剖宫产术后再次妊娠经阴道分娩的可行性及安全性分析

Analysis of the feasibility and safety of vaginal delivery in re-pregnancy after cesarean section

目的探讨剖宫产术后再次妊娠经阴道分娩的可行性及安全性。方法选取45例经剖宫产术后再次妊娠并自愿接受阴道试产的产妇作为研究组,另选同期45例初次妊娠无高危风险、无剖宫产指征的产妇作为对照组,两组均进行阴道试产方案,记录两组产妇的平均产程、阴道助产、新生儿窒息、产后出血情况,同时将两组产妇进行试产的成功率进行比较并分析失败的原因。结果研究组阴道试产成功32例(71.1%),阴道试产失败13例(28.9%),造成阴道试产失败的原因包括宫缩乏力4例(8.9%)、胎儿窘迫4例(8.9%)、脐带脱垂3例(6.7%)、先兆子宫破裂2例(4.4%);对照组阴道试产成功40例(88.9%),阴道试产失败5例(11.1%),造成阴道试产失败的原因包括宫缩乏力2例(4.4%)、胎儿窘迫3例(6.7%);对照组阴道试产成功率(88.9%)明显高于研究组(71.1%),差异具有统计学意义(P<0.05)。研究组平均产程时间为(14.1±3.2)h,产后出血量为(228.5±32.7)ml,新生儿窒息2例,阴道助产2例;对照组平均产程时间为(13.8±3.3)h,产后出血量为(218.1±31.2)ml,新生儿窒息1例,阴道助产3例;两组产妇平均产程、产后出血量、新生儿窒息和阴道助产情况比较,差异无统计学意义(P>0.05)。结论剖宫产术后再次妊娠分娩时,只要符合试产条件,在严密监护下阴道试产是安全可行的。

Objective To investigate the feasibility and safety of vaginal delivery in re-pregnancy after cesarean section. Methods There were 45 re-pregnancy women after cesarean section undergoing vaginal delivery as research group, and concurrent 45 pregnant women without high-risk risks and cesarean section indications. Both groups received vaginal delivery regimen, and record were made on average course of labor, vaginal delivery, neonatal asphyxia, postpartum hemorrhage and trial production success rate. The causes of failure were analyzed. Results The research group had successful vaginal trial production as 32 cases（71.1%）, failed vaginal trial production as 13 cases（28.9%）, and the causes of failed vaginal delivery were 4 cases of uterine inertia（8.9%）, 4 cases of fetal distress（8.9%）, 3 cases of umbilical cord prolapse（6.7%）, 2 cases of threatened uterine rupture（4.4%）. The control group had 40 successful vaginal trial production cases（88.9%）, failed vaginal trial production as 5 cases（11.1%）, and the causes of failed vaginal delivery were 2 cases of uterine inertia（4.4%） and 3 cases of fetal distress（6.7%）. The control group had obviously higher successful rate of vaginal trial production（88.9%） than the research group（71.1%）, and the difference was statistically significant（P〈0.05）. The research group had average labor time as（14.1±3.2） h, postpartum hemorrhage as（228.5±32.7） ml, 2 cases of neonatal asphyxia and 2 cases of vaginal midwifery, while the control group had average labor time as（13.8±3.3） h, postpartum hemorrhage as（218.1±31.2） ml, 1 case of neonatal asphyxia and 3 cases of vaginal midwifery. There were no statistically significant difference in average labor time, postpartum hemorrhage, neonatal asphyxia and vaginal midwifery condition between two groups（P〉0.05）. Conclusion For re-pregnancy after cesarean section, vaginal trial production is safe and feasible under close supervision as long as consistent with trial production conditions.