瘢痕子宫初次子宫不同缝合方式对再次妊娠阴道分娩的影响

Influence of first suturing mode in cicatricial uterus on subsequent pregnancy vaginal delivery

目的探讨瘢痕子宫初次子宫缝合方式对再次妊娠阴道分娩的影响。方法选取150例瘢痕子宫再次妊娠产妇,按照初次缝合方式进行分组,实验组为初次子宫双层缝合方式患者(n=74),对照组为初次子宫单层缝合方式患者(n=76)。比较两组患者再次妊娠试产成功率、新生儿评分以及术后并发症率。结果实验组试产成功率为81.10%,显著高于对照组(64.47%),差异具有统计学意义(x^2=5.21,P<0.05)。实验组新生儿Apgar评分显著高于对照组(t=19.29,P<0.05),且产时出血量、产程时间均显著低于对照组(t值分别为7.79、2.81,均P<0.05)。实验组产妇产后出血(>500mL)、子宫破裂或不完全破裂的发生率均显著低于对照组(x^2值分别为5.59、5.03,均P<0.05),两组产褥感染、新生儿窒息的发生率无显著性差异(x^2值分别为2.67、1.97,均P>0.05)。结论相比子宫单层缝合方式,瘢痕子宫初次子宫双层缝合方式的产妇再次妊娠阴道分娩试产成功率显著提高,并能够有效地减少单层缝合方式所引起的产后并发症,更有利于自然分娩,值得临床进一步推广应用。

Objective To investigate the influence of first suturing mode in cicatricial uterus on subsequent pregnancy vaginal delivery. Methods Totally 150 pregnant women with scar uterus on subsequent pregnancy were selected and divided into experimental group accepting uterus double suturing （ n = 74 ） and control group with uterus single suturing （ n = 76 ） according to primary suturing mode. The successful rate of trial delivery, neonatal Apgar score and incidence of postoperative complications were compared between two groups. Results The successful rate of trial delivery was 81.10% in the experimental group, which was significantly higher than that in the control group （ 64.47 % ） （X2 = 5.21, P 〈 0.05 ）. Compared with the control group, neonatal Apgar score was significantly higher （ t = 19.29, P 〈 0.05 ） but the amount of bleeding at delivery and labor process were less in the experimental group with significant differences （ t value was 7.79 and 2.81, respectively, both P 〈 0.05 ）. In the experimental group the incidence of hemorrhage exceeding 500mL and that of uterine rupture or incomplete rupture were remarkably lower than those in the control group （X2 value was 5.59 and 5.03, respectively, both P 〈 0.05 ）. There were no significant differences in the occurrence of puerperal infection and neonatal asphyxia between two groups （X2 value was 2.67 and 1.97, respectively, both P 〈 0.05 ）. Conclusion Compared with single suturing mode, pregnant women with double suturing mode have higher successful rate of trial vaginal delivery at subsequent pregnancy. Double suturing mode can effectively reduce some postnatal complications, and it is more beneficial to natural childbirth and worthy of further application in clinics.