剖宫产术后阴道分娩的临床结局及安全性分析

Clinical outcome and safety analysis of vaginal delivery after cesarean section

目的探讨剖宫产术后阴道分娩的临床结局及安全性。方法对东莞市塘厦医院及中山大学孙逸仙纪念医院于2014年1~12月分娩的512例瘢痕子宫再次妊娠者进行回顾性分析。结果 512例瘢痕子宫中,阴道试产163例（VBAC组）,占瘢痕子宫分娩的31.84%,其中阴道试产成功126例,阴道试产成功率达77.3%,试产失败后转剖宫产37例,试产失败率22.7%;瘢痕子宫未经试产直接再次剖宫产者349例（ERCS组）,占瘢痕子宫分娩的68.16%;512例瘢痕子宫再次剖宫产（包括阴道试产失败37例）为386例,占瘢痕子宫分娩的75.39%。VBAC组较ERCS组24 h产后出血量多、产后出血率高,VBAC组住院日更短、医疗费用更低,差异有统计学意义（P〈0.05）。两组子宫破裂、输血率、手术创伤、产后发热、新生儿呼吸道疾病、新生儿窒息、新生儿入住NICU发生率比较,差异无统计学意义（P〉0.05）。结论剖宫产术后再次妊娠孕妇如合理掌握试产指征,产程中严密监测,阴道试产安全可行且试产成功率高,可在一定程度上降低剖宫产率。

Objective To explore the clinical outcome and safety of vaginal delivery after cesarean section. Methods512 cases of scarred uterus who delivered in Tangxia Hospital of Dongguan and Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University from January to December 2014 and had a second pregnancy were retrospectively analyzed. Results Among 512 cases of scarred uterus,163 cases were vaginal trial labour（VBAC group）,accounting for 31.84% of scarred uterus delivery.Among them,vaginal trial labourwas carried out successfully in 126 cases,with the successful rate of vaginal trial labour of 77.3%.Trial labourwas failed in 37 cases and switched to cesarean section,with the failure rate of trial labour of 22.7%;Cesarean section without trial labourwas performed in 349 cases（ERCS group）,accounting for68.16% of the scarred uterus pregnancy;386 out of the 512 cases of scarred uterus were given a second cesarean section（including 37 cases of failed vaginal trial labour）,accounting for 75.39% of scarred uterus delivery.In the comparison of pregnancy outcome in VBAC group and ERCS group,VBAC group was higher than ERCS group in the volume and rate of postpartum bleeding,but VBAC group was shorter than ERCS group in the length of stay and lower than ERCS group in the medical expenses,which were statistically different（P0.05）.There were no statistical differences in the incidence rates of uterus rupture,blood transfusion rate,surgical trauma,postpartum fever,neonatal respiratory diseases,neonatal asphyxia and neonatal admission to NICU（P 0.05）. Conclusion As for the pregnant women with a second pregnancy after cesarean section,if the indication of trial labour is properly understood,severe monitoring is performed during the labour,and vaginal trial labour is safe and feasible with a high successful rate,then the rate of cesarean section can be reduced to a certain extent.