剖宫产术后疤痕子宫足月妊娠分娩方式的临床分析

The Delivery Mode of Scar Uterus in Term Pregnancy after Cesarean Section

目的:探讨剖宫产术后疤痕子宫足月妊娠经阴道分娩(VBAC)的可行性。方法:选取2009年1月至2016年8月剖宫产术后疤痕子宫足月妊娠经阴道分娩90例为观察组,选取我科2016年1月至6月间50例疤痕子宫足月妊娠行再次剖宫产术为对照1组,另选取我科2016年1月至6月间50例初产妇平产分娩为对照2组。分析3组间住院时间、产后出血量、产后24h出血量、产程时间等,同时比较一次剖宫产术后与两次剖宫产术后的月经异常的产妇例数。结果:与对照1组相比,观察组住院时间明显缩短,产后出血及产后24h出血量明显减少。两组之间差异有统计学意义,但两组内均未出现产褥感染及尿潴留。电话随访其产后恶露情况及月经情况,观察组中有8例出现产后恶露时间长且产后经期长、经量多情况,明显少于对照1组(19例),差异有统计学意义。观察组与对照2组相比,产时出血、产后24h出血量、胎儿体重方面的差异无统计学意义,产程时间相对较短,其差异有统计学意义。结论:对于剖宫产术后的疤痕子宫足月妊娠孕妇,在孕期及产前充分控制和评估后实施VBAC是可行的,同等条件下与再次剖宫产相比是利大于弊。

Objective： To investigate the feasibility of vaginal birth after cesarean section scar pregnancy（ VBAC）. Methods： 90 cases with vaginal delivery after cesarean uterine scar pregnancy from January 2009 to August 2016 were selected as the observation group; 50 cases of uterine scar pregnancy underwent cesarean section again as control group 1,the other in our hospital from January June,2016 to 50 primiparaes in delivery as control group 2. The hospital stay,the amount of postpartum hemorrhage,the amount of postpartum hemorrhage and the duration of labor in 3 groups were analyzed,and the menstrual abnormalities after cesarean section of two groups were compared between the 24 groups. At the same time,the number of cases of abnormal menstruation after cesarean section was compared. Results： Compared with control group 1,the hospitalization time was significantly shorter,the postpartum hemorrhage and postpartum hemorrhage of 24 h decreased significantly in the observation group. There was significant difference between the two groups,but there was no puerperal infection and urinary retention in the two groups. Postpartum lochia and menstruation followed up by telephone,8 cases of observation group had postpartum lochia long and prolonged postpartum period and increased menstrual volume,which significantly less than control group 1. The difference was statistically significant. Compared with the time of labor and the amount of intrapartum hemorrhage,postpartum hemorrhage of 24 hours,there was no significant difference between the observation group and the control group 2. Conclusion： For the scaruterus pregnant women,it is feasible to implement VBAC after control completely and evaluation during pregnancy and prenatal care,under the same condition compared with the recesarean section,there is more advantages in VBAC than cesarean section.