剖宫产术后子宫下段菲薄瘢痕子宫孕妇阴道分娩的可行性分析

Analysis on the feasibility of vaginal delivery in pregnant women with thin lower uterine segment after cesarean section

目的分析剖宫产术后子宫下段菲薄瘢痕子宫再次妊娠孕妇经阴道分娩的可行性。方法选取2013年1月-2016年9月成都市温江区妇幼保健院收治的瘢痕子宫再次妊娠孕妇97例为研究对象,根据妊娠36~40周彩超测量子宫下段瘢痕厚度分为下段菲薄组(≤3 mm)47例和下段正常组(>3 mm)50例,另选取同期该院收治的非瘢痕子宫健康孕妇50例为对照组。观察3组孕妇母婴情况。结果 3组阴道分娩成功率比较,差异有统计学意义(P<0.05)。按照孕妇分娩方式分别将下段菲薄组和下段正常组分为A(阴道分娩)、B(剖宫产)两个亚组,两组A亚组孕妇住院天数、产后24 h出血量、产褥感染例数及新生儿Apgar评分均明显优于同组B亚组,差异有统计学意义(P<0.05);但两组A亚组母婴各项指标比较,差异无统计学意义(P>0.05)。两组A亚组与对照组孕妇住院天数、产后24 h出血量、产褥感染例数、产道损伤、新生儿Apgar评分及产程时间比较,差异无统计学意义(P>0.05)。结论瘢痕子宫孕妇经阴道分娩相比于剖宫产在产后恢复与新生儿评分方面具有明显优势,子宫下段菲薄的瘢痕子宫并非阴道分娩的禁忌证,在严格掌握阴道分娩指征的情况下应给予产妇阴道试产机会,降低剖宫产率。

Objective To analyze the feasibility of vaginal delivery in pregnant women with thin lower uterine segment after cesarean section. Methods A total of 97 women of cesarean scar pregnancy（ CSP） treated in Maternal and Child Health Care Hospital of Wenjiang District from January 2013 to September 2016 were selected,then they were divided into thin lower uterine segment group（ 47 cases,≤3 mm） and normal thickness lower uterine segment group（ 50 cases,3 mm） according to the thickness of lower uterine segment during 36-40 gestational weeks by color ultrasonography. Fifty healthy pregnant women without scarred uterus treated in the hospital during the same period were selected as control group. Maternal and infantile situations in the three groups were observed. Results There was statistically significant difference in the successful rate of vaginal delivery among the three groups（ P 0. 05）. The women in thin lower uterine segment group and normal thickness lower uterine segment group were further divided into A subgroup（ vaginal delivey） and B subgroup（ cesarean section）. Hospitalization time,the amounts of hemorrhage within 24 hours after delivery,the numbers of puerperal infection,and neonatal Apgar scores in A subgroup were statistically significantly better than those in B subgroup（ P0. 05）. There was no statistically significant difference in maternal and infantile indexes between A subgroup in thin lower uterine segment group and A subgroup in normal thickness lower uterine segment group（ P0. 05）. There was no statistically significant difference in hospitalization time,the amount of hemorrhage within 24 hours after delivery,the number of puerperal infection,injury of birth canal,neonatal Apgar score,and labor time between A subgroup and control group（ P0. 05）. Conclusion Compared with cesarean section,vaginal delivery has significant advantages in postpartum recovery and neonatal score among CSP pregnant women. Thin lower uterine segment after cesarean section is not the contraindication of vaginal delivery,vaginal trial production should be caonducted to reduce cesarean section rate under circumstance of controlling vaginal delivery indications strictly.