剖宫产术后瘢痕子宫产妇再次妊娠选择阴道分娩的可行性及安全性

Feasibility and Safety of Vaginal Delivery for Women with Scarred Uterus after Cesarean Section

目的分析剖宫产术后瘢痕子宫产妇再次妊娠选择阴道分娩的可行性和安全性。方法回顾性分析2016年6月至2018年5月在我科分娩的67例剖宫产术后瘢痕子宫再次妊娠产妇的临床资料,根据产妇分娩方式的不同分为观察组(31例)和对照组(36例),观察组产妇选择阴道试产,对照组产妇选择剖宫产。比较两组产妇分娩结局、产后并发症发生情况、新生儿Apgar评分及住院时间。结果 31例阴道试产产妇试产成功24例,试产成功率77.42%,2例产妇因宫缩乏力改为剖宫产,1例产妇因持续性枕后位改为剖宫产,4例产妇因无法忍受疼痛改为剖宫产;36例剖宫产产妇全部顺利完成手术。观察组产妇产后并发症发生率低于对照组,住院时间短于对照组(P<0.05)。两组新生儿Apgar评分比较,差异无统计学意义(P>0.05)。结论对于无剖宫产手术指征的瘢痕子宫再次妊娠产妇,应在严格监测产程和胎心的前提下鼓励产妇经阴道试产。阴道分娩不仅能减少产后并发症的发生,加快产妇恢复,而且产道的挤压有也利于胎儿的健康成长。

Objective To analyze the feasibility and safety of vaginal delivery for women with scarred uterus after cesarean section.Methods A retrospective analysis was made on the clinical data of 67 women with scar uterus pregnancy after cesarean section from June 2016 to May 2018 in our department.They were divided into two groups according to different delivery methods.In the observation group,31 parturients were given vaginal trial delivery,while 36 parturients in the control group were given cesarean section.The maternal delivery outcome,incidence of postpartum complications,neonatal status(evaluated by Apgar score)and hospital stay were compared between the two groups.Results Twenty-four of 31 cases of vaginal delivery were successful,the success rate was 77.42%.Two cases were changed to cesarean section because of uterine inertia,one case was changed to cesarean section because of persistent occipital posterior position,four cases were changed to cesarean section because of intolerable pain,and 36 cases were all successfully completed the operation.The incidence of postpartum complications in observation group was lower than that in control group,and hospitalization time was shorter than that in control group(P<0.05).There was no significant difference in Apgar score between the two groups(P>0.05).Conclusion For the pregnant women with scarless uterus without cesarean section indication,we should encourage vaginal trial delivery on the premise of strict monitoring of labor process and fetal heart sounds.Vaginal delivery can not only reduce the incidence of postpartum complications and accelerate maternal recovery,but also conducive to the healthy growth of the fetus.