不同分娩方式对剖宫产术后再次妊娠妊娠结局和新生儿情况的影响

Effect of different delivery methods on pregnant again pregnancy outcome and neonatal status after cesarean section

目的探讨不同分娩方式对剖宫产术后再次妊娠妊娠结局和新生儿情况的影响。方法选取2018年1月~2019年1月我院收治的535例剖宫产术后再次妊娠自然临产产妇作为研究对象,按照产妇意愿选择不同分娩方式,分为剖宫产术后再次妊娠阴道试产(TOLAC)组(182例)和选择再次剖宫产(ERCS)组(353例)。TOLAC组根据最终分娩方式分为TOLAC成功组(135例)和TOLAC失败组(47例)。记录TOLAC成功率、阴道助产率、试产失败中转剖宫产率及原因。比较三组的基本情况、产妇分娩并发症及新生儿情况;分析TOLAC组的阴道试产情况。结果ERCS组距离前次剖宫产时间长于TOLAC成功组和TOLAC失败组,差异均有统计学意义(P<0.05)。TOLAC阴道试产成功率为74.2%(135/182),阴道助产率为6.7%(9/135),中转剖宫产率为25.8%(47/182)。三组的产后出血量、严重产后出血发生率、输血率、凝血功能障碍、不完全性子宫破裂、肠梗阻、深静脉血栓发生率、新生儿出生体重及新生儿窒息发生率比较,差异无统计学意义(P>0.05);TOLAC成功组的宫缩乏力发生率低于TOLAC失败组和ERCS组,差异有统计学意义(P<0.05);TOLAC成功组的产褥感染发生率低于ERCS组,差异有统计学意义(P<0.05);TOLAC失败组的绒毛膜羊膜炎发生率高于ERCS组,差异有统计学意义(P<0.05)。结论在严格掌握TOLAC适应证的前提下,剖宫产术后再次妊娠自然临产产妇选择阴道分娩是安全可行的,TOLAC阴道试产成功率在70%以上,与ERCS相比,TOLAC减少产褥感染发生及缩短住院时间,有较好的母婴结局。TOLAC失败增加绒毛膜羊膜炎发生,产程中应严密监测母婴情况。

Objective To investigate the effect of different delivery methods on pregnant again pregnancy outcome and neonatal status after cesarean section.Methods A total of 535 cases of pregnant again natural labor after cesarean section who were admitted to our hospital from January 2018 to January 2019 were selected as the research object,they were divided into vaginal trial of second pregnancy after cesarean section(TOLAC)group(182 patients)and the choice of second cesarean section(ERCS)group(353 patients),different delivery methods were selected according to the wishes of the mother.The TOLAC group was divided into the TOLAC success group(135 cases)and the TOLAC failure group(47 cases)according to the final delivery method.The success rate of TOLAC,vaginal assisted delivery,and trial delivery failure to cesarean delivery were recorded.The basic conditions,maternal delivery complications,and neonatal conditions of the three groups were compared;the vaginal trials of the TOLAC group were analyzed.Results The time since previous cesarean section in the ERCS group was longer than that of TOLAC successful group and TOLAC failure group,the differences were statistically significant(P<0.05).The success rate of TOLAC vaginal delivery was 74.2%(135/182),the vaginal delivery rate was 6.7%(9/135),and the rate of transfer to cesarean section was 25.8%(47/182).There were no significant differences in the amount of postpartum hemorrhage,incidence of serious postpartum hemorrhage,blood transfusion rate,coagulation dysfunction,incomplete uterine rupture,intestinal obstruction,incidence of deep vein thrombosis,birth weight of newborn and incidence of neonatal asphyxia among the three groups (P>0.05). The incidence rate of tocolytic weakness in the TOLAC success group was lower than that in the TOLAC failure group and the ERCS group, the differences were statistically significant (P<0.05). The incidence rate of puerperal infection in the TOLAC successful group was lower than that in the ERCS group, the difference was statistically significant (P<0.05). The incidence rate of chorioamnionitis in the TOLAC failure group was higher than that in the ERCS group, the difference was statistically significant (P<0.05). Conclusion Under the premise of strictly grasping the indications of TOLAC, it is safe and feasible for vaginal delivery of natural parturients to be pregnant again after cesarean section. The success rate of TOLAC vaginal delivery is more than 70%. Compared with ERCS, TOLAC reduces the incidence of puerperal infections. And shorten the length of hospitalization, have a better outcome of mother and child. The failure of TOLAC increases the incidence of chorioamnionitis, and the mother and infant situation should be closely monitored during the labor process.