剖宫产后阴道试产的产时及产后评估

Intrapartum and Postpartum Evaluation of Vaginal Trial Production after Cesarean Section

目的对剖宫产后阴道试产(TOLAC)的产时以及产后评估进行探讨。方法方便选取该院2016年2月—2017年5月接收的剖宫产后进行阴道分娩的患者38例,作为VBAC(剖宫产后阴道分娩)组,再选取同一时期在该院进行阴道分娩的45例患者作为常规分娩组、在该院就诊的瘢痕子宫急诊剖宫产患者45例作为CS(瘢痕子宫急诊剖宫产)组,临床上对3组患者产时、产后的母婴的具体情况进行仔细观察后予以比较。结果对3组患者的孕前体质量指数(BMI)、妊娠合并情况、年龄以及孕周等的临床基本资料比较后发现,差异无统计学意义(P>0.05);经比较显示,VNAC组患者胎儿的双顶径(BPD)(9.24±0.41)cm均小于常规分娩组(9.38±0.42)cm、CS组(9.37±0.24)cm,且宫颈Bishop评分(8.59±1.26)分则高于其他两组(7.29±1.06)分、(7.59±0.75)分,比较差异有统计学意义(P<0.05);经VBAC组和常规分娩组比较结果显示,VBAC组患者在产后2 h内的出血量(263.21±139.59)mL明显多于常规分娩组(200.39±87.04)mL,组间比较差异有统计学意义(P<0.05),但在新生儿5 min Apgar评分(9.63±0.73)分、(9.81±0.38)分,产后24 h内出血量(38.18±24.38)mL、(31.23±21.56)mL方面比较,两组差异无统计学意义(P>0.05);VBAC组同CS组比较结果显示,VBAC组患者的住院时间(1.78±0.83)d更短、24 h内出血量(301.29±140.28)mL更少,组间比较统计学上的差异有统计学意义(P<0.05),但两组的新生儿5 min Apgar评分(9.63±0.73)分、(9.47±0.86)分比较差异无统计学意义(P>0.05)。结论临床上,若产妇在自然林临产后出现胎儿的宫颈成熟度相对较高、BPD相对较小的瘢痕子宫情况,可对患者进行临床阴道试产,并同进行再次剖宫产的患者相比较,发现可有效减少患者的住院时间和出血量,但需在试产的过程中进行密切的监护和观察,避免意外的发生。

Objective To study the intrapartum and postpartum evaluation of vaginal trial production after cesarean section.Methods 38 cases of patients with vaginal delivery after the cesarean section admitted and treated in our hospital from February 2016 to May 2017 were convenient selected as the VBAC group, while 45 cases of patients with vaginal delivery at the same period were selected as the routine delivery group, and 45 cases of CS patients diagnosed in our hospital were selected as the CS group, and the specific conditions of maternal and infant of the three groups were observed and compared. Results The differences in the BMI, gestation, age and pregnant week between the three groups were not obvious（P〈0.05）, and the comparison showed that the BPD in the VNAC group was smaller than that in the routine delivery group and CS group,[（9.24±0.41）cm vs（9.38±0.42）cm,（9.37±0.24）cm], and the Bishop score was higher than that in the other two groups, [（8.59±1.26）points vs（7.29±1.06）points,（7.59±0.75）points], and the difference was statistically significant（P〈0.05）,and the comparison results showed that the bleeding amount in 2 h after delivery in the VBAC group was obviously more than that in the routine delivery group, [（263.21±139.59）mL vs（200.39±87.04）mL], and the difference was obvious, with statistical significance（P〈0.05）, but the 5 min Apgar score of newborns was（9.63±0.73）points,（9.81±0.38）points, and the hemorrhage amounts in 24 h after delivery were respectively（38.18±24.38）mL and（31.23±21.56）mL, and there were no obvious clinical differences between the two groups（P〈0.05）, and the results showed that the length of stay, and bleeding amount in 24 h in the VBAC group were respectively（1.78±0.83）d and（301.29±140.28）mL, and the differences were obvious（P〈0.05）,and the differences in the 5 min Apgar scores between the two groups were not obvious（9.63 ±0.73）points,（9.47 ±0.86）points, without statistical significance（P〉0.05）. Conclusion The patients can conduct the clinical vaginal trial production if the cervix maturity of fetuses in clinic after natural labor is relatively high and the BPD is relatively small, which can effectively decrease the length of stay and bleeding amount of patients, but we should closely monitor and observe it in the course of trial production to avoid the occurrence of accidents.