不同分娩方式对剖宫产后瘢痕子宫再次妊娠早产产妇妊娠结局的影响

Effect of different delivery methods on the pregnancy outcome of premature pregnant women with ecarred uterus re-pregnancy after prior cesarean section

目的探讨剖宫产后瘢痕子宫再次妊娠早产产妇采用不同分娩方式的临床效果及对妊娠结局影响。方法回顾性分析嘉兴市妇幼保健院2017年1月至2021年12月收治的瘢痕子宫再次妊娠早产产妇431例的临床资料,按分娩方式不同分为研究组和对照组,经阴道分娩的瘢痕子宫妊娠早产产妇107例为研究组,行剖宫产的瘢痕子宫妊娠早产产妇324例为对照组。比较两组产后出血量、子宫破裂发生情况、住院时间;比较两组新生儿窒息发生情况、新生儿1 min、5 min和10 min Apgar评分。结果研究组产后出血量[(232.31±73.82)mL]、住院时间[(4.32±0.61)d]显著少于、短于对照组[(354.27±89.49)mL、(6.23±0.94)d](t=12.74、19.69,均P<0.05);两组子宫破裂发生率比较,差异无统计学意义(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);两组新生儿1 min、5 min和10 min Apgar评分比较,差异均无统计学意义(均P>0.05)。结论剖宫产后瘢痕子宫再次妊娠早产产妇,选择剖宫产和阴道分娩均能顺利完成分娩,但阴道分娩产后出血量少,住院时间短,是安全性高、可行性好的一种分娩方式,鼓励剖宫产术后再次妊娠产妇选择经阴道分娩。

Objective To explore the clinical effects and impacts of different delivery methods on pregnancy outcomes in preterm women with scarred uterus re-pregnancy after prior cesarean section.Methods The clinical data of 431 pregnant women with scar uterus re-pregnancy and premature delivery admitted to Jiaxing Maternal and Child Health Hospital from January 2017 to December 2021 were retrospectively analyzed.According to the mode of delivery,107 patients who were delivered through vagina were included in the study group and 324 patients undergoing cesarean section were selected as the control group.Amount of postpartum bleeding,incidence of uterine rupture,and hospital stay were compared between two groups.Incidence of neonatal asphyxia and 1-,5-,and 10-minute Apgar scores were also compared between the two groups.Results Compared with the control group,postpartum bleeding volume and hospital stay were significantly lower in the study group[(232.31±73.82)mL vs.(354.27±89.49)mL,(4.32±0.61)days vs.(6.23±0.94)days;t=12.74,19.69,P<0.05).There was no significant difference in the incidence of uterine rupture(P>0.05),incidence of neonatal asphyxia(P>0.05),and 1-,5-,and 10-minute Apgar scores(P>0.05)between the two groups.Conclusion For premature delivery women with scarred uterus after prior cesarean section,both cesarean section and vaginal delivery can be chosen for successful delivery.However,vaginal delivery has less postpartum bleeding and shorter hospital stay,which is a feasible and safe delivery method.Vaginal delivery is encouraged for re-pregnancy after cesarean section.