剖宫产术后再次妊娠120例分娩方式的探讨

目的：对剖宫产术后再次妊娠的分娩方式进行探讨。方法：回顾性分析120例剖宫产术后患者再次妊娠的分娩方式及分娩结局,并对其中剖宫产术后阴道分娩21例（观察组）与同期非瘢痕子宫阴道分娩21例（对照组）进行对照分析,再次剖宫产（RCS）99例与随机抽取同期首次剖宫产（PCS）99例进行对照分析。结果：120例产妇中27例阴道试产,21例试产成功,成功率为77.78%（21/27）。RCS99例的手术产率为82.50%（99/120）。观察组（VBAC）新生儿窒息率、产后出血、先兆子宫破裂发生率与对照组比较,差异无统计学意义（P〉0.05）。对照组较观察组产后出血量多,平均住院天数比观察组长,医疗费用高,两组比较,差异有高度统计学意义（P〈0.01）。结论：剖宫产术后再次妊娠分娩并非是剖宫产的绝对指征,如无产科指征,应予以试产,阴道试产可以减少再次开腹给患者带来的各种危险和并发症,可减少患者手术痛苦和经济负担,所以,无试产禁忌者可在严密监护下阴道试产,临床医生应大力推广。

Investigation of the delivery pattern of secondary pregnancy after cesarean section in 120 cases

Objective：To investigate the delivery pattern on vaginal birth after cesarean section.Methods：120 cases of the way of delivery on vaginal birth after cesarean,pregnancy and delivery outcomes were analyzed retrospectively.Vaginal delivery after cesarean section and of which 21 cases of uterine scar with the same period in non-vaginal delivery in 21 cases were analyzed and compared,again cesarean section（RCS） 99 cases and the randomly selected from the same period in the first cesarean section（PCS） 99 cases were regulated by control analysis.Results：27 cases of vaginal trial production,21 cases of successful trial production,the success rate of 77.78%（21/27）.RCS 99 cases of surgical yield of 82.50%（99/120）.The observation group（VBAC） rate of neonatal asphyxia,postpartum hemorrhage,the incidence of threatened uterine rupture compared with the control group,no statistically significant difference（P〉0.05）.The control group had a high level of postpartum hemorrhage than that in the observation group,the average number of hospitalization days than the observation of team leader,high medical bills,the difference was statistically significant（P〈0.01）.Conclusion：The way of delivery on vaginal birth after cesarean is not an absolute indications for cesarean section,in the absence of obstetric indications,should be trial production,the vagina can reduce the pilot re-laparotomy for patients and the various risks and complications,it can reduce suffering and economic burden of patients with surgery,therefore,no contraindication for trial production in the vaginal trial production under intensive care,it＇s worthy of promotion.