瘢痕子宫再次足月妊娠阴道分娩临床分析

摘要目的：探讨瘢痕子宫再次足月妊娠阴道分娩的围生结局。方法：回顾性分析2006年9月-2011年9月瘢痕子宫再次足月妊娠阴道分娩25例产妇（观察组）的临床资料,并选择同期非瘢痕子宫足月妊娠拟经阴道分娩25例孕妇临床资料作为对照组,对比两组分娩结局及对母儿的影响等。结果：观察组阴道分娩成功20例（占80％）,对照组21例（占84％）产妇顺利分娩,两组产妇均无一例发生子宫破裂和产后感染。两组产妇产后出血量、产程时间及新生儿窒息率比较差异均无统计学意义（P〉0．05）。结论：瘢痕子宫患者再次足月妊娠选择阴道试产者,在掌握好适应证的前提下,产前积极准备,产中严密观察,产后防止出血,阴道分娩较为安全。     

剖宫产术后瘢痕子宫再次足月妊娠阴道分娩的临床效果探讨

目的:探究分析剖宫产术后瘢痕子宫再次足月妊娠产妇阴道分娩的效果.方法:从2019年3月至2021年3月本院收治的接受剖宫产术后瘢痕子宫再次足月妊娠产妇中抽选96例,根据产妇的分娩意愿分为两组.观察组55例,采取阴道分娩;对照组41例,采取剖宫产分娩,对比两组母婴分娩情况.结果:观察组产妇产时出血量、产后2h出血量、产后...     

瘢痕子宫再次足月妊娠阴道试产分析

近年来，剖宫产率的异常升高已引起社会广泛关注，有的医院剖宫产率达40％～50％，最高甚至达80％～90％以上。为了降低剖宫产率，瘢痕子宫再次妊娠分娩是一个重要问题，正受到多数人的重视。传统的一次剖宫产，次次剖宫产的观点已被临床医生所否定；本院自2004年10月至2006年10月，对67例瘢痕子宫再次妊娠孕妇，部分选择性阴道试产，现将结果如下。     

瘢痕子宫再次足月妊娠的不同分娩方式分析

目的:评价瘢痕子宫再次足月妊娠女性接受不同分娩方式的效果差异。方法:于2016年1月至2017年12月抽取40例瘢痕子宫再次足月妊娠患者作为研究对象,根据其分娩方式的不同将患者分为两组:阴道分娩组和剖宫产组,各20例。对比两组分娩方式下的产妇情况和新生儿情况。结果:阴道分娩组产妇的出血量、产后出血率、住院时间、产后感染率、产后发热、恶露过长的几率均低于剖宫产组(P<0.05);对比两组新生儿在出生后1分钟、5分钟的阿氏评分均为P>0.05,未见统计学意义。结论:瘢痕子宫再次足月妊娠产妇如果条件允许可尝试阴道分娩,整体效果更加安全。     

瘢痕子宫再次妊娠阴道分娩临床观察

目的分析瘢痕子宫再次妊娠阴道分娩的效果。方法从收治的瘢痕子宫再次妊娠产妇中抽取110例,按随机数字表法分成对照组和观察组。观察组56例经阴道分娩,对照组54例行剖宫产,比较两组妊娠结局。结果观察组分娩时间、住院时间短于对照组,新生儿Apgar评分评分、生活质量评分高于对照组,差异显著(P<0.05);观察组并发症发生率为5.4%,比对照组的18.5%低,差异显著(P<0.05)。结论对瘢痕子宫再次妊娠产妇实施阴道分娩,能减少出血量,降低并发症发生率,缩短住院时间。     

瘢痕子宫再次妊娠阴道分娩临床效果及安全性分析

目的探讨瘢痕子宫再次妊娠行阴道分娩的临床效果及安全性。方法回顾性分析180例瘢痕子宫再次妊娠行阴道分娩及剖宫产产妇临床资料,选取50例非瘢痕妊娠阴道分娩者为对照组。结果阴道分娩组与对照组新生儿体质量、住院时间、产后出血量及住院费用显著少于剖宫产组(P<0.01);3组新生儿窒息率及Apger评分无显著差异(P>0.05)。结论对于有阴道分娩适应证的瘢痕子宫再次妊娠产妇,阴道分娩疗效优于剖宫产。     

瘢痕子宫再次妊娠阴道分娩临床效果与安全性

收集86例瘢痕子宫再次妊娠产妇的临床资料,将患者随机分为研究组与对照组,各43例,研究组采用阴道分娩试产,对照组给予剖宫产。研究组产妇成功阴道分娩37例,成功率为86.05%;两组产妇的新生儿Apgar评分之间无明显差异性,无统计学意义(P0.05);研究组产妇的出血量、住院时间以及产后并发症发生率均明显优于对照组,差异显著,有统计学意义(P0.05)。在严密监护和及时采取处理措施的情况下,瘢痕子宫再次妊娠产妇采用阴道试产是可行的,且安全性比较高。     

探讨剖宫产术后瘢痕子宫再次足月妊娠进行阴道分娩的可行性

目的:探讨剖宫产术后瘢痕子宫再次足月妊娠进行阴道分娩的可行性。方法:选取本院2015年1月至2018年1月接收的100例剖宫产术后瘢痕子宫再次足月妊娠产妇作为临床研究对象,按照产妇是否自愿接受阴道试产将之分成阴道分娩组和剖宫产组,另选取本院同期接收的50例非瘢痕子宫足月妊娠阴道分娩产妇作为非瘢痕子宫组,对三组产妇的产程时间、新生儿情况、产后24h出血量、住院天数以及产褥感染情况等进行观察和对比。结果:100例剖宫产术后瘢痕子宫再次足月妊娠产妇中自愿接受阴道试产的有71例,其中53例阴道分娩成功(阴道分娩成功率74.65%),18例阴道分娩失败后转为剖宫产,列入剖宫产组,最终阴道分娩组有53例、剖宫产组有47例,非瘢痕子宫组有50例。阴道分娩组的产程时间、新生儿Apgar评分、产后24h出血量、住院天数以及产褥感染率等均显著优于剖宫产组,差异具有统计学意义(P<0.05);与非瘢痕子宫组比较均无显著差异(P>0.05)。结论:剖宫产术后瘢痕子宫再次足月妊娠阴道分娩能够有效缩短产程、提高新生儿结局、减少产后出血量、缩短住院时间以及降低产褥感染率,所以应在适宜的情况下尽量给予产妇阴道试产机会。     

瘢痕子宫足月妊娠合并子宫肌瘤孕妇阴道分娩的效果及安全性

目的 分析瘢痕子宫足月妊娠合并子宫肌瘤孕妇阴道分娩的临床效果和安全性.方法 选择2017年12月至2019年12月随机抽取56例瘢痕子宫足月妊娠合并子宫肌瘤孕产妇作为此次研究对象,用随机数字表法分组,每组各28例.对照组予以剖宫产,28例观察组予以阴道分娩,比较两种分娩方式的效果和安全性.结果 (1)观察组并发症发生率为3.57％,对照组并发症发生率21.43％,组间数据经比较差异有统计学意义(P＜0.05).(2)观察组分娩过程中和分娩后24小时出血量均少于对照组,组间数据经比较差异有统计学意义(P＜0.05).(3)观察组和对照组Apgar评分经过软件对比可知,差异无统计学意义(P＞0.05);观察组恢复时间显著缩短,和对照组相比差异有统计学意义(P＜0.05).结论 对于瘢痕子宫足月妊娠合并子宫肌瘤孕妇而言选择阴道分娩效果良好,具有一定的安全性,临床应依据产妇的实际情况选择合适的分娩方法.     

瘢痕子宫再次妊娠阴道分娩临床探讨

目的探讨瘢痕子宫再次足月妊娠阴道分娩的可行性,降低剖宫产率。方法选取我院2010-01—2012-12适合经阴道分娩的剖宫产术后(瘢痕子宫)再次妊娠孕妇90例作为观察组,同时随机抽取同期90例非瘢痕子宫孕妇阴道试产情况进行回顾性分析。比较两组阴道试产分娩结局及产时出血量、产程时间、新生儿情况。结果瘢痕子宫产妇阴道试产90例,试产成功71例,成功率79%;两组产妇的分娩结局及产后出血量、产程时间、新生儿情况比较差异无统计学意义(P均>0.05)。结论瘢痕子宫并非再次剖宫产的绝对指征,凡符合试产条件者,在严密监测下阴道试产效果良好,安全可行。     

剖宫产再次妊娠阴道分娩的影响因素分析

目的 探讨剖宫产再次妊娠产妇阴道分娩的影响因素。方 法采用病例对照研究方法,选择39例阴道分娩成功的产妇作为病例组,按1:2的比例选择78例失败病案为对照组,经单因素和多因素Logistic回归分析比较两组间12项影响因素的差异。结果单因素分析显示两组在前次剖宫产手术指征、产前BMI、年龄、前次剖宫产术后发热、新生儿体质量、妊娠合并症和子宫下段厚度方面具有统计学差异（P＜0.05）;多因素Logistic回归分析显示两组在产前BMI、年龄、新生儿体质量、妊娠合并症及子宫下段厚度方面具有统计学差异（P＜0.05）。结论临床工作中可按照产前BMI、年龄、新生儿体质量、妊娠合并症及子宫下段厚度对产妇进行筛选,确保产妇及婴儿的安全。     

剖宫产术后再次妊娠阴道分娩的社会因素质性研究

目的分析影响剖宫产术后再次妊娠阴道分娩的社会因素,为制定提高剖宫产术后阴道分娩率的策略提供依据。方法通过现象学研究方法对15名产科医务人员(7名医生、8名助产士)、7例成功进行剖宫产术后阴道分娩的妇女进行深度访谈,用Colaizzi内容分析法进行资料分析。结果通过对资料的整理和分析,提炼出认知因素、医疗资源、孕产期管理3个主题。结论剖宫产术后再次妊娠阴道分娩受多种社会因素的影响,应从多方面同步调整以提高剖宫产术后阴道分娩率。     

Vaginal birth after Caesarean risk decision‐making: Australian findings on the mothers' perspective

McGrath P, Phillips E, Vaughan G. International Journal of Nursing Practice 2010; 16 : 274–281
Vaginal birth after Caesarean risk decision‐making: Australian findings on the mothers' perspective The purpose of this paper is to explore, from the mothers' perspective, the decision‐making experience with regard to subsequent birth choice for women who had previously delivered by Caesarean section. A qualitative methodological approach was taken to the exploration of mothers' knowledge of the risks of vaginal birth after Caesarean (VBAC) or elective Caesarean following a prior birth by Caesarean section. This paper presents the insights provided by the four women who chose VBAC. The health professionals' attitude to birth, and thus the support they offer to mothers, is predominantly pro‐Caesarean. In view of the declining numbers of VBACs and the fact that the clinical literature documents risks for both elective Caesarean and VBAC, it is important for health professionals to be very sensitive and balanced in the information and support offered for the VBAC birth option.     

Reframing birth: a consequence of cesarean section

AIM: This paper is a report of a study to describe the childbirth expectations, influences and knowledge of a group of Western Australian women who experienced a cesarean section (CS) and would prefer a CS in a subsequent pregnancy. BACKGROUND: Evidence suggests that a previous CS is not an indication for an elective CS in a subsequent pregnancy, but western world data indicate high probability of repeat CS. METHODS: Community advertisements invited women who had experienced a CS to participate in a telephone interview. The thematic analysis presented in this paper is derived from data collected during 2003/2004 from 49 participants who had initially expected to birth vaginal but had a CS and who had planned a CS in a subsequent pregnancy or stated that they would choose this option in a future pregnancy. FINDINGS: Before the first CS most women expected and wanted to give birth normally. After having a CS, however, many reframed vaginal birth as uncertain, unsafe and unachievable. For this group of women, the medical discourse that promoted CS as the safest option was a major influence on their decisions. As a result, they reconstructed CS as an acceptable alternative that was safer for them and their babies, allowed them to be better prepared, and was convenient. CONCLUSION: In the present climate, enabling women to keep birth 'fear' in perspective may be an important strategy if we are to improve the uptake of vaginal birth after CS and the quality of care offered to women during the normal, but major, life event of childbirth.     

非脱垂子宫经阴道全子宫切除术探讨

目的 探讨非脱垂子宫经阴道全子宫切除术的临床效果.方法 将100例行子宫全切术的子宫及宫颈良性病变患者按随机数字表法分为2组,每组50例.TVH组采用经阴道全子宫切除术(TVH)治疗,TAH组采用经腹全子宫切除术(TAH)治疗,对2组术中、术后的情况进行比较.结果 TVH组的手术时间和术中出血量分别为(90.0±19.5)min和(162.8±69.5)Ml,TAH组的手术时间及术中出血量分别为(122.4±19.6)min和(245.5±70.6)Ml,2组手术时间和术中出血量比较差异均有统计学意义(均P＜0.01).TVH组术后进食、排气、下床活动时间早,术后病率小、疼痛轻、住院时间短,明显优于TAH组(P＜0.05或P＜0.01).结论 TVH具有创伤小、术后恢复快、住院时间短的优点,是一种理想的子宫切除手术.     

瘢痕子宫再次剖宫产时前置胎盘风险的评估

目的 探讨瘢痕子宫再次妊娠伴有前置胎盘再次行剖宫产的并发症及其防治.方法 收集分析2006年1月至2010年4月在我院行单胎再次剖宫产337例患者的临床资料,其中伴有前置胎盘者26例,同期单胎初次剖宫产6832例,其中伴有前置胎盘者201例.结果 瘢痕子宫再次妊娠的前置胎盘发生率为7.72%(26/337),明显高于初次剖宫产组的2.94%(201/6832),差异有统计学意义(x2=22.33,P＜0.01);且更易并发中央性前置胎盘(42.30%与0.00%,x2=0.43,P＜0.01).瘢痕子宫伴前置胎盘再次剖宫产组的子宫破裂率、胎盘植入率、产后出血率、子宫切除率分别为26.92%(7/26)、23.08%(6/26)、26.92%(7/26)、7.69%(2/26),而瘢痕子宫不伴前置胎盘组的以上发生率分别为2.57%(8/311)、0.32%(1/311)、1.29%(4/311)、0.00%(0/311),差异有统计学意义(x2值分别为27.97、50.41、42.16、12.79,P均＜0.01).结论 瘢痕子宫再次妊娠时前置胎盘发生率增加,且中央性比例增高,瘢痕子宫伴前置胎盘更易发生子宫破裂、胎盘植入、产后出血,甚至切除子宫,故降低剖宫产率、降低风险、提高产科质量非常重要.

Abstract：

Objective To explore the complications and the treatments of repeated cesarean delivery in scar uterus pregnancy accompanied by the placenta praevia. Methods We performed a retrospective study in 6832 cases underwent first cesarean delivery,within which 201 cases were accompanied by the placenta praevia;and 337 cases underwent repeated cesarean deliver, within which 26 cases were accompanied by the placenta praevia. All subjects accepted cesarean delivery from January2006 toApril 2010 in our hospital. Results The occurrence rate of placenta previa was significantly higher in the repeated cesarean delivery than first-ever cesarean delivery (7. 72% vs 2. 94%, x2 = 22. 33, P ＜ 0. 01 ) , especially the occurrence of complete placenta previa (42. 30% vs 0. 00%, x2 = 80. 43, P ＜ 0. 01 ). The rates of uterus rupture, placenta accreta, postpartum hemorrhage and hysterectomy (r = 26. 92% ,23.08% ,26. 92% and 7. 69%, respectively) in repeated cesarean delivery in scar uterus pregnancy accompanied by the placenta praevia were significantly higher than those of the cases ( r = 2. 57% ,0. 32%, 1.29% and 0. 00%, respectively ) had repeated cesarean delivery in scar uterus pregnancy but no placenta previa ( x2 = 27.97,50. 41,42. 16,12. 79, respectively, Ps ＜ 0. 01 ). Conclusion The incidence of placenta previa increased in scar uterus pregnancy, especially the complete placental previa.Scar uterus pregnancy accompanied by the placenta praevia are more likely to occur uterus rupture,placenta accreta,postpartum hemorrhage and had hysterectomy. Obstetricians should give more effort to reduce the cesarean section rate,improve the quality of medical care.