瘢痕子宫再次妊娠分娩方式的选择及经阴道分娩安全性的临床分析

Clinical analysis on the selection of delivery mode for secondary pregnancy of cicatricial uterus and the safety of vaginal delivery

目的：观察瘢痕子宫再次妊娠选择不同分娩方式的临床情况并分析经阴道分娩的安全性。方法选取2011年7月-2014年12月本院收治的瘢痕子宫再次妊娠产妇225例，其中选择阴道试产分娩产妇107例作为研究组，选择再次剖宫产分娩产妇118例作为对照A组，另选取同期首次妊娠阴道分娩产妇90例作为对照B组，比较3组的临床情况。结果225例再次妊娠产妇中，107例（47.56%）自愿选择且适宜阴道分娩，试产成功71例（66.36%）（观察组），118例（52.44%）自愿要求或具有剖宫产指征；观察组产妇的的产时、产后出血量明显少于对照A组（剖宫产分娩），住院时间明显短于对照A组，术后并发症发生率明显低于对照A组（P〈0.05）；观察组产妇的产后出血量、产程时间、住院时间、试产成功率及新生儿评分与对照B组差异无统计学意义（P〉0.05）。结论瘢痕子宫再次妊娠产妇选择实施阴道分娩，相比实施剖宫产仍然具有较明显的优势，亦有一定的风险，但实施严格控制阴道试产适应证与禁忌证、加强产时监护等措施能有效提高其安全性与可行性，从而促进临床自然分娩。

Objective To observe the clinical conditions of different delivery mode for secondary pregnancy of cicatri-cial uterus and to analyze the safety of vaginal delivery. Methods 225 puerperae with cicatricial uterus for secondary delivery treated in our hospital from July 2011 to December 2014 were selected.among them,107 puerperae selecting vaginal delivery for trial-production were selected as observation group,118 puerperae selecting secondary cesarean section for delivery were selected as control group A,and another 90 puerperae with initial vaginal delivery were select-ed as control group B.Clinical condition of among 3 groups were compared. Results Among 225 puerperae with sec-ondary pregnancy,107 puerperae （47.56%） voluntarily selected and were also appropriate for vaginal delivery and a-mong them,71 cases （66.36%） （observation group） succeeded in delivery.118 puerperae （52.44%） voluntarily requested or had the indication for cesarean section.Bleeding amount during delivery and after delivery in observation group were obviously fewer than those control group A,hospital stay of observation group was obviously shorter than that of control group A,incidence rate of complication after operation in observation group was obviously lower than that of control group A （P〈0.05）;there was no statistical difference of bleeding amount,labor time,hospital stay,success rate of trial-production and neonatal score between observation group and control group B （P〉0.05）. Conclusion Vaginal delivery selected by puerpera with cicatricial uterus for secondary delivery still have relatively significantly advantages com-pared with cesarean section,while it also has certain risk,but conducting measures of strictly controlling indications and contraindications of vaginal delivery as well as strengthening monitoring during delivery can effectively improve its safety and feasibility to promote clinical natural delivery.