584例剖宫产后再次妊娠分娩孕妇的产科处理方式探讨

目的:探讨剖宫产术后再次妊娠的适宜产科处理方式.方法:对我科2006年1月至2010年12月期间收治孕妇584例剖宫产后再次妊娠分娩孕妇的临床资料进行回顾性分析,并对以瘢痕子宫为剖宫产指征的再次剖宫产(RCS)孕妇与随机抽取的同期非瘢痕子宫阴道分娩(VBNC)孕妇及剖宫产后阴道分娩(VBAC)孕妇的相关资料进行比较.结果:584例剖宫产后再次妊娠,阴道试产102例,其中有阴道分娩史者61例,成功阴道分娩56例,没有阴道分娩史孕妇41例,成功阴道分娩31例,再次剖宫产497例.RCS者产时出血量以及住院天数较VBNC及VBAC者明显增加,差异有统计学意义(P＜0.05)；VBNC与VBAC者的产时出血量及住院天数的差异无统计学意义(P＞0.05).子宫破裂0例、先兆子宫破裂2例,羊水污染3例,继发性子宫收缩乏力2例,胎儿功能窘迫1例,产钳助产11例.结论:过分强调子宫破裂的问题而选择再次剖宫产是不必要的,符合试产指征者在严密监护下进行阴道试产是安全的,提高阴道分娩质量,严格掌握剖宫产指征,可降低剖宫产率.

Study on the Appropriate Obstetric Management of 584 Cases Secondary Pregnancy after Cesarean Section

Objective: To investigate the appropriate obstetric managment of secondary pregnancy after cesarean section. Method:A total of 584 cases with secondary pregnancy after cesarean section from Jan.2006 to Dec.2010 were retrospectively studied.The relevant circumstances of two forms that made up two categories in each form selective re-cesarean section;re-cesarean section and vaginal labor had been cautiously compared. Result: In 584 labors of secondary pregnancy after cesarean section,there were 102 cases of attemped vaginal labor which 61 cases had vaginal labor history and 41 cases had no vaginal labor history,there were 31 cases of vaginal labor successfully,and there were 497 cases with selective re-cesarean section.Volume of delivery blood loss and days of hospitalization between re-cesarean section and vaginal delivery of non-uterine scar and secondary pregnancy after cesarean section(P﹤0.05);Conversely,there was no significant differences in volume of delivery blood loss and days of hospitalization between vaginal delivery of non-uterine scar and secondary pregnancy after cesarean section(P﹥0.05).There wes no uterine rupture,2 cases of threatened uterine rupture,3 cases of amniotic fluid pollution,2 cases of secondary uterine inertia,1 case of fetal distress,11 cases of forceps delivery. Conclusion:Too much emphasis on the problem of uterine rupture and choose re-cesarean section is unnecessary.Attempted vaginal labor in line with indications after cesarean section is safe.Improving the quality of vaginal labor and strict handing of restictive re-casarean section indications can reduce the cesarean rate.