60例剖宫产后瘢痕子宫再次妊娠分娩方式的临床研究

The clinical analysis of delivery mode of 60 cases with scar uterus second pregnancy after cesarean section

目的:探讨剖宫产后瘢痕子宫再次妊娠的分娩方式。方法:2015年5月-2017年5月收治瘢痕子宫再次妊娠分娩产妇60例,根据剖宫产指征和产妇及家属意愿分为阴道分娩组20例和剖宫产组40例。所有患者均进行产科检查,了解患者分娩史,评估瘢痕愈合情况、自然分娩的条件,是否会出现瘢痕破裂导致大出血,并结合产妇及家属的意愿选择分娩方式。若经阴道分娩的产妇出现宫内出血,怀疑破裂出血要及时进行床旁超声检查,立即转剖宫产。结果:经阴道分娩组成功10例,失败10例。经阴道分娩成功组Apgar评分最高,出血最少,住院时间最短;剖宫产组Apgar评分低于经阴道分娩成功组,出血量、住院时间均高于经阴道分娩成功组;经阴道分娩失败组出血量和住院时间最长,三者比较差异有统计学意义(P<0.05)。60例产妇中,剖宫产50例,剖宫产率为83.3%,其中符合剖宫产指征为30例(60.0%),产妇或家属强烈要求10例(20.0%),阴道试产失败10例(20.0%)。结论:剖宫产手术仍是剖宫产后瘢痕子宫再次妊娠的主要分娩方式,但若符合阴道分娩指征,可以选择阴道试产,对降低剖宫产率有着积极的作用,但应做好抢救、输血和手术的准备。

Objective:To explore the delivery mode of scar uterus second pregnancy after cesarean section.Methods:From May 2015 to May 2017,60 pregnant women with scar uterus second pregnancy were selected,according to the indications of cesarean section and the wishes of mothers and their families,they were divided into two groups:vaginal delivery group(20 cases)and cesarean section group(40 cases).All patients underwent obstetric examination to understand the delivery history of the patients,to evaluate the cicatricial healing and the conditions of natural delivery,and whether there would be scar rupture leading to massive bleeding,the delivery mode should be selected according to the wishes of the mothers and their families.If there was intrauterine bleeding in vaginal delivery,it was necessary to timely check bedside ultrasound if it was suspected that the bleeding was ruptured,and immediately transfer to cesarean section.Results:In the transvaginal delivery group,10 cases were successful and 10 cases failed.In the vaginal delivery success group,the Apgar score was the highest,the bleeding was the least,and the hospital stay was the shortest,the cesarean section group was significantly higher than the vaginal delivery success group.In the failure group of vaginal delivery,the amount of bleeding and the length of hospital stay were the longest,and the difference was statistically significant in the three groups(P<0.05).Among 60 cases of parturient women,50 cases were cesarean section,the rate of cesarean section was 83.3%,among them,60.0%were in accordance with the indications of cesarean section,10 cases were strongly demanded by the mothers or their families,10 cases failed in vaginal trial.Conclusion:Cesarean section was still the main mode of delivery of scar uterus second pregnancy after cesarean section,however,if the indications of vaginal delivery were met,vaginal trial can be selected,it had a positive effect to reduce the rate of cesarean section,but we should make preparations for rescue,blood transfusion and operation.