瘢痕子宫阴道分娩产妇行会阴侧切术后结局分析

Outcome analysis of episiotomy in vaginal birth after cesarean puerpera

目的探讨瘢痕子宫孕妇经阴道分娩时行会阴侧切与未行会阴侧切在产程时间、母儿结局等方面的影响。方法抽取广州市3家三甲医院产科2015年1月至2018年12月收治的瘢痕子宫阴道分娩755例产妇的临床资料进行回顾性分析,依据分娩中是否行会阴侧切分为会阴侧切组(n=345)和非侧切组(n=410),对比分析两组在会阴损伤情况、产后2 h出血量、第二产程时间、产妇子宫破裂率以及新生儿窒息率方面的差异。结果侧切组产妇出现会阴损伤率高于非侧切组(P <0.01);侧切组产后2 h出血量较非侧切组多(P <0.05);侧切组的第二产程时间比非侧切组时间长(P <0.05);侧切组产妇子宫破裂率和新生儿窒息率与非侧切组对比差异无统计学意义(P> 0.05)。结论会阴侧切不能减轻瘢痕子宫阴道分娩产妇的会阴损伤及产后出血,并未缩短第二产程时间及降低子宫破裂率与新生儿窒息率。建议助产士在瘢痕子宫孕妇阴道分娩时严格遵守会阴侧切的指征,减少并发症的发生有效保障母婴健康。

Objective To investigate the effects of episiotomy and non-episiotomy on the time of labor and the outcomes of maternal and child in Vaginal Birth after Cesarean. Methods A retrospective study was conducted on 755 cases of clinical data of Vaginal Birth After Cesareanpuerpera who gave birth in the Departments of Obstetrics,of three Hospitals in GuangZhou from January 2015 to December 2018. According to whether had episiotomy,they were divided into episiotomy group(n = 345)and non-episiotomy group(n = 410). Analyze the differencesof perineal injury,postpartum hemorrhage,second stage of labor,the rate maternal uterine ruptureand neonatal asphyxia between these two groups. Results The degree of perineal injury in the episiotomy group was generally higher than that in the non-episiotomy group(P < 0.01). The amount of bleeding in theepisiotomy group was more than that in the non-episiotomy group(P < 0.05). The second stage of labor in the episiotomy group was longer than that in the non-episiotomy group(P < 0.05). There was no significant difference in the rate of uterine rupture and neonatal asphyxia between two groups(P > 0.05). Conclusion Episiotomycan not relieveserious perineal damage to Vaginal Birth after Cesareanpuerpera,and not decrease maternal postpartum hemorrhage,not shorten the second stage of labor and not reduce the rate of uterine rupture and neonatal asphyxia. It is suggested that midwives should coordinate the indications of episiotomy so as to reduce its adverse effects during Vaginal Birth after Cesarean to protect maternal and infant health effectively.