剖宫产术后再次妊娠阴道分娩椎管内分娩镇痛应用的临床分析

Impact of analgesia of intraspinal delivery on perinatal outcome of vaginal birth after cesarean delivery

目的探讨椎管内分娩镇痛在剖宫产术后再次妊娠经阴道分娩(VBAC)中应用的可行性和安全性。方法回顾性分析2017年1月至2018年5月我院剖宫产术后再次妊娠要求阴道试产180例,将研究对象分为镇痛组(60例)和非镇痛组(120例)。比较两组的产程时间、分娩方式、围生结局等。结果镇痛组产痛程度明显减轻,总产程、第一产程时间长于非镇痛组(P<0.05)。两组的中转剖宫产率、器械助产率、产后出血量差异无统计学意义,均无子宫破裂。结论椎管内分娩镇痛应用于VBAC镇痛效果明确,不增加剖宫产率、新生儿窒息率,无不良妊娠结局。

Objective To discuss the efficacy and safety of intraspinal labor analgesia in vaginal birth after cesarean(VBAC).Methods One hundred and eighty women with VBAC in our hospital between January 2017 and May 2018 were retrospectively reviewed.Sixty patients were treated with labor analgesia and 120 without analgesia were kept as controls.The progress of labor,mode of delivery and perinatal outcome were compared.Results The pain in analgesia group was significantly reduced.The total stage and the first stage of labor were longer than controls(P<0.05).There was no significant difference in the rate of cesarean section,instrumental midwifery and postpartum hemorrhage.No serious complications such as uterine rupture occurred.Conclusion Intraspinal labor analgesia applied to VBAC is safe and effective,which does not increase the rate of cesarean section and neonatal asphyxia,and has no adverse pregnancy outcome.