分娩方式对剖宫产术后再次妊娠结局的影响

The influence of different delivery methods on the clinical outcome of repregnancy after cesarean section

目的观察不同分娩方式下剖宫产术后再次妊娠结局。方法选取2014年2月至2017年2月贵港市妇幼保健院收治的剖宫产术后再次妊娠产妇341例,观察产妇采用不同分娩方式后,产后出血、产褥感染、新生儿窒息等情况。结果选择剖宫产231例,经阴道试产110例,其中阴道分娩91例,试产成功率为82.73%,有19例试产过程中改行剖宫产;剖宫产组分娩24 h内阴道出血量和产褥感染率分别为(320.16±27.43)m L和10.40%,明显高于阴道分娩组(P<0.05);阴道试产成功组瘢痕厚度为(4.12±1.03)mm,明显高于试产失败组(P<0.05),而距上次剖宫产时间为(3.76±0.97)年,明显短于试产失败组(P<0.05);logistic回归分析结果显示瘢痕厚度是试产成功的影响因素(OR=0.457,P<0.05)。结论剖宫产术后再次妊娠产妇应根据自身情况选择分娩方式,如符合阴道分娩条件应首选阴道试产,阴道分娩产妇产后出血量及产褥感染较少,不会增加新生儿窒息的风险。

Objective To investigate the effect of different delivery methods on repregnancy after cesarean section.Methods 341 cases of repregnancy after cesarean section were selected from February 2014 to February 2017 in our hospital,of which the postpartum hemorrhage,puerperal infection,neonatal asphyxia,etc.were observed.Results 231 cases of cesarean section and 110 cases of vaginal trial were selected.Among them,91 cases of vaginal delivery,with 82.73%success rate,19 cases changed to cesarean section during the trial production.The amount of vaginal bleeding within delivery 24 h and puerperal infection rate in cesarean section were(320.16±27.43)ml and 10.40%,significantly higher than that in vaginal delivery group(P<0.05).The thickness of scar in the successful trial production group was(4.12±1.03)mm,which was significantly higher than that of trial failure production group(P<0.05).From the last cesarean section time was(3.76±0.97)years,significantly shorter than the trial failure production group(P<0.05).The results of Logistic regression analysis showed that the thickness of scar was the influential factor in the success of trial production(OR=0.457,P<0.05).Conclusion The mode of delivery were chosen according to the situation after cesarean sectionin pregnant women.If meet the conditions of vaginal delivery,vaginal trial production is the first choice,which with less postpartum hemorrhage and puerperal infection,will not increase the risk of asphyxia newborn.