闭环式管理对子宫下段横切口再次妊娠孕妇妊娠结局的影响

Effect of closed-loop management on pregnancy outcomes in pregnant women with second pregnancy after transverse incision of lower uterine segment

目的探讨对剖宫产术后瘢痕子宫再次妊娠阴道试产的孕妇实施孕产期闭环式管理对其分娩结局的影响。方法选取产检的150例子宫下段横切口剖宫产再次妊娠的孕妇,按照随机数字表法分为对照组与观察组,每组75例。对照组孕妇进行规范孕期保健和产检,观察组孕妇在对照组基础上给予闭环式管理模式。比较两组孕妇产前情况、妊娠结局及新生儿结局。结果观察组孕期增重、产前体质量指数(BMI)及产前胎儿体重评估明显小于对照组,孕期并发症发生率低于对照组,差异有统计学意义(P<0.05)。观察组产妇宫产后阴道试产率、剖宫产后阴道分娩率明显高于对照组,产钳助产术率、中转剖宫产术率、产后24h出血率、产后住院时间低于对照组(P<0.05);两组产妇先兆子宫破裂发生率比较,差异无统计学意义(P>0.05)。观察组胎儿窘迫率2.67%、巨大儿发生率0低于对照组的12.00%、5.33%,观察组新生儿出生体重明显小于对照组,差异均有统计学意义(P<0.05);两组新生儿窒息发生率比较,差异无统计学意义(P>0.05)。结论对剖宫产术后瘢痕子宫再次妊娠阴道试产的孕妇实施孕产期闭环式管理,有效控制了孕妇孕期BMI及新生儿出生体重,提高阴道试产率,降低再次剖宫率。

Objective To investigate the effect of closed-loop management of pregnancy and perinatal period on delivery outcomes of pregnant women with second vaginal trial after caesarean section with scar uterus.Methods 150 pregnant women with second pregnancy after cesarean section with lower section transverse incision were selected and divided into control group and observation group according to random number table method,with 75 cases in each group.Pregnant women in the control group received standardized prenatal health care and prenatal examination,and pregnant women in the observation group were given closed-loop management mode on the basis of the control group.The prenatal condition,pregnancy outcome and neonatal outcome were compared between the two groups.Results The pregnancy weight gain,prenatal body mass index(BMI)and prenatal fetal weight assessment in the observation group were significantly lower than those in the control group,and the incidence of pregnancy complications was lower than that in the control group,with statistical significance(P<0.05).The rate of vaginal trial and vaginal delivery after cesarean section in observation group was significantly higher than that in control group,and the rate of forceps assisted delivery,transfer cesarean section,24 h postpartum hemorrhage and postpartum hospital stay in observation group were lower than those in control group(P<0.05).There was no significant difference in the incidence of threatened uterine rupture between the two groups(P>0.05).The fetal distress rate of 2.67%and the incidence of macrosomia 0 in the observation group were lower than those in the control group(12.00%and 5.33%).The birth weight of newborns in the observation group was significantly lower than that in the control group,with statistical significance(P<0.05).There was no significant difference in the incidence of neonatal asphyxia between the two groups(P>0.05).Conclusion The closed-loop management of pregnancy and perinatal period was implemented for the pregnant women who had a second vaginal trial after caesarean section, which effectively controlled the BMI of pregnant women and the birth weight of newborns, increased the rateof vaginal trial and reduced the rate of resection.