完全性前置胎盘剖宫产后阴道分娩2次严重出血1例报告及对三孩时代边境山区农村孕产妇保健管理的启示

A case report of two severe bleeding of vaginal delivery after complete placenta previa cesarean section and its enlightenment to the health management of pregnant women in the border mountainous areas of the three-child era

剖宫产术后阴道分娩(VBAC)是指既往有剖宫产手术史的妇女再次妊娠生产时采用经阴道分娩的方式。本病例阴道分娩后,自然流产,前置胎盘急诊剖宫产,其后两次妊娠均自然临产并顺利阴道分娩,说明减少医疗干预对VBAC的重要性。介于其均发生严重出血,提醒广大产科工作者,务必加强全程监护,积极防治产后大出血,警惕母婴意外;同时提醒产科医生剖宫产术后再次妊娠、已自然临产者,务必认真仔细检查与评估,严控剖宫产指征,谨防进入手术室、麻醉甚至开腹下,新生儿从阴道娩出。

Vaginal birth after cesarean(VBAC)refers to the way of vaginal delivery in women with a history of previous cesarean delivery.In this case,spontaneous abortion after vaginal delivery,emergency cesarean section for placenta praevia,and spontaneous labor and successful vaginal delivery in both subsequent pregnancies illustrate the importance of reducing medical interventions for VBAC.In view of the occurrence of serious bleeding,obstetricians are reminded to strengthen monitoring throughout the whole process,actively prevent and treat postpartum hemorrhage,and be alert to maternal and infant accidents.Obstetricians are also reminded to carefully examine and evaluate new pregnancies after cesarean section and those who have already delivered spontaneously,strictly control the indication of cesarean section,guard against entering the operating room,anesthesia,or even laparotomy under which the newborn is delivered vaginally.