71例瘢痕子宫阴道试产的母儿结局分析

Clinical analysis on maternal and neonatal outcomes for 71 pregnant women with scarred uterus

目的探讨瘢痕子宫足月妊娠后阴道试产成功与否的临床综合指标。方法 2015年1月至2016年5月对核工业四一六医院无阴道分娩禁忌证的71例瘢痕子宫孕妇足月妊娠后选择剖宫产术后阴道试产(TOLAC),按分娩结果分成TOLAC成功组和TOLAC失败组,综合分析试产成功组与失败组母儿临床资料及相关风险因素。结果 71例瘢痕子宫孕妇足月妊娠后51例阴道分娩成功(成功组),20例阴道试产失败(失败组)。2组在围产期并发症、宫颈成熟度、产后出血量、自主哺乳时间、新生儿体质量比较,差异有统计学意义(P<0.05),新生儿并发症比较差异无统计学意义(P>0.05)。结论瘢痕子宫再次妊娠足月的孕妇,在宫颈Bishop评分大于5分、无孕期并发症和自然临产条件下,阴道试产成功率高、恢复快,对阴道试产失败者及时重复剖宫产,妊娠结局仍然良好。

Objective To evaluate the comprehensive indexes of the outcome of vaginal delivery in full-term pregnancy with caesarean scar. Methods Full-term pregnant women without any contraindications of vaginal delivery in 416 Hospital of China National Nuclear Corpo- ration from January 2015 to May 2016 were enrolled in the study. According to the delivery outcomes, the pregnant women with cesarean scars were divivded into successful group and failed group. The clinical data and relevent risk factors of maternal and fetal outcomes in two groups were analyzed comprehensively. Results Fifty-one cases have succeeded 71 pregnant women ,20 cases failed. There were significantly differ- ences in perinatal complications, cervical ripening, the amount of postpartum bleeding, the time of colostrums spontaneous secretion and breastfeeding, neonatal weight between the two groups（ P 〈 0.05 ）. There was no significant difference in the incidence of neonatal complica- tions between the two groups （ P 〉 0.05 ）. Conclusion Full-term pregnant women with caesarean scar had a higher success rate of vaginal delivery under conditions of Bishop score 〉 5, without pregnancy complication, which recoverd quickly with short hospitalization time. Failed vaginal delivery group applied repeated cesarean section, then resulted in favorable pregnancy outcomes.