疤痕子宫二次妊娠经阴道分娩的母婴结局分析

Maternal and neonatal outcomes of vaginal delivery in second pregnancy of women with uterine scars

目的分析疤痕子宫二次妊娠经阴道分娩的母婴结局。方法选取中国人民解放军第三医院2016年1至12月214例二次妊娠经阴道分娩的产妇,其中116例疤痕子宫者为研究组,98例非疤痕子宫者为对照组。对比两组产时出血量、产后住院时间、孕妇平均产程、新生儿窒息率及Apgar评分情况。结果两组产时出血量、产后住院时间对比均无明显差异(t值分别为0.42、0.32,均P>0.05);两组孕妇平均产程、Apgar评分对比均无明显差异(t值分别为0.48、0.63,均P>0.05);研究组新生儿窒息率(1.72%)与对照组对比(1.02%)并无明显差异(χ~2=0.09,P>0.05)。研究组子宫切口撕裂、产后出血率、产褥病等并发症的发生率均明显高于对照组(χ~2值分别为6.48、6.15,7.37,均P<0.05),而产时娩头困难、切口愈合不良发生率的比较,均无明显差异(χ~2值分别为0.48,0.79,均P>0.05)。结论疤痕子宫并非二次剖宫产的绝对指征,在符合试产条件并严密监测的基础上允许进行阴道分娩,利于改善母婴结局。

Objective To analyze the maternal and neonatal outcomes of vaginal delivery in second pregnancy of women with uterine scars.Methods Totally 214 cases of vaginal delivery in second pregnancy were selected from the Third Hospital of the Chinese People＇s Liberation Army,including 116 cases with uterine scar in study group and 98 cases with non-uterine scar in control group.The bleeding loss during delivery,hospitalization time after delivery,average maternal labor,neonatal asphyxia rate and Apgar score were compared between two groups.Results The bleeding loss during delivery and hospitalization time after delivery between two groups showed no significant difference（t value was 0.42 and 0.32,respectively,both P〈0.05）.The average maternal labor and Apgar score between two groups were not significantly different（t value was 0.48 and 0.63,respectively,both P〈0.05）.The rate of neonatal asphyxia in the study group（1.72%）did not show significant difference compared with the control group（1.02%）（χ~2=0.09,P〈0.05）.The incidence rates of uterine incision laceration,postpartum hemorrhage,and puerperal disease in the study group were significantly higher than those in the control group（χ~2 value was 6.48,6.15 and 7.37,respectively,all P〈0.05）,while the incidence rates of childbirth difficulties and bad wound healing showed no significant difference（χ~2 value was 0.48 and 0.79,respectively,both P〈0.05）.Conclusion The uterine scar isn＇t an absolute indication for second cesarean section.Vaginal delivery based on trial of labor and careful monitoring is helpful to improve maternal and neonatal outcomes.