疤痕子宫再次妊娠二次剖宫产与非疤痕子宫剖宫产的对比评价

Comparative Evaluation of Second Cesarean Section with Scarred Uterus and Non-scarred Uterus

目的对比评价疤痕子宫再次妊娠二次剖宫产与非疤痕子宫剖宫产的效果。方法选取该院在2018年4月—2019年4月收治的200例疤痕子宫再次妊娠二次剖宫产患者为实验组研究对象,再选取同期该院收治的200例非疤痕子宫剖宫产患者为对照组。分析两组研究对象的子宫异常(完全破裂、不完全破裂)发生率、胎盘异常(胎盘粘连、前置胎盘以及胎盘植入等)发生率、平均术中出血量、平均手术时间、平均产后24 h出血量、平均产后恶露持续时间以及对新生儿的相关影响(乳酸水平、胆红素水平、平均5 minApgar评分)。结果实验组完全破裂、不完全破裂等子宫异常发生率以及胎盘粘连、前置胎盘以及胎盘植入等胎盘异常发生率高于对照组(χ^2=4.230、12.021、15.236、20.124、26.527,P<0.05);实验组平均术中出血量、平均产后24 h出血量多于对照组(χ^2=12.215、18.225,P<0.05),实验组平均手术时间、平均产后恶露持续时间长于对照组(χ^2=26.367、33.102,P<0.05);实验组新生儿乳酸水平、平均5 min Apgar评分、胆红素水平分别为(5.6±1.3)mmol/L、(9.4±0.5)分、(19.4±1.2)μmol/L,对照组分别为(1.7±0.3)mmol/L、(8.3±1.2)分、(23.1±2.3)μmol/L,实验组新生儿乳酸水平、平均5 min Apgar评分高于对照组(t=1.258、11.365,P<0.05),实验组新生儿胆红素水平低于对照组(t=22.359,P<0.05)。结论疤痕子宫再次妊娠二次剖宫产产妇的分娩风险高于非疤痕子宫剖宫产产妇,术后出血量多且产后恶露持续时间长,对产妇的伤害更大,临床中需高度关注且谨慎选择分娩方式。

Objective To compare the effects of second cesarean section and non-scarred uterus cesarean section.Methods Select 200 patients with scar uterus re-pregnancy and second cesarean section admitted to the hospital from April 2018 to April 2019 as the experimental group research subjects,and then select 200 non-scar uterine cesarean section patients admitted to the hospital during the same period of the control group.Analyze the incidence of uterine abnormalities(complete rupture,incomplete rupture),placental abnormalities(placental adhesions,placenta previa,placenta accreta,etc.),average intraoperative blood loss,average surgical time,average postpartum 24 h bleeding,average duration of postpartum lochia,and related effects on newborns(lactic acid level,bilirubin level,average 5 min Apgar score).Results The incidence of uterine abnormalities such as complete rupture and incomplete rupture in the experimental group and placental abnormalities such as placental adhesions,placenta previa,and placenta accreta were higher than those in the control group(χ^2=4.230,12.021,15.236,20.124,26.527,P<0.05));the experimental group's average intraoperative blood loss and average postpartum 24 h blood loss were more than those of the control group(χ^2=12.215,18.225,P<0.05),and the experimental group's average operation time and average postpartum lochia duration were longer than those of the control group(χ^2=26.367,33.102,P<0.05);the neonatal lactate level,average 5 min Apgar score,and bilirubin level of the experimental group were(5.6±1.3)mmol/L,(9.4±0.5)minutes,(19.4±1.2)μmol/L,respectively,The control group were(1.7±0.3)mmol/L,(8.3±1.2)minutes,(23.1±2.3)μmol/L,the neonatal lactate level and average 5 min Apgar score of the experimental group were higher than those of the control group(t=1.258,11.365,P<0.05), the bilirubin level of newborns in the experimental group was lower than that of the control group (t=22.359, P<0.05). Conclusion The risk of childbirth for women with a second cesarean section with scarred uterus is higher than that for women with non-scarred uterus cesarean section. The postoperative bleeding is more and the postpartum lochia lasts longer, which is more harmful to the mother. The clinic needs high attention and caution to choose the delivery method.