剖宫产术后再次妊娠产妇的适宜分娩方式探讨

Investigation on the approach of delivery after previous cesarean section

目的探讨剖宫产术后再次妊娠产妇的适宜分娩方式。方法 2014年1月~2015年6月期间我院产科分娩产妇总数7250例,对其中一次剖宫产术后再次妊娠的产妇320例资料进行回顾性分析。结果 320例产妇中阴道试产80例,阴道试产率为25%（80/320）,阴道试产且分娩成功68例（即阴道分娩组）,试产成功率85%（68/80）,阴道分娩成功率21.3%（68/320）,12例阴道试产失败改为剖宫产术。320例产妇中有240例再次行剖宫产术（即剖宫产组）。阴道分娩组和剖宫产组产妇分娩孕周、新生儿窒息比较差异无统计学意义,产妇产后出血量、产后出血率、住院天数、产褥感染等比较差异有统计学意义。结论剖宫产术后再次妊娠的产妇只要产前做好充分评估,严格掌握阴道试产的指征,可在严密监护下行阴道试产且成功分娩,可以大大促进自然分娩,降低剖宫产率。

Objective To explore the appropriate approach of delivery after cesarean section. Methods Totally 7,250 women delivered in the department of obstertrics in our hospital from Jannuary 2014 to June 2015. A retrospective analysis was made of 320 cases approach of delivery after cesarean section. Results Among the 320 cases, 80 cases attempted vaginal labor, the rate of attempting vaginal labor was 25%（80/320）. A total of 68 cases succeed in vaginal delivery（the vaginal delivery group）,with the succeeful rate of attempting vaginal delivery of 85.0%（68/80）,and the successful rate of vaginal delivery was 21.3%（68/320）,12 cases attempting vaginal delivery failed and turned to cesarean section.240 cases received the second cesarean section（the cesarean section group）. Gestational weeks at delivery, rates of newborn asphyxia in the vaginal delivery and cesarean section groups showed no significant statistical difference. The average blood loss after delivery, the rate of blood loss,the mean hospitalization and the puerperal infection, respectively. There was significant statistical difference between the two groups. Conclusion Vaginal delivery after cesarean section could be attemped,if doctors could assessment risk fully and choose the indications strictly. There could increase the success rate of the vaginal delivery and therefore reduce the cesarean section rate.