊娠经阴道试产的产程特点及临床结局，探讨经阴道试产的安全性，减少重复剖宫产，提高阴道分娩率。方法：选择2011年6月-2013年6月在该院分娩的疤痕子宫足月妊娠孕妇48例作为观察组，经产前综合评估并知情同意后行阴道试产，同时以足月初产妇经阴道试产48例作为对照组，比较两组病例在阴道分娩率、潜伏期、活跃期、总产程、产后出血、新生儿Apgar评分方面的差异。结果：48例瘢痕子宫足月妊娠经阴道试产阴道分娩34例，14例试产失败改剖宫产，阴道分娩率70．83％。对照组48例阴道分娩41例，剖宫产7例，阴道分娩率85．42％，两组比较P〈0．05，有统计学差异。观察组阴道分娩与对照组比较在潜伏期、活跃期、总产程、产时出血量、新生儿Apgar评分方面无统计学差异（P〉0．05）。结论：瘢痕子宫足月妊娠孕妇经综合评估，严密产程监测经阴道试产安全可行，可减少重复剖宫产带来的二次损伤。

Objective： To observe birth process feature and clinical outcome of vaginal trial parturition in uterogestation cases with scar uterus, probe the security of vaginal trial parturition, reduce subsequent cesarean section and raise vaginal delivery rate. Methods： 48 cases of uterogestation with scar uterus were chosen as observation group in the hospital from June 2011 to June 2013. All patients were ap- plied with vaginal trial parturition after antepartum synthetic evaluation, information and permission. Simultaneously, 48 uterogestation cases of normal gravida were selected as control group. The rate of vaginal delivery, incubation, active stage, total birth process, postpartum hemorrhage, and neonatal Apgar＇s score were compared in two groups. Results： 34 cases （70. 83% ） of observation group and 41 cases （85.42%） of control group were successfully applied with vaginal trial parturition （P 〈 0. 05） . There were no statistical difference in incu- bation period, active stage, total birth process, postpartum hemorrhage and neonatal Apgar＇s score in two groups （P 〉 0. 05） . Conclu- sion： With synthetic evaluation and strict birth process monitoring, vaginal delivery of full - term pregnancy in scared uterus is feasible, safe and can reduce secondary damage caused by repeat cesarean.