140例剖宫产后疤痕子宫再次妊娠分娩方式的临床分析

Clinical analysis of delivery method in 140 cases of cesarean scar pregnancy

目的通过对剖宫产后疤痕子宫再次妊娠分娩产妇的临床资料进行回顾性分析,以探讨合理选择疤痕子宫再次妊娠分娩方式。方法回顾性分析140例剖宫产后疤痕子宫再次妊娠的临床资料,分娩方式包括剖宫产及经阴道分娩,比较不同分娩方式产妇的分娩结局,并比较疤痕子宫阴道试产成功产妇与随机选取的同期非疤痕子宫阴道分娩产妇的分娩结果,采用t检验或χ2检验对结果数据进行统计学处理。结果 140例剖宫产后疤痕子宫再次妊娠阴道试产成功率为77.77%(28/36),再次剖宫产率为80.00%(112/140);再次剖宫产组出血量为(421.5±92.8)ml,明显多于阴道分娩组的(201.4±48.7)ml,产褥病率[16.96%(19/112)]及住院天数[(7.1±0.6)d]均明显高于阴道分娩组的3.57%(1/28)、(3.9±0.8)d,差异有统计学意义(P<0.05);2组新生儿出生Apgar评分差异无统计学意义(P>0.05);产时出血量、产褥病率、新生儿Apgar评分及住院天数等指标在28例疤痕子宫经阴道分娩成功者与同期随机选取的140例非瘢痕子宫经阴道分娩组间比较差异均无统计学意义(P>0.05)。结论对于剖宫产术后疤痕子宫再次妊娠的分娩方式的选择,在严格掌握经阴道分娩指征且密切监测产程的前提下,经阴道分娩是安全可行的。

Objective To discuss the selection of delivery method for cesarean scar pregnancy. Methods The clinical data of 140 cases of cesarean scar pregnancy were analyzed retrospectively,and the delivery outcomes between cesarean and vagina successful trial production of pregnant women were compared,while the delivery outcomes between vagina successful trial production in scar pregnancy and vaginal delivery in pregnant women without uterine scar were also compared. The data of results was statistically by T test or chi-square test. Results The success rate of vaginal trial production was 77. 77%（28 /36） in the 102 pregnancies,and in the cesarean section was 80. 00%（112 /140）;In the second cesarean group,the bleeding volume was（421. 5 ± 92. 8） ml,puerperal morbidity was 16. 96%（19 /112） and hospital stay time was（7. 1 ± 0. 6）d,they were significantly higher than those in vaginal delivery group which were（201. 4 ± 48. 7）ml,3. 57%（1 /28） and（3. 9 ± 0. 8）d,there were statistically significant difference（P〈0. 05）;and the Apgar score was of no significant difference（ P 〉0. 05）;Comparing the cesarean scar pregnancy with vaginal delivery successfully with non-scarred uterus vaginal,there were no significant difference in bleeding,puerperal morbidity,Apgar score and hospital stay time（P〉0. 05）. Conclusion The vaginal delivery is safe and feasible in the cesarean scar pregnancy through strictly controlling vaginal delivery indications and monitoring the stage of labor closely.