瘢痕子宫妊娠早产经阴道分娩的可行性与安全性

The Feasibility and Safety of Preterm Delivery Through Vagina with Scar Uterus

目的:探讨瘢痕子宫妊娠早产经阴道分娩的可行性与安全性。方法:选择2012年1月至2016年12月在广州医科大学附属第三医院产科经阴道分娩的瘢痕子宫妊娠早产患者137例为研究组,同时期的瘢痕子宫妊娠早产行剖宫产患者454例为对照组,对两组的分娩结局、母婴并发症及住院时间等进行分析。结果:研究组产后24小时出血量(302.3±173.3 ml)和住院时间(5.01±3.60天)明显少于对照组(358.9±223.6 ml,9.80±6.20天),差异有统计学意义(P<0.05)。研究组与对照组在新生儿死亡、新生儿窒息率、新生儿黄疸、心肌损害、新生儿肺炎、代谢性酸中毒、新生儿呼吸窘迫综合征、入住NICU方面比较,差异无统计学意义(P>0.05)。结论:瘢痕子宫妊娠早产患者经阴道分娩未增加新生儿并发症,母儿获得较好妊娠结局。严格把握剖宫产指征,充分评估病情,瘢痕子宫妊娠早产经阴道分娩是安全可行的,并能减少产后出血量及住院时间。

Objective:To explore the feasibility and safety of preterm delivery through vagina in pregnant women with scar uterus.Methods:Retrospective analysis was performed on 137 cases of premature delivery of pregnancy with scar uterus via vaginal delivery in the department of obstetrics,the third hospital affiliated to guangzhou medical university from January 2012 to December 2016,and 454 cases of premature delivery by cesarean section with scar uterus in the same period,as the control group.The outcomes of delivery,complications of mother and fetus,as well as the hospital stay were analyzed in two groups.Results:The amount of postpartum hemorrhage(302.3±173.3 ml)and the length of hospital stay(5.01±3.60 days)in the observation group is less than that in the control group(358.9±223.6 ml,9.80±6.20 days)(P<0.05).There was statistical difference.There was no statistically significant difference of neonatal death,the rate of neonatal asphyxia,neonatal jaundice,myocardial damage,neonatal pneumonia,metabolic acidosis,neonatal respiratory distress syndrome,check in NICU(P>0.05),between observation group and control group.Conclusions:Vaginal delivery does not increase neonatal complications in premature delivery with scar uterus,and with good outcomes of mother and fetus.It is safe and feasible to vaginal delivery in preterm delivery with scar uterus by strictly controlling the indications of cesarean section and fully assessment,and the amount of postpartum hemorrhage and the length of hospital stay could be reduced.