瘢痕子宫再次妊娠经阴道试产患者472例的产程观察与护理

Labor Process Observation and Nursing Practice of Vaginal Delivery with Scar Uterus in 472 Cases

目的分析并总结瘢痕子宫再次妊娠经阴道试产患者的产程观察要点,以提高其自然分娩率,并降低二次剖宫产率。方法回顾性分析2014年9月至2015年8月在我院生产的472例瘢痕子宫妊娠阴道试产者的病例资料,包括年龄、孕周、产程、新生儿体质量、产时及产后2h出血量、子宫下段厚度、距前次剖宫产时间、前次剖宫产原因以及阴道试产的结局。结果472例瘢痕子宫病例中顺产417例(88.3%),吸引产6例(1.3%),故阴道试产成功率为89.6%;剖宫产49例(10.4%),均未发生子宫破裂和新生儿窒息。结论在充分考虑孕妇自身情况的前提下,应用全程连续性助产护理,做好产前健康教育、产时监护和产后观察,可保障瘢痕子宫再妊娠者阴道试产的安全性和成功率。

Objective To analyze and sum up the points of labor process observation of vaginal delivery in further pregnancy of scar uterus in order to improve the success rate of vaginal delivery and reduce the cesarean rate.Methods Retrospective study was performed among 472 cases in our hospital who had vaginal delivery in further pregnancy of scar uterus from September 2014 to August 2015,with their age,gestational weeks,stages of labor,neonatal birth weight,intrapartum and postpartum haemorrhage amount 2 hours,the thickness of the lower uterine segment,from a previous cesarean delivery time,the cause of the previous cesarean section and the end of the vaginal trial production analyzed.Results Among 472 cases,there were 417 cases of natural labors(88.3%),6 cases of vacuum extraction(1.3%).Success rate of vaginal trial-produce rate was 89.6%,and49 cases had cesarean section(10.4%).Neither uterine rupture nor neonatal asphyxia occurred.Conclusion With full consideration of the case of pregnant women's own premise,application of whole process continuity midwifery care,good prenatal health education,care and postnatal observation capacity can ensure the safety and success rate of vaginal delivery in further pregnancy of scar uterue.