46例剖宫产术后瘢痕子宫再次妊娠阴道分娩可行性分析及对母儿结局的影响

Feasibility Analysis on Vaginal Delivery of Scar Uterus Re-pregnancy in 46 Cases After Cesarean Section and Its Influence on Maternal and Neonatal Outcomes

目的分析46例剖宫产术后瘢痕子宫再次妊娠阴道分娩的可行性及观察对母儿结局的影响。方法回顾性分析我院收治的46例宫产术后瘢痕子宫再妊娠产妇的临床妊娠资料,按分娩方式不同分为剖宫产术后阴道分娩(VBAC)组和择期再次剖宫产(ERCS)组,VBAC组26例,ERCS组20例,比较两组产妇的母亲输血率、产时出血量、住院时间、住院费用,新生儿的质量、新生儿Apgar评分以及并发症情况。结果 VBAC组的产时出血量、住院时间、住院费用均少于ERCS组,新生儿质量、新生儿Apgar评分均高于ERCS组,比较差异具有统计学意义(P<0.05),VBAC组的母亲输血率为3.85%,ERCS组的母亲输血率为5.00%,比较差异不具有统计学意义(P>0.05);两组均未有子宫破裂的情况,VBAC组的并发症发生率为7.69%,ERCS组为15.00%,比较差异不具有统计学意义(P>0.05)。结论剖宫产术后瘢痕子宫再次妊娠阴道分娩的可行性较高,且安全良好,并发症较低,有效保证母儿安全,可进行推广。

Objective To analyze the feasibility of vaginal delivery of scar uterus re-pregnancy in 46 cases after cesarean section,and to observe the influence on maternal and neonatal outcomes.Methods The clinical pregnancy data of 46 puerperae with scar uterus re-pregnancy after cesarean section who were admitted to the hospital were retrospectively analyzed.According to delivery mode,they were divided into vaginal birth after cesarean(VBAC)group(26 cases)and elective repeat cesarean section(ERCS)group(20 cases).The maternal transfusion rate,intrapartum hemorrhage,hospitalization time,hospitalization cost,neonatal weight,neonatal Apgar score and complications were compared between the two groups.Results The intrapartum hemorrhage,hospitalization time and hospitalization cost in VBAC group were less than those in ERCS group,while The neonatal weight and neonatal Apgar score were higher than those in ERCS group(P<0.05).There was no significant difference in maternal transfusion rate between VBAC group and ERCS group(3.85%vs 5.00%)(P>0.05).There was no uterine rupture in either groups.There was no significant difference in incidence of complication between VBAC group and ERCS group(7.69%vs 15.00%)(P>0.05).Conclusion The vaginal delivery feasibility of scar uterus re-pregnancy after cesarean section is relatively higher.It is safe and good,with low complications.It can effectively ensure the safety of mother and neonates and it can be promoted.