剖宫产术后再次足月妊娠分娩方式的探讨

Investigation of delivery mode for full-term re-pregnant women after cesarean section

目的：探讨剖宫产术后再次足月妊娠分娩方式的选择。方法选取石家庄市第四医院2012年1月至2013年5月瘢痕子宫再次足月妊娠188例患者完整的临床资料，就分娩方式及妊娠结局进行回顾性分析，随机选取同期非瘢痕子宫阴道分娩（VBNC）患者70例与瘢痕子宫阴道分娩（VBAC）59例进行对照研究；同时随机选取同期首次剖宫产（PCS）患者120例与再次剖宫产组（ RCS）120例进行比较。结果①选择阴道试产68例，成功59例，成功率86．76％；②VBNC组与VBAC组总产程、产后出血量、新生儿体重、住院费用及助产率比较均无统计学差异（t值分别为0．44、0．08、0．74、0．16，χ^2＝0．38，均P＞0．05）；③VBAC组的产后出血量、住院时间及医疗费用明显低于RCS组（t值分别为6．43、7．30、11．50，均P＜0．05）；④RCS组的产后出血量、手术时间、盆腹腔粘连和前置胎盘的发生率均率均高于PCS组，差异有统计学意义（t值分别为6．10、4．75，χ2值分别为5．11、5．66，均P＜0．05），但两组脏器损伤、切口乙级愈合率及胎盘植入的发生率相比无统计学差异（χ^2值分别为1．00、2．74、2．02，均P＞0．05）。结论剖宫产术后再次足月妊娠经阴道分娩具有必要性及可行性，只要掌握好阴道试产的适应症，严密监测，可在减少母婴并发症的同时降低再次剖宫产率。

Objective To investigate the delivery mode for full-term re-pregnant women after cesarean section.Methods From January 2012 to May 2013, 188 cases hospitalized in Fourth Hospital of Shijiazhuang giving birth again after cesarean section were retrospectively analyzed in terms of delivery mode and pregnancy outcomes.Fifty-nine cases of vaginal birth after cesarean section （ VBAC） and 70 cases of vaginal birth never cesarean （ VBNC） selected over the same period were compared and analyzed.Meanwhile, 120 cases of primary cesarean section （ PCS） were compared with 120 cases of repeat cesarean section （ RCS） over the same period.Results Sixty-eight cases selected vaginal trial production, and 59 cases were successful.The successful rate was 86.76%.There were no significant differences between VBAC group and VBNC group in duration of labor, amount of postpartum hemorrhage, birth weight, hospitalization expenses and midwifery rate （t value was 0.44, 0.08, 0.74 and 0.16,respectively,χ2 =0.38, all P〉0.05）.The amount of postpartum hemorrhage, length of hospital stay and hospitalization expenses of VBAC group were significantly less than PCS group （ t value was 6.43, 7.30 and 11.50, respectively, all P〈0.05）.The amount of postpartum hemorrhage, operation duration, the incidence of abdominal adhesion and placenta previa of RCS group were significantly more than PCS group （ t value was 6.10 and 4.75, χ^2 value was 5.11 and 5.66, respectively, all P〈0.05）, but there were no significant differences between two groups in organ injury rate, surgical incision healing of B degree and placenta increta （χ^2 value was 1.00, 2.74 and 2.02, respectively, all P〉0.05）.Conclusion Vaginal birth for full-term re-pregnant women after cesarean section is necessary and feasible.With trial production conditions and close monitoring, it can reduce cesarean section rate and reduce complications of cesarean section.