剖宫产术后疤痕子宫足月妊娠分娩方式探讨

Investigation on the delivery mode for full term pregnancy with scar uterus after cesarean section

目的:探讨剖宫产术后疤痕子宫足月妊娠分娩方式选择。方法:回顾分析2017年8～10月我院产科足月分娩的110例剖宫产术后疤痕子宫及同期51例非疤痕子宫阴道分娩产妇病历资料。疤痕子宫阴道试产(TOLAC)组59例,其中疤痕子宫阴道分娩(VBAC)组51例;疤痕子宫择期重复剖宫产(ERCS)组51例;非疤痕子宫阴道分娩(NSVD)组51例。比较VBAC组与ERCS组、VBAC组与NSVD组分娩情况(产后出血量、产程时间、新生儿出生Apgar评分及体质量、产褥感染率及产后住院时间)。结果:疤痕子宫阴道试产成功率86%; VBAC组与ERCS组相比产后出血量、产后住院时间及新生儿出生体质量差异有统计学意义(P<0.05);与NSVD组相比上述各项指标差异均无统计学意义(P>0.05)。结论:阴道分娩对剖宫产术后疤痕子宫足月妊娠产妇及新生儿不良影响小,故对无明确再次剖宫产指征的足月妊娠孕妇,应鼓励其阴道试产。

Objective:To investigate the delivery options for full term pregnancy with scar uterus following cesarean section.Methods:Retrospective analysis was conducted in 110 cases of full term delivery with scar uterus after cesarean section and another 51 cases of vaginal delivery without scar uterine in our department between August and October of 2017.Of the total subjects,59 were included in the trial of labor after cesarean delivery(TOLAC),51 in vaginal birth after cesarean section(VBAC group),51 in elective repeat cesarean section(ERCS group)and 51 in the non-scar uterine vaginal delivery(NSVD group).Comparison was performed regarding the postpartum bleeding,labor time,Apgar score,birth weight,puerperal infection rate and postpartum hospital stay between VBAC and ERCS group,VBAC and NSVD group.Results:The success rate for trial of vaginal labor was 86%for women with scar uterus.The difference was significant in postpartum bleeding,birth weight,postpartum hospital stay between VBAC and ERCS group(P<0.05),yet was insignificant as compared with NSVD group pertinent to the indicators aforementioned(P>0.05).Conclusion:Vaginal delivery for full term pregnancy with scar uterus after cesarean section produces minor adverse effect on the women themselves as well as neonates,therefore,vaginal trial should be encouraged for full-term pregnant women without definite indications for re-caesarean.