瘢痕子宫再次妊娠434例分娩方式

Mode of Delivery in 434 Cases of Repregnancy of Scarred Uterus

目的 探讨瘢痕子宫再次妊娠后如何决定分娩方式。方法 2011年6月至2015年6月云南省昭通市第一人民医院收治434例瘢痕子宫再次妊娠孕妇,对其如何决定分娩方式及母儿结局进行回顾性分析。把同期随机132例非瘢痕性子宫经阴道分娩(VBNC)与瘢痕子宫再次妊娠经阴道分娩(VBAC)132例及重复剖宫产(RCS)302例进行对照分析;同期随机首次剖宫产(PCS)302例与重复剖宫产(RCS)302例进行对照分析。结果 132例阴道试产,100例试产成功,成功率75.76%;RCS334例,手术产率76.96%。瘢痕子宫再次妊娠阴道分娩(VBAC)组产后出血率、子宫先兆破裂发生率、新生儿出生Apgar评分与非瘢痕性子宫经阴道分娩(VBNC)组相比较,无明显统计学差异(P>0.05);VBAC组产时出血量、住院时间、住院费用及产后出血率均低于RCS组[(170.5±20.)vs(205.7±5.0)mL]、[(3.5±0.5)vs(6.5±0.5)d、[(2 321.0±125.0)vs(4 943.0±196.3)元、10.0% vs. 18.7%)(P均<0.05);RCS组产后出血率(18.7%)较PCS组(3.3%)高,差异有统计学意义(P<0.05)。结论 瘢痕子宫再次妊娠后可选择性进行阴道分娩,条件是分娩前充分评估,临产后严密监护,做好急诊剖宫产准备。

Objective To explore how to determine the mode of delivery after repregnancy of scar. Methods 434 cases of repregnancy with scarred uterus were treated in the First People's Hospital of Zhaotong City from June 2011 to June 2015. The data of the childbirth way, the outcome of mother and infants were retrospectively analyzed. In this study, a total of 132 cases of non-cicatricial vaginal delivery (VBNC) were performed in the same period, and a total of 132 cases of recurrent vaginal delivery (VBAC) and 302 cases of repeated cesarean section (RCS) were analyzed. In the same period, 302 cases of random caesarean section (PCS) and 302 cases of repeated cesarean section(RCS) were analyzed. Results Among 132 cases of vaginal trial, 100 were successful, and the success rate was 75.76%. RCS 334 cases, the operation rate was 76.96%. There was no significant statistically difference in the incidence rate of postpartum hemorrhage, uterine aura rupture, neonatal Apgar score after Vaginal delivery between repregnancy of scarred uterus group and non-scarred uterus group(P > 0.05). In the VBAC group, the amount of hemorrhage, hospitalization time, hospitalization expense and postpartum bleeding rate were lower than that in the RCSgroup [(170.5±20.8)mL vs.(205.7±5.0)mL,(3.5±0.5)d vs.(6.5±0.5)d,(2321.0±125.0)RMB vs (4943.0±196.3)RMB,10.0%vs(18.7%respectively P < 0.05]. The postpartum bleeding rate (18.7%) of RCS group was higher than that of PCS (3.3%), and the difference was statistically significant (P < 0.05). Conclusions After the pregnancy of the scar uterus, the vaginal delivery can be performed selectively. The condition is full evaluating before delivery, close monitoring after labor, and preparing for emergency cesarean section.