瘢痕子宫再次妊娠产妇经阴道分娩与剖宫产的母婴结局

Maternal and Infant Outcomes of Vaginal Delivery and Cesarean Section in Women with Second Pregnancy of Scar Uterus

目的探讨阴道分娩与剖宫产对瘢痕子宫再次妊娠产妇母婴结局的影响。方法本次研究时间为2019年3月至2021年3月,采取回顾性研究法,纳82例无产科并发症的瘢痕子宫经产妇作为研究对象,并以本次分娩方式差异作为分组依据;经阴道分娩的经产妇纳入阴道分娩组,经剖宫产分娩的经产妇纳入剖宫产组,各自41例。比较阴道分娩组与剖宫产组新生儿娩出1min后的Apgar评分和胎儿窘迫发生率、窒息发生率、湿肺发生率,以及经产妇平均住院时间、产后出血量、住院费用、分娩时间和产后大出血发生率、盆腔粘连发生率、产褥感染发生率、恶露过长发生率差异。结果(1)阴道分娩组平均住院时间与分娩时间短于剖宫产组,产后出血量少于剖宫产组,住院费用低于剖宫产组,且盆腔粘连(4.88%)、恶露过长发生率(2.44%)低于剖宫产组(24.39%、19.51%),差异有统计学意义(P<0.05);两组产后大出血(2.44%VS 17.07%)、产褥感染发生率(0.00%VS 12.20%)比较,差异无统计学意义(P>0.05)。(2)两组新生儿娩出1min后的Apgar评分比较,虽阴道分娩组略高于剖宫产组,但差异无统计学意义(P>0.05);阴道分娩组胎儿窘迫(2.44%)、窒息(2.44%)、湿肺发生率(0.00%)低于剖宫产组(21.95%、19.51%、17.07%),差异有统计学意义(P<0.05)。结论瘢痕子宫再次妊娠的经产妇分娩风险高,建议临床加大产前引导,鼓励阴道试产,尽量避免二次剖宫产;另外,临床要继续严控初产妇的剖宫产指标,即使剖宫产,也需考虑产妇再次妊娠阴道分娩的适应症要求。

Objective To investigate the effect of vaginal delivery and cesarean section on maternal and infant outcomes of repregnancy with scar uterus.Method A total of 82 patients without obstetric complications who were admitted to our hospital from March 2019 to March 2021 with scar uterus were retrospectively selected as the study subjects.They were grouped according to different delivery methods,those who delivered vaginally were included in the vaginal delivery group,those who delivered by cesarean section were included in the cesarean delivery group,40 cases in each group.Apgar score,incidence of fetal distress,asphyxia,and wet lung were compared between the two groups 1min after delivery,as well as the differences in average length of hospital stay,postpartum hemorrhage,hospitalization cost,delivery time,and incidence of postpartum hemorrhage,pelvic adhesion,puerperal infection,and lochia overlength were compared between the two groups.Results(1)The average length of hospital stay and delivery time in the vaginal delivery group were shorter than those in the cesarean delivery group,the amount of postpartum bleeding was less than that in the cesarean delivery group,the hospitalization cost was lower than that in the cesarean delivery group,and the incidence of pelvic adhesion(4.88%)and lochia overduration(2.44%)were lower than those in the cesarean delivery group(24.39%,19.51%),with statistical significance(P<0.05).There were no significant differences in the incidence of postpartum hemorrhage(2.44%VS 17.07%)and puerperal infection(0.00%VS 12.20%)between the two groups(P>0.05).(2)Apgar score was slightly higher in the vaginal delivery group than in the cesarean delivery group,but the difference was not statistically significant(P>0.05).The incidence of fetal distress(2.44%),asphyxia(2.44%)and wet lung(0.00%)in vaginal delivery group were lower than those in cesarean delivery group(21.95%,19.51%,17.07%),and the difference was statistically significant(P<0.05).Conclusion The risk of second pregnancy is high in the women with scar uterus.It is suggested to increase prenatal guidance,encourage vaginal trial delivery and avoid second cesarean section as far as possible.In addition,the clinical should continue to strictly control the cesarean section indicators of primiparas,even if cesarean section,also need to consider the indications for vaginal delivery of maternal pregnancy again.