单中心5年2423例剖宫产后妊娠分娩方式分析

Elective repeat caesarean section versus vaginal birth for 2423 women with a previous caesarean birth

目的探讨延安大学附属医院5年2 423例剖宫产后妊娠病例分娩方式,临床特征及其临床结局。方法纳入延安大学附属医院产科2013年1月-2017年12月剖宫产后妊娠产妇2 423例,根据分娩选择方式分为择期重复剖宫产(elective repeat cesarean delivery,ERCD)组(n=2 184)和剖宫产后阴道试产(trial of labor after cesarean,TOLAC)组(n=239),分别比较妊娠合并症与并发症、产后并发症和新生儿结局情况。结果与TOLAC组相比,ERCD组分娩孕周、产次更少[孕周:(38.2±2.6)周vs(39.4±1.3)周;产次:1(1~1)vs 1(1~2),P均<0.05)];子宫下段肌层厚度更小[(30.5±3.6)mm vs(33.7±2.9)mm,P<0.001],距前次分娩时间更短[(3.8±2.7)年vs(4.6±3.1)年,P<0.001];ERCD组子痫前期发生率高于TOLAC组(6.2%vs0.8%,P=0.001),子宫破裂发生率低于TOLAC组(0例vs 2例,P<0.001);ERCD组新生儿5'Apgar评分和出生体质量均低于TOLAC组[Apgar:(9.6±0.7)vs(9.8±0.4);体质量:(3 168.5±418.2)g vs(3 250.3±441.3)g,P均<0.05];其余指标差异无统计学意义(P均>0.05)。结论对剖宫产后妊娠产妇,根据相关指南规范实施TOLAC的母儿结局相对安全,应"个体化"选择分娩方式。

Objective To investigate the delivery mode, clinical characteristics and outcome of 2 423 women with a previous caesarean birth in Affiliated Hospital of Yan＇an University in recent 5 years. Methods From January 2013 to December 2017, 2 423 pregnant women with previous cesarean section admitted to our hospital. According to the mode of delivery, they were divided into elective repeat cesarean delivery （ERCD） group （n=2 184） and trial of labor after cesarean （TOLAC） group （n=239）. The complications of pregnancy, postpartum complications and neonatal outcomes were compared between two groups. Results Compared with TOLAC group, ERCD group had less gestational age [ （38.2±2.6） weeks vs （39.4±1.3） weeks], less parity [1 （1-1）vs 1 （1-2）], smaller lower uterine segment thickness [ （30.5±3.6） mm vs （33.7±2.9） mm] and shorter interdelivery interval [ （3.8±2.7） years vs （4.6±3.1） years] （all P〈 0.05）. The incidence of preeclampsia in ERCD group was higher than that in TOLAC group （6.2% vs 0.8%）, while the incidence of uterine rupture was lower （0 case vs 2 cases） （P〈 0.05, respectively）. The 5＇Apgar score and birth weight of neonates in ERCD group were all less than those in TOLAC group [Apgar, （9.6±0.7） vs （9.8±0.4）; birth weight （3 168.5±418.2） g vs （3 250.3±441.3） g] （P 〈0.05, respectively）. Conclusion For pregnant women with a previous caesarean birth, the implementation of TOLAC is relatively safe according to the guidelines, and the mode of delivery should be individualized.