宫腔外取胎头在瘢痕子宫剖宫产术中的应用效果

Application Effect of the Fetal Head Extraction Outside of the Uterine Cavity in the Cesarean Section of Scar Uterus

目的:研究宫腔外取胎头在瘢痕子宫剖宫产术中的应用效果。方法:通过回顾性分析的方式,选取2018年10月-2020年10月在东莞市第八人民医院进行剖宫产术的瘢痕子宫产妇作为研究对象,根据手术方法将其分为对照组与观察组,对照组40例行传统手入宫腔取胎头,观察组40例行宫腔外取胎头。对比分析两组新生儿出生后1、10 min的Apgar评分,以及取胎头时间、术中出血量、子宫切口撕裂率、切口愈合不良率、新生儿窒息和感染发生率、产后并发症发生率(切口血肿、切口感染、盆腔粘连、产后出血、产褥感染)。结果:观察组新生儿出生后1、10 min Apgar评分明显高于对照组,差异有统计学意义(P<0.05)。观察组的取胎头时间短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05)。观察组的子宫切口撕裂率、切口愈合不良率、新生儿窒息和感染发生率均低于对照组,差异有统计学意义(P<0.05)。观察组的产后并发症发生率为7.50%,低于对照组的37.50%,差异有统计学意义(P<0.05)。结论:在瘢痕子宫剖宫产术中实施宫腔外取胎头的方式,能缩短取胎头时间,减少术中出血量,避免切口撕裂和愈合不良,一定程度上可以降低新生儿窒息情况,减少产妇产后并发症发生风险,提高新生儿的Apgar评分,应用效果理想。

Objective:To explore the application effect of the fetal head extraction outside of the uterine cavity in the cesarean section of scar uterus.Method:Through retrospective analysis,the scar uterus pregnant women who underwent cesarean section in Dongguan Eighth People’s Hospital from October 2018 to October 2020 were selected as the research objects.According to the operation method,they were divided into control group and observation group.The 40 cases in the control group underwent traditional hand-in-uterine fetal head extraction,and the 40 cases in the observation group underwent the fetal head extraction outside of the uterine cavity.The Apgar scores of newborns at 1 and 10 min after birth,the time of extract fetal head,intraoperative bleeding volume,rate of incision tear,poor healing rate of incision union,incidence of asphyxia and infection of newborn,incidence of postpartum complications (incision hematoma,incision infection,pelvic adhesion,postpartum hemorrhage,puerperal infection) were compared between the two groups.Result:The Apgar scores of 1 and 10 min after birth in the observation group were significantly higher than those of the control group,the differences were statistically significant (P<0.05).The time of extract fetal head in observation group was shorter than that in control group,and the intraoperative bleeding volume was less than that of control group,the differences were statistically significant (P<0.05).The rate of incision tear,poor healing rate of incision union,neonatal asphyxia and infection in observation group were lower than those in control group,the differences were statistically significant (P<0.05).The incidence of postpartum complications in observation group was 7.50%,which was lower than 37.50% of the control group,and the difference was statistically significant (P<0.05).Conclusion:In cesarean section of scar uterus,fetal head extraction outside of the uterine cavity can shorten the time of extract fetal head,reduce the intraoperative bleeding volume,avoid incision tear and poor healing,reduce the risk of neonatal asphyxia and reduce the risk of postpartum complications,and improve the Apgar score of newborns.The application effect is ideal.