瘢痕子宫妊娠引产及促宫颈成熟的研究进展

Research progress of induced labor and cervical ripening methods used in pregnant women with scarred uterus

瘢痕子宫患者剖宫产术后阴道分娩(VBAC)引产面临的问题日益严峻,如引产是否安全、何时引产及采用何种方式引产等,常困扰产科医师。对于足月妊娠且胎儿存活的瘢痕子宫患者,VBAC引产可能失败,并增加子宫破裂风险,因此瘢痕子宫患者VBAC引产需要严格把握引产指征,并在具备抢救条件的大型医疗机构进行。对于因胎儿畸形或死胎引产的瘢痕子宫患者,引产的关键是选择个体化引产方式,使对母体的损伤降至最低。笔者拟对中、晚孕期瘢痕子宫患者VBAC引产及促宫颈成熟的国内外指南及近期较重要的临床研究进行综述,旨在为产科医师提供临床指导。

The situation of induced labor in scarred uterus patients of vaginal birth after previous caesarean section（VBAC） has been getting more and more serious. Obstetricians always feel puzzles about the problems such as whether it is safe to induce labor, when to perform and which way is the best for induce labor. For a full-term pregnancy, induced labor in scarred uterus patients of VBAC may fail and increase the risk of uterine rupture. It is necessary to make strict indications for induced labor in scarred uterus patients of VBAC, and the procedure should be performed in hospital with rescue facilities. In scarred uterus patients of VBCA with fetal malformations and stillbirth, it is the key to select the individualized project and minimize the potential risks for puerperant. This paper reviewed the domestic and abroad guidelines and recent important clinical trials about induced labor and cervical ripening methods in scarred uterus patients of VBAC in second and third trimester,in order to provide clinical directions for obstetricians.