疤痕子宫再次妊娠分娩方式372例临床分析

Clinical Analysis of Delivery Methods for 372 Cases of Cesarean Scar Pregnancy

目的探讨疤痕子宫再次妊娠合理分娩方式。方法回顾性分析372例疤痕子宫再次妊娠分娩产妇临床资料,比较剖宫产和经阴道分娩的分娩结局;比较阴道试产成功疤痕子宫产妇与同期随机选取的非疤痕子宫产妇分娩结局。结果 372例疤痕子宫产妇再次剖宫产率为77.42%(288/372),阴道试产成功率为82.35%(84/102);剖宫产组产时出血量(396.3±88.6)m L、产褥病率14.24%(41/288)及住院时间(7.4±0.9)d均明显高于阴道分娩组的(188.2±45.3)m L、4.76%(4/84)、(3.1±0.6)d,差异有统计学意义(P<0.05);新生儿出生Apgar评分差异无统计学意义。疤痕子宫阴道分娩成功者与非疤痕子宫阴道分娩组相比,产时出血量、产褥病率、住院时间及新生儿Apgar评分等指标差异均无统计学意义(P>0.05)。结论在严格掌握阴道分娩指征且密切监测产程的条件下,疤痕子宫再次妊娠经阴道分娩安全可行。

Objective To evaluate the selection of delivery methods for cesarean scar pregnancy. Methods 372 cases of cesarean scar pregnancy from January 2013 to December 2013 in our hospital were retrospectively analyzed, and the delivery outcomes between caesarean and vaginal delivery were compared. In addition, the outcomes of successful vaginal delivery in scar pregnancy and non-scar pregnancy were also compared. Results The cesarean delivery rate was 77.42% （288/372）, and successful vaginal delivery rate was 82.35% （84/102） in 372 cases of cesarean scar pregnancy. The intrapartum bleeding of （396.3±88.6 ml）, puerperal morbidity of 14. 24% （41/288） and hospital stay time （7. 4±0. 9 d） of cesarean delivery group were significantly higher than （188.2±45.3 ml）, 4.76% （4/84）, and （3.1±0. 6 d） of the vaginal delivery group. The difference was statistically significant （P〈0.05）. But newborns Apgar score was of no significant difference （P〉0. 05）. Compared with non-uterine scar vaginal delivery group, there were no significant differences in intrapartum bleeding, puerperal morbidity, hospital stay time and Apgar scores （P〈0.05） in uterine scar vaginal delivery group. Conclusion Vaginal delivery is safe and feasible under strictly controllod vaginal delivery indications.