剖宫产术后阴道分娩的产程分析

Parturition analysis of vaginal birth after cesarean section

目的重点探讨剖宫产术后阴道分娩的产程,指导临床对剖宫产后阴道试产(TOLAC)的产程管理,提高TOLAC的安全性。方法回顾分析2016年1月~2017年7月在扬州市妇幼保健院住院分娩的产妇:剖宫产术后阴道分娩(VBAC),且前次剖宫产均未进入产程30例产妇为VBAC组;抽取同期非瘢痕子宫经阴道分娩的经产妇30例为经产妇组,初产妇30例为初产妇组。三组均自然临产,产程中无缩宫素及人工破膜等干预,对三组的总产程、第一产程、第二产程、第三产程进行比较,同时对产后出血及新生儿评分进行比较。结果 VBAC组的总产程、第一产程明显短于初产妇组(P<0.01),与经产妇组比较,差异无统计学意义(P>0.05);第二产程时间明显长于经产妇组(P<0.01),与初产妇组比较,差异无统计学意义(P>0.05);三组第三产程时间差异无统计学意义(P>0.05)。产后出血、新生儿Apgar评分差异均无统计学意义(P>0.05)。结论剖宫产术后阴道分娩第一产程临床表现与非瘢痕子宫经阴道分娩的经产妇相似,胎心正常允许充分阴道试产,第二产程与初产妇相似,需要更有耐心地观察第二产程,有利于提高剖宫产术后阴道分娩率,但还需大样本研究。

Objective To guide the clinical management of birth process of cesarean delivery after cesarean section to improve the safety of TOLAC,it focuses on the labor course of vaginal delivery after cesarean section.Methods A retrospective analysis was conducted on the maternal births delivered at the Maternal and Child Health Hospital of Yangzhou from January 2016 and July 2017:vaginal birth after cesarean section(VBAC),and no previous cesarean section 30 cases were VBAC group.30 cases of vaginal delivery of non-scarring uterus during the same period were selected as the maternal group and 30 cases of primipara.The three groups were all natural labor,labor without oxytocin and artificial rupture of membranes and other interventions.The total production process,the first stage of labor,the second stage of labor,the third stage of labor were compared among three groups,postpartum hemorrhage and neonatal score were also compared.Results The total length of labor in the VBAC group was significantly shorter than that in the primipara group(P<0.01),but there was no significant difference between the VBAC group and the multipara group(P>0.05).The duration of the second stage of labor was significantly longer than that of the multipara group(P<0.01).There was no significant difference between the VBAC group and the primipara group(P>0.05).There was no significant difference in the third stage of labor between the three groups.Postpartum hemorrhage,neonatal Apgar score difference was not statistically significant(P>0.05).Conclusion The clinical manifestations of the first stage labor of VBAC are similar to those of non-scarred vaginal delivery.The normal fetal heart rate allows for full vaginal trial.The second stage of labor of VBAC is similar to that of primipara and requires more patient observation of the second Labor.It is conducive to improving vaginal delivery rate after cesarean section,but large sample studies are necessary