切口外子宫下段取胎头法在瘢痕子宫剖宫产手术中的应用

Application of Fetal Head Delivery from Lower Uterine Segment Outside Incision in Cesarean Section of Scarred Uterus

目的:探讨切口外子宫下段取胎头法在瘢痕子宫择期剖宫产手术中的应用效果。方法:回顾性分析2019年4月~2019年9月就诊于我院的瘢痕子宫择期剖宫产手术患者472例。其中,对照组245例采用传统方法手入宫腔取胎头,试验组227例采用切口外子宫下段取胎头。比较两组在取胎头时间、子宫切口撕裂率、切口血肿形成率、切口愈合不良或感染发生率、新生儿窒息率以及产后出血发生率之间的差异。结果:试验组子宫切口撕裂率、切口血肿形成率、子宫切口愈合不良或感染率均低于对照组(均P<0.05);两组患者的平均取胎头时间、新生儿窒息率以及产后出血率比较,差异无统计学意义(均P>0.05);试验组产钳助产率高于对照组(P<0.05)。结论:在瘢痕子宫择期剖宫产手术中,切口外子宫下段取胎头法在减少不良事件发生率的同时,增加术中产钳助产率,但对母婴无不良影响,值得临床推广使用。

Objective:To investigate the effect of fetal head delivery from lower uterine segment outside incision in elective cesarean section of scarred uterus.Methods:A total of 472 cases of elective cesarean section for scarred uterus from April 2019 to September 2019 were retrospectively analyzed.There were 245 cases in the control group treated with traditional manual fetal head delivery,and 227 cases in the experimental group treated with fetal head delivery from lower uterine segment outside incision.The time of fetal head delivery,rate of uterine incision laceration,rate of incision hematoma formation,rate of incision undesirable healing or infection,rate of neonatal asphyxia and the incidence of postpartum hemorrhage were compared and analyzed between the two groups.Results:The rate of uterine incision laceration,incision hematoma formation and incision undesirable healing or infection in the experimental group were lower than those in the control group(all P<0.05).There were no significant differences in the time of fetal head delivery,rate of neonatal asphyxia and incidence of postpartum hemorrhage between the two groups(all P>0.05).The rate of forceps midwifery in the experimental group was higher than that in the control group(P<0.05).Conclusion:In the elective cesarean section of cicatricial uterus,the fetal head delivery from lower uterine segment outside incision could reduce the incidence of adverse reactions and increase the rate of forceps midwifery,with no adverse effects on mother and baby,which is worthy of clinical application.