122例剖宫产术后再次妊娠阴道分娩的临床结局分析

Analysis of clinical outcomes of vaginal delivery after cesarean section in 122 cases

目的:分析剖宫产术后再次妊娠阴道分娩的可行性以及安全性。方法:回顾性分析122例剖宫产术后再次妊娠阴道分娩孕妇的临床资料,将91例剖宫产术后再次妊娠阴道分娩成功的产妇作为观察组1,剩余31例转为剖宫产作为观察组2;随机选取同一时期非疤痕子宫阴道分娩成功的经产妇95例作为对照组。分析各组产妇分娩的结局、并发症,并分析观察组2阴道分娩失败原因。结果:122例剖宫产术后再次妊娠阴道分娩成功率为74. 59%(91/122)。观察组1产后出血量、总产程、住院天数、新生儿体重、Apgar评分以及并发症发生率与对照组差异不显著,无统计学意义(P> 0. 05)。观察组1与观察组2对比,产后出血量、住院天数、Apgar评分以及并发症发生率差异显著(P <0. 05)。观察组2阴道分娩失败原因是剧烈疼痛放弃试产15例,继发性宫缩乏力11例,胎儿窘迫3例,先兆子宫破裂2例。结论:严格掌握剖宫产术后再次妊娠阴道试产的适应证在严密观察产程的前提下,并做好相关输血、抢救准备,阴道分娩是安全可行的。

Objective： To analyze the feasibility and safety of vaginal delivery after cesarean section. Methods ： A retrospective analysis of the clinical data of 122 pregnant women were to adopt vaginal delivery after cesarean section was conducted, including 91 eases of successful vaginal delivery as observation group 1, the remaining 31 eases who transferred to cesarean section as the observation group 2. Another 95 nmltiparae with successful vaginal delivery and no sear uterus were chosen as the control group. The delivery outcome and complications were analyzed and the causes of vaginal delivery- failure in the observation group 2 were analyzed. Results ： The successful rate of vaginal delivery in the 122 eases after cesarean section was 74. 59% （91/122）. Differences in postpartum hemorrhage volume, total stage of labor, hospital stay, neonatal weight, Apgar score and incidence of complication were not statistically significant between observation group 1 and the control group （ P 〉 0. 05 ）. Differences in postpartum hemorrhage volume, hospital stay, Apgar score and incidence of complication between observation group 1 and observation group 2 were significant （ P 〈 0. 05 ）. The causes of vaginal delivery- failure in observation group 2 included giving up due to severe pain （15 eases） ,secondary uterine atony （11 eases）, fetal distress （3 eases） and threatened uterine rupture （2 eases）. Conclusions： It is safe and feasible to strictly control the indications of vaginal delivery after repeated cesarean section and to provide the related blood transfusion and rescue preparation under the condition of close observation of the labor process.