有剖宫产史孕妇再次妊娠分娩方式的探讨

目的：探讨剖宫产术后再次妊娠分娩的最佳方式。方法：回顾分析上海交通大学医学院附属瑞金医院2004年1月—2012年9月剖宫产术后再次妊娠的286例孕妇的分娩方式,其中剖宫产234例,阴道试产52例,并随机抽取同期首次行剖宫产术300例孕妇为对照组。结果：286例孕妇中258例（90.2%）再次行剖宫产术,28例阴道分娩,试产成功率53.9%。阴道分娩组无大出血发生,再次剖宫产组发生10例（3.88%）,对照组发生2例（0.67%）,差异有统计学意义（P〈0.05）。再次剖宫产组术中出血量（325.4±12.5）mL,高于对照组（225.6±26.8）mL及阴道分娩组（148.4±15.7）mL,差异有统计学意义（P〈0.05）。再次剖宫产组平均手术时间（59.2±20.5）min,高于对照组（30.9±14.6）min;腹腔粘连146例（56.59%）,高于对照组0例,差异均有统计学意义（P〈0.05和0.01）。再次剖宫产组住院时间（7.2±0.9）d,与对照组（6.8±1.2）d和阴道分娩组（3.5±1.8）d比较,差异有统计学意义（P〈0.05）。结论：瘢痕子宫再次妊娠不是剖宫产的绝对指征。有剖宫产史孕妇再次妊娠后,若无剖宫产指征,应增加阴道试产机会;而提高剖宫产手术水平,是降低剖宫产史孕妇再次剖宫产并发症的关键。

Exploration of Delivery Ways of 286 Re-pregnant Women after Caesarean Section

Objective：To study the best delivery way of the re-pregnant women after caesarean section.Methods：The delivery ways were retrospectively analyzed in286 re-pregnant women after caesarean section in Ruijin Hospital,Shanghai Jiaotong University School of Medicine from January 2004 to September 2012.A total of 234 pregnant women selected caesarean section,52 pregnant women selected vaginal delivery.300 conesponding pregnant women with first caesarean section were randomly selected as the control.Results：There were 28 pregnant women selected vaginal delivery（53.9 %）and 258 pregnant women selected repeated caesarean section（90.2 %）.During the operation,the occurrence of hematorrhea in vaginal delivery was 0,repeated caesarean section was 10（3.88%）and control was 2（0.67%）,（P〈0.05）.The average bleeding amount in repeated caesarean section was（325.4±12.5）mL,control was（225.6±26.8）mL and vaginal delivery was（148.4±15.7）mL（P 0.05）.The average operation time in repeated caesarean section was（59.2±20.5）min,which was higher than that in control（30.9±14.6）min（P〈0.05）.The occurance of abdomen adherence in repeated caesarean section was 146（56.59 %）,which was higher than that in control（0,P〈0.01）.Hospitalization time in repeated caesarean section was（7.2±0.9）d,control was（6.8±1.2）d and vaginal delivery was（3.5±1.8）d,and there were differences in 3 groups（P〈0.05）.Conclusions：The repregnancy with scared uterus is not the absolute indication of the caesarean section.Those who satisfy the condition of test childbirth will be safe in vaginal childbirth under strict care.To enhance the surgical techniques of caesarean section can reduce the complications of cesarean section on the scared uterus.