剖宫产后不同时间子宫瘢痕愈合情况及其指导再次妊娠分娩方式选择的临床价值

Uterine Scar Healing Status after Cesarean Section in Different Time and Its Clinical Value to Guide the Choice of Delivery Mode for the Next Pregnancy

目的探讨剖宫产后不同时间子宫瘢痕愈合情况及其指导再次妊娠分娩方式选择的临床价值。方法选择2013年12月至2014年12月来延安大学附属医院进行分娩的妊娠晚期孕妇200例为研究对象,孕妇均有剖宫产史。根据上次剖宫产据此次妊娠时间间隔将患者分为4组,剖宫产后10~12个月组(13例)、剖宫产后13~24个月组(45例)、剖宫产后25~36个月组(116例)、剖宫产后>37个月组(26例),比较不同剖宫产后据此次妊娠时间子宫瘢痕愈合分级、子宫破裂、孕妇最终分娩方式的选择。结果剖宫产后10~12个月组子宫瘢痕愈合情况差于13~24个月组、25~36个月组、>37个月组[Ⅰ级、Ⅱ级、Ⅲ级分别为0例、3例、10例比12例、27例、6例比76例、34例、6例比16例、7例、3例](均P<0.05),剖宫产后13~24个月组子宫瘢痕愈合情况差于25~36个月组和>37个月组(均P<0.05),>37个月组子宫瘢痕愈合情况好于25~36个月组(P<0.05)。10~12个月组的子宫破裂率高于25~36个月组[23.08%(3/13),0.86%(1/116)](P<0.008)。最终根据孕妇自身意愿和外界条件,共有93例行阴道分娩,107例行剖宫产,4组孕妇剖宫产率比较差异有统计学意义[19.23%(5/26)比100.00%(13/13)比88.89%(40/45)比42.24%(49/116)](P<0.05)。结论对于有过剖宫产手术史的孕妇,适当延长上次剖宫产至下次妊娠的时间间隔有助于子宫瘢痕愈合,时间越长,愈合越佳。距上次时间大于2年者,再次妊娠时可行阴道试产。

Objective To investigate the healing status of uterine scar after cesarean section in different time and its clinical value to guide the choice of delivery mode for the next pregnancy .Methods A total of 200 pregnant women in late trimester of pregnancy admitted to Affiliated Hospital of Yan′an University from Dec.2013 to Dec.2014 for examination and delivery were selected ,and they all had a history of cesarean section .The pregnant women were divided into four groups acco rding to the time interval to the last cesarean section to this pregrency .These four groups were 10-12 months after cesarean section group(13 cases),13-24 months after cesarean section group (45 cases),25-36 months after cesarean section group (116 cases) and >37 months after cesarean section group (26 cases).The relationship between the time interval and the grade of uterine scar healing was investigated .The uterine rupture rate during vaginal delivery and the final delivery modes were compared.Results For the grades of uterine scar healing of the four groups ,10-12 months after cesarean section group was worse than 13-24 months after cesarean section group and 25-36 months after cesarean section group and >37 months after cesarean section group [grade one,grade two,grade three were 0 case,2 cases,10 cases vs 12 cases,27 cases, 6 cases vs 76 cases,34 cases,6 cases vs 6 cases,7 cases,3 cases](all P<0.05),13-24 months after cesarean section group was worse than 25-36 months after cesarean section group and >37 months after cesarean section group ( P<0.05 ) , 37 months after cesarean section group was the best ( P<0.05 ) .The uterine rupture ate of 10-12 months group was much higher than that of 25-36 months group[23.08%(3/13) vs 0.86%(1/116)](P<0.008).Finally, according to the&nbsp;wishes of the pregnant women and external conditions , 93 cases adopted vaginal delivery ,and 107 cases adopted cesarean section.The cesarean section rate of >37 months was lower than the other three groups [19.23%(5/26) vs 42.24%(49/116),88.89%(40/45),42.24%(49/116)](P<0.05).Conclusion For pregnant women with a history of cesarean section, appropriate extending of the time interval from the last cesarean section to the next pregnancy is positive to the healing of uterine scar,the longer the time interval,the better the healing.For cases with time interval >2 years,vaginal delivery can be tried.