剖宫产术后阴道分娩的研究

Study on Vaginal Delivery after Cesarean Section

目的:探讨剖宫产术后阴道分娩的相关条件,总结剖宫产术阴道分娩的临床经验,提高剖宫产术后阴道分娩的成功率。方法:选取某院2015年8月~2016年8月的剖宫产术后阴道分娩74例临床资料作为观察组(年龄21~44岁,平均(29.5±4.1)岁;孕周32~41周,平均(39.0±1.7)周),另随机选取同期65例剖宫产术后剖宫产的临床资料为对照组(年龄24~39岁,平均(30.5±4.2)岁;孕周37~41周,平均(38.3±0.9)周),判断两组的年龄、孕周、BMI、子宫下段疤痕厚度和新生儿出生体重的差异,并分别对既往二次剖宫产术史的分娩结局和前次剖宫产术原因为产程停滞的分娩结局进行比较。结果:两组的年龄、子宫下段疤痕厚度、新生儿出生体重差异均无统计学意义(P>0.05)。观察组的BMI较对照组BMI低(t=3.698,P<0.05),观察组的孕周较对照组大(t=2.709,P<0.05)。既往二次剖宫产术史的剖宫产率高于阴道分娩率(χ2=4.865,P<0.05)。前次剖宫产术原因为产程停滞的剖宫产率高于阴道分娩率(χ2=5.8965,P<0.05)。结论:符合试产条件的剖宫产术后阴道分娩是可行的,并严密观察产程进展,做好手术准备。

Objective：To explore the relevant conditions of vaginal delivery after cesarean section,to summarize the clinical experience of vaginal delivery of cesarean section,and to improve the success rate of vaginal delivery after cesarean section.Methods：A total of 74 cases of postoperative cesarean section vaginal delivery were collected from August 2015 to August 2016 as an observation group（aged 21～44years,（29.5±4.1）years on average;gestational age 32～41weeks,（39.0±1.7）weeks on average）.The clinical data of cesarean section in 65 cases of cesarean section were randomly selected as the control group（aged 24～39years,（30.5±4.2）years on average;gestational age 37～41weeks,（38.3±0.9）weeks on average）.Then compare the differences of age,gestational age,BMI,lower uterine segment scar thickness and newborn birth weight between the two groups,and the causes of labor stagnation of the delivery by the previous secondary cesarean section history of delivery and the previous cesarean section.Results：There was no significant difference in the age,the thickness of the lower uterine segment and the birth weight of the newborn of the two groups（P〈0.05）.The BMI of the observation group was lower than that of the control group（t=3.698,P〈0.05）.The gestational age of the observation group was longer than that of the control group（t=2.709,P〈0.05）.The previous cesarean section rate of cesarean section was higher than the rate of vaginal delivery（χ2=4.865,P〈0.05）.The cesarean section rate of labor stagnation caused by previous cesarean section is higher than vaginal delivery rate（χ2=5.8965,P〈0.05）.Conclusion：It is feasible to implement vaginal delivery after cesarean section with the conditions of trial production,and observe the progress of labor and prepare for operation.