瘢痕子宫孕妇阴道试产失败转急诊剖宫产者分娩并发症观察

Obstetric complications of pregnant women with scar uterus who failed vaginal trial delivery and transferred to emergency cesarean section

目的观察瘢痕子宫孕妇阴道试产失败转急诊剖宫产者的母婴结局及分娩并发症。方法选择2018年1月~2020年1月本院收治的146例瘢痕子宫孕妇作为研究对象,所有孕妇行阴道试产,根据阴道试产结果将孕妇分为两组,其中阴道试产失败转急诊剖宫产孕妇54例为观察组;阴道试产成功孕妇92例为对照组。收集患者临床资料,包含年龄、孕周、孕前身体质量指数(body mass index,BMI)、瘢痕厚度、距上次剖宫产时间、剖宫产原因等;两组围术期相关指标,包括手术时间、分娩时间、术中出血量、术后出血量、切口甲级愈合、住院时间;记录两组新生儿性别、出生体重、阿氏(Apgar)评分、新生儿窒息或感染的发生情况;手术前1 d检测两组凝血酶原时间(prothrombin time,PT)、凝血酶时间(thrombin time,TT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、纤维蛋白原(fibrinogen,FIB)水平;记录两组孕妇并发症发生情况。结果与对照组相比,观察组孕妇年龄较大、孕周较长、孕前BMI较高(P<0.05);与对照组相比,观察组手术时间、住院时间较长,分娩时间较短,术中出血量和术后出血量较大(P<0.05);与对照组相比,观察组新生儿体重较重(P<0.05);两组PT、TT、APTT、FIB水平无明显差异(P>0.05);与对照组相比,观察组子宫破裂、产后出血、盆腔黏连的发生率较高(P<0.05)。结论对于瘢痕子宫孕妇,阴道试产失败转急诊剖宫产会增加子宫破裂、产后出血、盆腔黏连等并发症的发生率,阴道试产失败可能与孕周、孕妇年龄、孕前BMI、新生儿体重等因素有关。

Objective To observe the maternal and infant outcomes and delivery complications of cicatrix pregnant women who failed vaginal trial delivery and transferred to emergency cesarean section.Methods A total of 146 pregnant women with scar uterus treated in our hospital from January 2018 to January 2020 were selected as the research object.All pregnant women underwent vaginal trial delivery.According to the results of vaginal trial delivery,pregnant women were divided into two groups,among which 54 pregnant women who failed vaginal trial delivery and transferred to emergency cesarean section were selected as the observation group.The control group included 92 pregnant women with successful vaginal trial delivery.Clinical data of patients were collected,including age,gestational age,body mass index(BMI)before pregnancy,scar thickness,time since last cesarean section,and reasons for cesarean section,etc.Perioperative related indexes of the two groups,including operation time,delivery time,intraoperative blood loss,postoperative blood loss,grade A incision healing,length of hospital stay;Gender,birth weight,Apgar score,occurrence of neonatal asphyxia or infection were recorded.And 1 d before operation,prothrombin time(PT),Thrombin time(TT),activated partial thromboplastin time(APTT),and fibrinogen(FIB)in both groups were detected.The incidence of complications in the two groups was recorded.Results Compared with the control group,the pregnant women in the observation group were older,gestational age was longer,and BMI before pregnancy was higher(P<0.05).Compared with the control group,the observation group had longer operation time,longer hospital stay,shorter delivery time,and larger intraoperative and postoperative blood loss(P<0.05).Compared with the control group,the newborn weight in the observation group was heavier(P<0.05).There were no significant differences in PT,TT,APTT and FIB between the two groups(P>0.05).Compared with the control group,the incidence of uterine rupture,postpartum hemorrhage and pelvic adhesion were higher in the observation group(P<0.05).Conclusion For pregnant women with scar uterus,vaginal trial delivery failure and emergency cesarean section will increase the incidence of uterine rupture,postpartum bleeding,pelvic adhesion and other complications,and vaginal trial delivery failure may be related to gestational age,maternal age,pre-pregnancy BMI,newborn weight and other factors.