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剖宫产术后再次妊娠分娩266例临床分析
引用本文:张小兰,陈晓艳,梁建敏,张芳.剖宫产术后再次妊娠分娩266例临床分析[J].临床和实验医学杂志,2009,8(8):86-88.
作者姓名:张小兰  陈晓艳  梁建敏  张芳
作者单位:广州天河区红十字会医院妇产科,广东,广州,510660
摘    要:目的探讨剖宫产术后再次妊娠分娩方式及对产妇结局的影响。方法对我院3年来266例剖宫产术后再次妊娠的孕妇住院分娩资料进行回顾性分析。结果阴道试产22例,阴道分娩14例,成功率为63.64%,发生先兆子宫破裂2例,占9.09%。再次剖宫产252例,占95.45%,发生不完全性子宫破裂5例,占1.98%。再次剖宫产产后出血率(6.35%)及量(≥1500ml,1.19%)均高于首次剖宫产组(5.21%,0.87%)、阴道组(3.82%,0.03%)(P〈0.05,P〈0.01)。瘢痕子宫再次妊娠前置胎盘发生率(2.65%)显著高于非瘢痕子宫再次妊娠组(0.52%)(P〈0.01)。结论单纯剖宫产史不能作为瘢痕子宫再次妊娠剖宫产的指征,符合试产条件者,严密监护下可阴道试产,以降低剖宫产率、产后出血率及前置胎盘发生率。

关 键 词:剖宫产  再次妊娠  分娩方式  产妇结局

Clinical analysis of 266 cases of repregnant women with previous cesarean section
Institution:ZHANG Xiao - lan, CHEN Xiao -yan, LIANG Jian - min, et al.( The Red Cross Hospital of Tianhe Region, Gnangzhou, Guangdong 510660, China. )
Abstract:Objective To explore the delivery mode and matemal outcome in patients with previous cesarean section. Methods The clinical data of 266 eases of repregnant women with previous cesarean section during recent 3 years in this hospital were retrospectively analyzed. Results Twenty two of them were allowed for trial vaginal delivery, it was succeeded in 14 eases with the successful rate of 63.64%. It led to 2 eases of threatened uterine rupture with the incidence rate of 9.09%. 252 cases chosed repeat cesarean section with a rate of 95.45%. and it led to 5 cases of incomplete uterine rupture with a rate of 1.98%. The blood loss and rate of postpartum hemorrhage in repeat cesarean section group (6.35% & ≥ 1500 ml, 1.19% ) were significantly increased in comparison with those of previous cesarean section group (5.21%, 0.87% ) and vaginal delivery group( 3.82% ,0.03% ) , P 〈 0.05&P 〈 0.01. The incidence of placenta previa in repregnancy after cesarean section( 2.65% ) was significantly higher than that of repregnaney group without previous cesarean section( 0.52% ), P 〈 0.01. Conclusion The history of cesarean section is not the indication for second cesarean section, we should decide trial vaginal delivery under satisfaetroy conditions, and it should be closely monitoring, thus it can decrease the rate of caesarean section, placenta previa and postpartum hemorrhage.
Keywords:Cesarean section  Repregnaney  Delivery mode  Maternal outcomes
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