初次剖宫产对再次妊娠分娩结局的影响研究

目的:探讨初次剖宫产对再次妊娠分娩结局的影响,以期合理控制初次剖宫产率. 方法:收集2015年1月至6月在国际和平妇幼保健院正规建卡产检并分娩二胎的所有单胎孕妇资料共计1610例. 按照其初次分娩方式的不同将所有对象分为两组,一组为初次剖宫产再次妊娠分娩者,即前次剖宫产分娩组,共746例,另一组为初次阴道分娩(包括顺产及产钳助产)再次妊娠分娩者,即前次阴道分娩组共864例. 统计比较两组对象再次妊娠时的分娩方式及妊娠结局,并探讨初次分娩方式对再次妊娠的影响. 结果:前次阴道分娩组的分娩方式中,剖宫产率为11.93%,而前次剖宫产分娩组的分娩方式中,剖宫产率高达96.75%,有统计学差异( P<0.01) ,表明前次妊娠的分娩方式会很大程度上影响再次妊娠时的分娩方式选择;而前次剖宫产分娩组的产后出血率( 4. 20%)、产褥感染率( 2. 17%)、新生儿窒息率(3.66%)及胎盘前置或植入的发生率(3.79%)均高于前次阴道分娩组,且有统计差异( P<0.05). 表明疤痕子宫者再次妊娠时的并发症发生率较高,妊娠结局较差. 结论:鉴于初次剖宫产对后续妊娠分娩的不良影响,临床上亟需采取相应措施来有效控制首次剖宫产率,以改善母婴结局.

Influence of the Previous Cesarean Section on the Outcomes of Re-pregnancy

Objective:To investigate the influence of the previous cesarean section on the outcomes of the re-pregnancy so as to control the first cesarean section rate.Method:A total of 1610 cases delivered in International Peace Maternity&Child Health Hospital, who had the second child birth,from January 2015 to June 2015 were studied. According to the first mode of delivery, all subjects were divided into two groups, one group had 746 cases by primary cesarean section,called previous cesarean section delivery group, and another group had 864 cases by natural labor or forceps delivery,called previous vaginal delivery group. The second delivery mode and pregnancy outcomes of the two groups were compared, and the influence of the ini-tial delivery mode on the second pregnancy was discussed.Result:The cesarean section rate in previous vagi-nal delivery group was just 11.93%, while up to 96.75%in previous cesarean section group, there was a sta-tistically significant difference between the two groups ( P < 0.01) , indicating that the previous mode of de-livery would largely affect the next pregnancy delivery mode. And compared with previous vaginal delivery group,the previous cesarean section group had a higher postpartum bleeding rate (4.20%), a higher puer-peral infection rate(2.17%), a higher neonatal asphyxia rate (3.66%) and also a higher placenta previa or implantation rate (3.79%),and the difference has statistical significance (P<0.05). Conclusion:The result shows that the incidence of complications will be higher, and the pregnancy outcome will be worse when a woman has previous cesarean section. So measures should be taken to control the first cesarean section rate to improve the pregnancy outcome.