剖宫产术后瘢痕子宫再次妊娠产妇阴道分娩的安全性和可行性及其对新生儿的影响

Feasibility Analysis of Vaginal Delivery after Cesarean Section in Women with Scarred Uterus

目的探讨剖宫产术后瘢痕子宫再次妊娠产妇选择阴道分娩的安全性和可行性及其对新生儿的影响。方法选择2016年1月至2018年12月期间在我院妇产科进行分娩的127例剖宫产术后瘢痕子宫再次妊娠且无阴道分娩禁忌证的产妇为研究对象,根据产妇自愿选择分娩方式的不同分成观察组(58例)和对照组(69例)。观察组产妇首选阴道分娩,分娩不成功后改为剖宫产;对照组产妇直接选择剖宫产。记录并比较两组产妇分娩结果、术中出血量、并发症发生情况、住院时间以及新生儿Apgar评分。结果观察组39例产妇经阴道分娩成功,分娩成功率为67.24%,19例产妇阴道分娩失败改为剖宫产,其失败原因为宫缩乏力11例,胎儿窘迫5例,要求剖宫产3例。经阴道分娩的观察组产妇术中出血量、并发症发生率和住院时间均优于采用剖宫产的对照组产妇(P<0.05);两组新生儿Apgar评分比较,差异无统计学意义(P>0.05)。结论虽然剖宫产术后瘢痕子宫再次妊娠的产妇经阴道分娩存在一定风险,但阴道分娩能显著降低产妇及新生儿并发症的发生,有利于产妇的恢复,只要临床对其做好产前检查,严格掌控阴道分娩试产的适应证,密切监测整个产程,就能有效提高阴道分娩的成功率和安全性。

Objective To investigate the safety and feasibility of vaginal delivery for pregnant women with scar uterus after cesarean section and its influence on newborns.Methods From January 2016 to December 2018 in our hospital obstetrics and gynecology department 127 cases of cesarean scar uterus pregnancy again without vaginal delivery contraindications were selected as the research object,according to the maternal voluntary choice of different delivery methods were divided into observation group(58 cases)and control group(69 cases).The observation group preferred vaginal delivery,and changed to cesarean section after unsuccessful delivery;the control group chose cesarean section directly.The delivery results,intraoperative blood loss,complications,hospital stay and neonatal Apgar score were recorded and compared between the two groups.Results In the observation group,39 cases of vaginal delivery were successful,the delivery success rate was 67.24%,19 cases of vaginal delivery failure changed to cesarean section,the causes of failure were uterine atony in 11 cases,fetal distress in 5 cases,and cesarean section in 3 cases.The amount of bleeding,the incidence of complications and hospitalization time in the observation group were better than those in the control group(P<0.05);there was no significant difference in Apgar score between the two groups(P>0.05).Conclusion Although there is a certain risk of vaginal delivery for pregnant women with scar uterus after cesarean section,vaginal delivery can significantly reduce the incidence of maternal and neonatal complications,which is conducive to maternal recovery.As long as clinical prenatal examination is done,indications of vaginal delivery trial production are strictly controlled,and the whole labor process is closely monitored,the success rate and safety of vaginal delivery can be effectively improved Sex.