疤痕子宫间隔1年内妊娠再次足月剖宫产102例分析

目的:探讨剖宫产后1年内妊娠再次足月剖宫产的安全性。方法:收集近3年深圳市福田区妇幼保健院及深圳福永人民医院收治的剖宫产术后1年内妊娠至足月的102例孕妇(研究组)及剖宫产术后2~3年妊娠至足月的100例孕妇(对照组)。分析孕妇再次妊娠距前次剖宫产的时间、再次妊娠的原因及此次妊娠的结局。结果:剖宫产术后1年内妊娠者多为4~11个月后妊娠,其终止妊娠方式均为剖宫产,其再次妊娠原因主要为未哺乳或母乳喂养少于4个月,未避孕或避孕失败;子宫下段厚度平均为(0.61±0.28)cm,与对照组(0.53±0.24cm)比较,差异有统计学意义(P0.05)。研究组患者中盆腔粘连16例、前置胎盘5例、胎盘黏连3例、胎盘植入1例、产后出血6例、隐性子宫破裂2例,与对照组比较(分别为15例、1例、0例、0例、4例、0例),差异无统计学意义(P0.05);两组的新生儿结局比较,差异无统计学意义(P0.05)。结论:剖宫产术1年内妊娠并维持至足月,并未增加新生儿风险,但其安全性需高度重视。对剖宫产产妇,需在产褥期做好宣教,指导避孕,最好于术后2年再孕,若短期内已妊娠者,应密切观察及时予以适当的产科处理。

Analysis of 102 cases of repeat cesarean section within one year to previous.

Objective：To explore the safety for pregnant women in one year after cesar- ean section and cesarean section again. Method： 102 patients with term of pregnancy who ac- cepted cesarean section for less than 1 year and 200 cases with pregnancy after cesarean section 2 to 3 years were collected from recent 3 years from our hospital and Fuyong hospital. We ana- lyze its subsequent pregnancy from the time of previous cesarean section, pregnant reasons and the pregnant outcomes. Result： The time of these women was about 4 to 11 months after cesare- an section. The way of termination of pregnancy was cesarean section. Reasons of repeat preg- nancy due to not breastfeeding,less than 4 months breastfeeding, not contraception or contracep- tive failure, lower uterine segment thickness [ （0.61-＋0.28 ）cm ] compare to that in control group [ （0.53 - 0.24cm ） ] was significant difference （ P 〈 0.05 ）. Pelvic adhesions ; placenta previa, placenta accrete,postpartum hemorrhage,and uterine rupture in group A as 16,5,3,1,6 and 2 cases respectively was no significant difference compare to that in control group（ 15,1,0,0,4, and 0 cases respectively） （P〉0.05）. Their neonatal outcome were no significant differences（P 〉0.05 ）. Conclusion： Cesarean section within one year of pregnancy and maintain to term does not increase neonatal risk, but the safety need to be pay most attention. Women in puerperium need to a good guidance for contraception after cesarean section. It＇had best pregnant more than 2 years after cesarean section. Shot term pregnancy should be closely observed and to provide appropriate obstetric management in a timely manner.