瘢痕子宫再次妊娠经阴道分娩的可行性分析

目的分析瘢痕子宫再次妊娠经阴道分娩的可行性。方法选取我院妇产科收治的剖宫产后再次妊娠产妇112例,按照是否满足阴道分娩条件分为试产组51例和剖宫产组61例,同时按照1∶1比例随机抽取我院同期经阴道分娩初产妇与试产组比较分析其分娩结局;随机抽取同期剖宫产初产妇与剖宫产组比较分析其手术情况;同时比较试产组与剖宫产组间的母婴结局。结果试产组共51例,其中试产成功47例,成功率42.0%,与经阴道分娩初产妇相比,试产组在产程时间、产时出血量、住院时间、新生儿Apgar评分及新生儿窒息发生率等方面比较差异均无统计学意义（P〉0.05）;剖宫产组共65例,手术时间、术中出血量、术后血象异常率及住院时间均显著高于剖宫产初产妇组（P〈0.05）;在手术复杂性及风险性方面,剖宫产组胎盘异常（胎盘前置、粘连、植入）率21.54%显著高于剖宫产初产妇组（P〈0.05）,子宫破裂率3.08%,高于初产妇但比较差异无统计学意义（P〉0.05）;试产组分娩出血量、住院时间及新生儿体重均显著低于剖宫产组（P〈0.05）,二组新生儿Apgar评分、新生儿窒息率及产褥病率差异无统计学意义（P〉0.05）。结论瘢痕子宫再次妊娠在按照高危孕产妇管理,经仔细筛选符合试产条件和严密监测产程及时发现并采取处理措施的条件下可以进行经阴道分娩。

THE FEASIBILITY OF VAGINAL DELIVERY IN PUERPERA WITH SCAR UTERUS

Objective To analyze the feasibility of vaginal delivery in puerpera with scar uterus.MethodsTotal 112 puerpera with scar uterus were divided into vaginal delivery group（51 puerpera）and cesarean group（61 puerpera）,compared the surgical constitution of vaginal delivery group,cesarean group and primipara. Results The success rate in the vaginal delivery group was 42%,the labor time,intrapartum bleeding,hospital stay,apgar score and neonatal asphyxia had no significantly differences between vaginal delivery group and primipara group（P〈0.05）;The operative time,blood loss,postoperative blood abnormality rate,hospitalization time and placental abnormalities of cesarean group were significantly higher than primipara（P 〉0.05）;The bleeding,hospitalization and birth weight of vaginal delivery group were all significantly lower than cesarean group（P〈0.05）.Conclusion Uterine scar pregnancy can be vaginal delivery in accordance with the management of high-risk pregnant women,after careful screening pilot production line with labor conditions and close monitoring to detect and take action conditions.