剖宫产术后再次妊娠阴道分娩的临床探讨

Clinical study of vaginal birth after cesarean section

目的:探讨剖宫产术后再次妊娠(VBAC)的产妇阴道分娩的可行性和安全性,为疤痕子宫产妇分娩方式的选择和减少剖宫产率提供一定的临床参考价值。方法:选取某院剖宫产术后再次妊娠阴道分娩的产妇共84例为VBAC组,剖宫产术后再次妊娠阴道试产(TOLAC)失败15例为TOLAC失败组,选取同期非剖宫产的初次阴道分娩产妇81例为VBNC组,选择性重复剖宫产(ERCS)82例为ERCS组。采集4组产妇的临床资料,分析产妇产程时间、产后出血量、抗生素使用率、住院时间、住院费用、妊娠结局及新生儿情况等相关指标。结果:剖宫产术后再次妊娠阴道试产成功率较高,为84.85%(84/99),阴道分娩产后出血量少、住院时间短、住院费用及抗生素使用率低;各组均无严重产后并发症发生;与VBNC组比较,VBAC组产程时间较短,人工干预率、会阴侧切率、产钳使用率较高(P<0.05)。结论:严格掌握适应证的情况下,加强产程的监护,做好手术准备,剖宫产术后再次妊娠经阴道分娩是安全可行的,值得临床推广应用。

Objective :To explore the feasibility and safety of vaginal birth after cesarean section (VBAC),to provide certain clinical reference value for the choice of delivery mode and the reduction of cesarean section rate of scar uterus parturients. Methods :84 pregnant women with VBAC were selected as a VBAC group,15 pregnant women with failure of trial of labor after cesarean section (TOLAC) were selected as a TOLAC failure group,81 non-cesarean women with first vaginal delivery (VBNC) during the same period were selected as a VBNC group, and 82 women with selective repeated cesarean section (ERCS) were selected as a ERCS group.Clinical data of the 4 groups of parturients were collected, and the related indicators such as duration of parturition,postpartum hemorrhage,antibiotic use rate, hospitalization time, hospitalization expenses, pregnancy outcome and neonates were analyzed. Results :1.The success rate of vaginal trial delivery after cesarean section was 84.85%(84/99). There were fewer postpartum bleeding, shorter hospitalization, lower hospitalization costs and antibiotic use rate in the vaginal delivery. There were no serious postpartum complications in each group. 2. Compared with the VBNC group, the duration of labor in VBAC group was shorter, and the rates of manual intervention, lateral perineal incision and forceps use were higher (P<0.05). Conclusion :Under strict indications and with full preparations, VBAC is feasible and safe for pregnant women with history of cesarean section. It is worthy of clinical application.