瘢痕子宫再次妊娠孕妇终止妊娠的方式选择研究

Study on the Choice of Termination Methods for Pregnant Women with Scar Uterus

目的分析瘢痕子宫再次妊娠孕妇终止妊娠的方式选择。方法回顾性分析2019年1月至2021年12月南阳市中心医院收治的96例晚期妊娠瘢痕子宫孕妇的临床资料,结合不同终止妊娠方式分成对照组(在适宜时机采取剖宫产终止妊娠)50例和观察组(在适宜时机采取阴道分娩终止妊娠)46例。比较两组产时及产后2 h出血量、住院时间和住院费用;母婴并发症;新生儿体质量及Apgar得分;分娩前后血清皮质醇(Cor)、去甲肾上腺素(NE)及血管紧张素Ⅱ(ATⅡ)水平。结果观察组的产时及产后2 h出血量少于对照组,差异有统计学意义(P<0.05),住院时间短于对照组,差异有统计学意义(P<0.05),住院费用少于对照组,差异有统计学意义(P<0.05)。观察组的产褥感染、子宫出血、子宫破裂、新生儿黄疸、新生儿湿肺以及新生儿窒息等并发症发生率低于对照组,差异有统计学意义(P<0.05)。两组的新生儿体重及Apgar得分相比,差异无统计学意义(P>0.05)。分娩后,两组的Cor、NE、ATII水平均较前升高,差异有统计学意义(P<0.05),观察组的Cor、NE、ATII水平低于对照组,差异有统计学意义(P<0.05)。结论瘢痕子宫再次妊娠孕妇,于晚孕期仔细评估其阴道分娩可能性,并严密监测母婴状态,在具备输血和抢救等条件下,能采取阴道分娩以终止妊娠,可降低产后出血量,缩短住院时间,减少住院费用及母婴并发症发生,缓解应激反应,改善新生儿预后。

Objective To analyze the choice of termination of pregnancy in the second pregnancy of cicatricial uterus.Methods Clinical data about 96 late-stage pregnancy women with scarred uterus admitted to our hospital from January 2019 to December 2021 were retrospectively analyzed.According to the different pregnancy termination modes,women were assigned to control group(N=50,properly terminate the pregnancy by cesarean section)and observation group(N=46,properly terminate the pregnancy by vaginal delivery).The pregnancy outcomes were appraised through the intrapartum and 2-hour postpartum bleeding volume,hospital stays,hospital expenses,maternal and neonatal complications,neonatal body weight,Apgar points,serum cortisol(Cor),norepinephrine(NE)and angiotensin-Ⅱ(ATII)levels.Results The intrapartum and 2-hour postpartum bleeding volume in the observation group were smaller than those in the control group,with statistically significant differences(P<0.05);The hospital stays in the observation group was shorter than control group,with statistically significant difference(P<0.05);The hospitalization costs in the observation group was lower than control group,with statistically significant difference(P<0.05);The incidences of complications like puerperal infection,uterine bleeding,uterine rupture,neonatal jaundice,wet lung and neonatal asphyxia in the observation group were lower than those in the control group,with statistically significant differences(P<0.05);The neonatal body weight and Apgar points between groups were not significantly different(P>0.05);After delivery,Cor,NE and ATII levels in two groups were significantly higher than before,with statistically significant differences(P<0.05);Cor,NE and ATII levels in the observation group were lower than those in the control group,with statistically significant differences(P<0.05).Conclusion For pregnant woman with cicatricial uterus,in the late period of the second pregnancy,the possibility of having a vaginal delivery should carefully evaluated,the maternal and neonatal states should be monitored.Under conditions of the blood transfusion and emergency rescue,the vaginal delivery could be appraised and recommended to reduce the postpartum bleeding volume,hospital stays,hospitalization costs,maternal and neonatal complications and stress reactions,improve the neonatal prognosis.