宫颈扩张球囊在瘢痕子宫阴道试产中的安全性及有效性分析

Efficiency and security of cervical expansion balloon in trial of labor after cesarean

目的：探讨宫颈扩张球囊在瘢痕子宫足月妊娠阴道试产过程中促宫颈成熟的安全性及有效性，提高瘢痕子宫足月妊娠阴道试产成功率。方法：选取2015-07-2016-03在我院住院有引产指征且具备阴道试产意愿及条件的瘢痕子宫足月妊娠孕妇50例为观察组，选取同等条件下非瘢痕子宫孕妇50例为对照组，两组均使用宫颈扩张球囊促宫颈成熟并引产。比较两组促宫颈成熟的效果、分娩结局及母儿不良结局发生率。结果：观察组促宫颈成熟的总有效率为66％，对照组为76％，差异无统计学意义（P〉0．05）。观察组引产成功率为76％，对照组为84％，差异无统计学意义（P〉0．05）。两组的产程、24h出血量、新生儿出生即刻Apgar评分、阴道分娩率等方面比较，差异无统计学意义（P〉O．05）。母儿不良结局方面：观察组1例出现先兆子宫破裂中转剖宫产；两组急性绒毛膜羊膜炎、宫颈裂伤等方面比较，差异无统计学意义（P〉O．05）；对照组有1例新生儿发生轻度窒息，观察组中无新生儿窒息发生；两组均无产后出血发生。结论：在严格把握适应证前提下，宫颈扩张球囊在瘢痕子宫足月妊娠阴道试产中用于促宫颈成熟，可提高引产成功率，降低重复剖宫产率，且不增加母儿不良结局。

Objective： To explore the safety and effectiveness of cervical expansion balloon in trial of labor after cesarean delivery（TOLAC）, and to improve the success rate of vaginal birth. Methods：Fifty cases of pregnant women at third trimester with scar uterus in our hospital from July 2015 to March 2016 were chosen as observation group,all patients had indications for labor induction, vaginal delivery intention and conditions.Simultaneously, 50 cases of pregnant women at third trimester with normal uterus were selected as control group. Cervical expansion balloons were used in the two groups to promote cervical ripening.The effective rates of cervical ripening, the outcomes of delivery and the incidences of adverse outcomes were compared between two group. Results： The effective rate of cervical ripening was 66% in observation group and 76% in the control group,the difference was not statistically significant（P〉0.05）. The success rate of induced labor of cervical ripening was 76% in observation group and 84% in the control group, the difference was not statistically significant （P 〉0.05）. There were no significant differences in the time of birth process, postpartum hemorrhage, birth immediate Apgar score and vaginal delivery rate between two groups （P 〉 0.05）. Although there were 1 case of incomplete uterine rupture occurred in the observation group, there were no statistically significant difference in the incidence rate of acute chorioamnionitis, cervical laceration（P〉0.05）. Though there were 1 case of neonatal mild asphyxia in the observation group,the difference was not statistically significant （P〉0.05）. There were no postpartum hemorrhage cases in both observation group and control group.Conclusion： Under the premise of strictly follow the indications, cervical expansion balloon be used in promoting cervical ripening at third trimester of TOLAC, can increase the success rate of vaginal birth,decrease the rate of repeat cesarean section（RCS） and not increasing the incidence of adverse maternal and fetal outcomes.