瘢痕子宫阴道试产的可行性分析

Analysis on the feasibility of scar uterus vaginal delivery

目的分析瘢痕子宫足月产妇阴道试产的可行性以及阴道试产与前次手术间隔时间对试产成功率的影响。方法回顾性分析1 068例瘢痕子宫患者的临床资料,根据分娩方式分为阴道试产组896例、剖宫产组172例。比较阴道分娩与剖宫产产妇的产时出血量、产后住院天数以及新生儿出生Apgar评分情况。瘢痕子宫产妇根据本次分娩与上次手术间隔时间分为3组:2~3年、3~5年、5~7年,分析3组阴道试产例数及阴道试产成功率。结果瘢痕子宫足月产妇中阴道试产896例,成功637例,成功率71.09%。阴道试产失败中转剖宫产259例,失败率28.91%;瘢痕子宫足月产妇直接行剖宫产172例,占瘢痕子宫足月产妇总数的16.10%。阴道分娩、中转剖宫产和直接剖宫产产妇的产时出血量分别是(236.33±58.16)ml、(514.13±78.21)ml,和(506.72±82.37)ml,阴道分娩较中转剖宫产和直接剖宫产产时出血量均减少,差异具有统计学意义(P<0.01);而产后住院天数分别为(3.13±1.57)d、(9.08±1.76)d和(8.96±1.97)d,阴道分娩较中转剖宫产和直接剖宫产者产后住院天数缩短(P<0.01)。2~3年组阴道试产148例,成功114例,成功率77.03%;间隔3~5年组阴道试产576例,成功414例,成功率71.88%;5~7年组阴道试产172例,成功109例,成功率63.37%。3组间阴道试产成功率存在统计学差异(P<0.01),且本次阴道试产距离上次手术间隔时间越长阴道分娩成功率越低。结论严格掌握试产条件,对符合阴道试产指征的瘢痕子宫足月妊娠患者开展阴道试产,对减少产时出血量、缩短住院时间、降低剖宫产率有重要意义,而阴道试产与前次手术间隔时间对阴道试产成功率具有一定影响。

Objective To analyze the feasibility of scar uterus vaginal delivery and the effects of vaginal trial production and interval time between previous surgery and vaginal trial production on sucessful rate of vaginal trial production.Methods The clinical data of 1 068 patients with scar uterus were analyzed retrospectively,then they were divided into vaginal trial production group（ 896 patients） and cesarean section group（ 172 patients）.The amounts of intraoperative blood loss,hospitalization time after delivery and neonatal Apgar scores were compared between vaginal trial production group and cesarean section group.According to the interval time between previous surgery and vaginal trial production,the patients were divided into 2- 3-year group,3- 5-year group and 5- 7-year group,the numbers and successful rates of vaginal trial production in the three groups were analyzed.Results Among 896 patients adopting vaginal trial production,637 patients succeeded,the successful rate was 71.09%; 259 patients failing in vaginal trial production converted to cesarean section,the failure rate was 28.91%; 172 patients adopted cesarean section directly without vaginal trial production,accounting for 16.10%.The amounts of intraoperative blood loss in vaginal delivery patients,cesarean section conversion patients and cesarean section patients were（ 236.33 ±58.16） ml,（ 514.13±78.21） ml and（ 506.72± 82.37） ml,respectively.The amount of intraoperative blood loss in vaginal delivery patients was statistically significantly less than those in cesarean section conversion patients and cesarean section patients（ P〈0.01）; hospitalization time after delivery were（ 3.13±1.57） days,（ 9.08±1.76） days and（ 8.96±1.97） days,hospitalization time after delivery in vaginal delivery patients was statistically significantly shorter than those in cesarean section conversion patients and cesarean section patients（ P〈0.01）.The successful rates of vaginal trial production in 2- 3- year group,3- 5- year group and 5- 7- year group were 77.03%（ 114 /148）,71.88%（ 414/576） and 63.37%（ 109/172）,respectively,there was statistically significant difference among the three groups（ P〈0.01）.The longer the interval time between previous surgery and vaginal trial production was,the lower the successful rate of vaginal delivery was.Conclusion Strictly mastering the indications of vaginal trial production and conducting vaginal trial production among the scar uterus full-term pregnant patients meeting the indications of vaginal trial production have significant importance in reducing the amount of intrapartum blood loss,shortening hospitalization time and reducing cesarean section rate.The interval time between previous surgery and vaginal trial production has an certain impact on the successful rate of vaginal trial production.