350例剖宫产术后再次妊娠分娩结局的分析

Analysis of delivery outcomes of a second-time pregnancy after caesarean section in 350 cases

目的探讨剖宫产术后阴道分娩（VBAC）的可行性及影响其成功的因素。方法回顾性分析我院2014年7~12月350例剖宫产术后再次妊娠孕妇的分娩方式及母儿结局。根据分娩方式分为VBAC组,重复剖宫产组（ERCS）组,失败的VBAC组,比较VBAC组与ERCS组的母儿结局,以及VBAC组与失败的VBAC组的产科情况及母儿结局。结果 350例剖宫产术后再次妊娠孕妇中180例阴道试产,165例VBAC,VBAC成功率为91.7%。ERCS组的产时出血量,产褥感染,住院时间明显高于VBAC组（P〈0.05）。VBAC组的阴道分娩史,既往VBAC史,宫颈成熟度,自然临产,新生儿评分显著高于失败的VBAC组（P〈0.05）,而新生儿体重,产时出血量,产褥感染,子宫破裂显著低于失败的VBAC组,P〈0.05。结论选择合适的病例,VBAC是安全可行的,影响VBAC成功的因素有自然临产,宫颈成熟度,阴道分娩史,既往VBAC史,新生儿体重等。

Objective To explore the feasibility of vaginal birth after cesarean section（VBAC）and factors influencing on its success. Methods From July to December in 2014,delivery mode and outcome of mother-child from 350 women for a second-time pregnancy after caesarean section were retrospectively analyzed. According to delivery mode, they were divided into VBAC group, elective repeat cesarean section（ERCS）group,and failed VBAC group.Outcome of mother-child in VBAC group and ERCS group was compared.Obstetrical conditions and outcome of mother-child were compared in VBAC group and failed VBAC group. Results Among these 350 pregnant women after cesarean sections,vaginal trial production was in 180 cases.The VBAC was 165 cases and the success rate was 91.7%.In the ERCS group,Intrapartum amount of bleeding, puerperal infection,and hospital stay were all significantly longer than those in the VBAC group（P〈0.05）.In the VBAC group,history of vaginal delivery,past history of VBAC,cervical ripening,natural labor,and neonatal scores were remarkably higher than those in the failed VBAC group（P〈0.05）.However,birth weight,amount of bleeding during delivery,puerperal infection,and uterine rupture were all significantly lower than those in the failed VBAC group（P〈0.05）. Conclusion VBAC is safe and feasible for suitable cases.Factors influencing on the success of VBAC were natural labor,cervical ripening,history of vaginal delivery, past history of VBAC,and birth weight and so on.