非高危妊娠二次剖宫产术中出血情况研究

Hemorrhage analysis of second cesarean section in non-high-risk pregnancies

目的比较非高危妊娠二次剖宫产与首次剖宫产术中出血量。方法选择2014年6月至2015年6月在徐州医科大学附属徐州妇幼保健院住院足月妊娠行剖宫产手术病例120例,其中前次术后子宫瘢痕60例为研究组,首次剖宫产60例为对照组,两组产妇均无流产史;排除多胎妊娠、羊水过多、巨大儿、前置胎盘、妊娠期高血压疾病等高危妊娠,手术指征为胎儿窘迫、脐带绕颈、羊水过少、胎位不正;回顾性分析术中、术后24h出血量和术后血红蛋白下降情况及缩宫剂使用情况。结果研究组术中缩宫素与欣母沛使用量多于对照组,差异有统计学意义(P<0.05);研究组术中、术后24h出血量为(351.67±79.17)ml、(489.25±180.56)ml,多于对照组(316.67±48.42)ml、(404.33±71.22)ml,差异有统计学意义(P<0.05);研究组术后血红蛋白下降(11.56±9.43)g/L,大于对照组(8.35±5.16)g/L,差异有统计学意义(P<0.05)。结论非高危妊娠二次剖宫产术中出血量多于首次剖宫产,缩宫剂使用量大于首次剖宫产。因此,如何采取有效措施降低剖宫产率,提高阴道分娩率,是亟待研究解决的产科重要课题。

Objective To clinically comparehemorrhage between second cesarean section and first cesarean section in non-high-risk pregnancies.Methods A retrospective analysis ofhemorrhage and dinoprostone and oxytocin applied in and post（within 24h）cesarean section of 120 term pregnancy cases in Xuzhou Medical University Affiliated Xuzhou Maternity and Child Health Care Hospital during 2014 June to 2015 June,including60 uterine scar cases（study group）and 60 first cesarean section cases（control group）.All the 120 cases whichhad no abortionhistory and out ofhigh- risk pregnancy symptoms like polycyesis, polyhydramnios, fetal macrosomia,placenta previa and pregnancy-inducedhypertension syndrome,were indicated to operate by fetal distress,cord around neck,oligoamnios or malposition.Results Dinoprostone and oxytocin were applied in the study group more than control group,and the difference was statistically significant（P〈0.05）.Hemorrhage in and post（within 24h）cesarean section of study group（351.67±79.17）ml,（489.25±180.56）ml exceeded that of control group（316.67±48.42）ml,（404.33±71.22）ml,and the difference was statistically significant（P〈0.05）.Hemoglobin declinedheavier in study group（11.56±9.43）g/L than in control group（8.35±5.16）g/L,and the difference was statistically significant（P〈0.05）.Conclusions Hemorrhage in and post（within 24h）non-highrisk pregnancies second cesarean section is more than that of first cesarean section,and dinoprostone and oxytocin applied in the study group are more than that in control group.Therefore,how to take effective measures to reduce the cesarean section due to social psychological factors,improve the rate of vaginal delivery,is an urgent and important issue for obstetrics.