瘢痕子宫再次足月妊娠经阴道分娩的评估与可行性分析

Evaluation of a second-time transvaginal delivery in scarred uterus in a full-term pregnancy and its feasibility analysis

目的探讨瘢痕子宫再次足月妊娠经阴道分娩的安全性与可行性。方法选取2016年1~12月在我院生产的瘢痕子宫孕妇89例,按照自愿原则分为阴道试产组与剖宫产术组,另选取同期在我院经阴道分娩的非瘢痕子宫健康孕妇40例,设为非瘢痕子宫组;观察三组孕妇产后24 h出血量、产程时间、住院天数、新生儿情况、产褥感染等情况。结果 64例孕妇选择经阴道试产,17例试产失败转为剖宫产,列入剖宫产组;最终阴道分娩组47例,阴道试产成功率为73.44%;剖宫产组42例,选择非瘢痕子宫组40例;阴道分娩组在住院天数、产后24 h出血量、新生儿Apgar评分、产褥感染、产程时间方面明显优于剖宫产组,差异有统计学意义(P<0.05);阴道分娩组在产程时间、住院天数、产后24 h出血量、产褥感染、新生儿Apgar评分方面与非瘢痕子宫组比较,差异无统计学意义(P>0.05)。结论瘢痕子宫孕妇再次妊娠经阴道分娩相比于剖宫产能够有效改善妊娠及新生儿结局,在严格掌握阴道分娩适应证的情况下,应给予产妇阴道试产机会。

Objective To explore the safety and feasibility of transvaginal delivery in scarred uterus in a full-term pregnancy.Methods From January to December 2016,89 pregnant women with scarred uterus delivered in our hospital were selected.According to the principle of voluntariness,they were divided into vaginal trial group and cesarean section group.Meanwhile,40 healthy pregnant women without scarred uterus who gave delivery in our hospital were selected during the same period and categorized into non-scarred uterus group.The postpartum 24 h bleeding,labor time,hospital stay,neonatal conditions,and puerperal infection in pregnant women among three groups were compared.Results Sixty- four pregnant women tried vaginal trial,and 17 cases were failed and turned to cesarean section,which were classified into the cesarean section group.Tbe number of the final vaginal delivery was 47 cases,and the success rate of vaginal trial was 73.44%.There were 42 cases and 40 cases in the cesarean section group and non-scarred uterus group re- spectively.The indexes of hospital stay,amount of bleeding 24 h after delivery,neonatal Apgar score,puerperal infection, and labor time in the vaginal delivery group were greatly superior to those in the cesarean section group with statistical differences （P〈0.05）.No statistical difference was displayed in labor time,hospital stay,amount of bleeding 24 h after de- livery,puerperal infection,and neonatal Apgar score after comparing with those in the non-scarred uterus group （P〉 0.05）.Conclusion In comparison with delivery by cesarean section,a second-time transvaginal delivery in scarred uterus can effectively improve outcomes in pregnancy and neonates.Under the strict control of indications of vaginal delivery, opportunity for vaginal trial delivery in pregnant women should be provided.