瘢痕子宮再次妊娠經陰道分娩對母嬰結局影響的回顧性分析

Retrospective analysis of effect of vaginal delivery in scarred uterus on maternal and neonatal outcomes

目的探討瘢痕子宮婦女再次妊娠分娩方式的選擇及其對母嬰結局的影響。方法對2015年5月1日~2016年4月30日本院婦產科收治的579例分娩的瘢痕子宮產婦臨床資料進行回顧性分析,其中再次剖宮產447例(RCS組),陰道試產132例(TOLAC組),陰道試產成功96例(VBAC組)。隨機選取同時期543例分娩的非瘢痕子宮產婦,其中首次剖宮產447例(PCS組),陰道分娩96例(VBNC組),比較和分析各組母嬰分娩結局及併發症。結果579例瘢痕子宮產婦再次分娩試產率為22.8%(132/579);有36例陰道試產失敗,中轉剖宮產,陰道試產成功96例,成功率為72.7%(96/132),陰道分娩率為16.6%(96/579);行剖宮產者483例,瘢痕子宮產婦剖宮產率為83.4%(483/579);有1例孕婦出現子宮破裂(0.17%,1/579);RCS組和VBAC組患者在孕婦年齡、孕週、產褥病率及新生兒Apgar評分等方面比較差異無統計學意義。VBAC產婦產後出血量、住院時間分別為220.52±17.31mL、3.23±0.43d,均低於RCS組;VBAC組與VBNC組母嬰分娩結局及併發症無顯著差異;RCS組產婦產後出血量丶產後出血發生率均高於PCS組;而Apgar評分、住院時間、產後發熱丶新生兒體重和先兆子宮破裂發生率無顯著性差異。結論瘢痕子宮婦女再次妊娠採用陰道分娩,不會增加母嬰不良結局的發生,在嚴格監護手術適應症下,符合條件的瘢痕子宮婦女陰道試產是安全可行的。

Objective To explore the mode of redelivery in women with scarred uterus and the effect on maternal and neonatal outcomes.Methods The clinical data of 579 pregnant women with scarred uterus having delivery in the O&G Department of Kiang Wu Hospital from May 2015 to April 2016 were retrospectively analyzed.447 women opted for second cesarean section(RCS group)while 132 women chose to have trial of vaginal delivery(TOLAC group),with 96(72.73%)successfully delivered vaginally(VBAC group).The maternal and neonatal outcomes and complications of these two groups were compared to tow other groups which consisted of 447 patients with first cesarean section(PCS group)and 96 patients undergoing vaginal delivery with no prior cesarean section(VBNC group).Results For the VBAC group,the postpartum hemorrhage volume(220.52ml),hospitalization days(3.23 days)and the incidence of bleeding or fever(2.08%)were all significantly lower than those in RCS group.There was no significant difference in maternal and infant ad adverse outcome rates between VBAC and VBNC groups.The postpartum hemorrhage volume and incidence of bleeding in RCS group were higher than those in PCS group.There was no significant difference in Apgar score,hospitalization days,incidence of fever and threatened uterine rupture RCS and PCS groups.Conclusion Vaginal delivery for uterine scar pregnancy will not increase the incidence of poor outcomes of mothers and infants.