瘢痕子宫再次妊娠阴道分娩的临床分析

目的 分析瘢痕子宫再次妊娠经阴道分娩的产程特点及母婴结局。方法 分析2019年3月1日至2020年2月29日在泰州市人民医院产科收治的瘢痕子宫再次妊娠后孕足月经阴道分娩者30例（瘢痕子宫组），并收集同期孕足月自然临产经阴道分娩的初产妇30例（初产组）及经产妇30例（经产组），比较分析三组产妇的产程特点、新生儿结局及产后出血情况。结果 瘢痕子宫组分娩成功率90%（27/30）。瘢痕子宫组的第一产程、第二产程均短于初产组（P<0.05）且均长于经产组（P<0.05）；而第三产程、新生儿出生体重、Apgar 1 min评分、产妇产后住院时间方面，三组均无显著差异（P>0.05）；瘢痕子宫组的产后2 h、24 h出血量，多于初产组及经产组，差异均有显著性（P<0.05）；经产组产后2 h出血量多于初产组（P<0.05），而两组产后24 h出血量无明显差异（P>0.05）。结论 瘢痕子宫再次妊娠经阴道分娩具有一定的安全性和可行性，需严格把握试产标准，产程中须严密监测，并做好产后出血的预防处理措施。

Clinical analysis of vaginal birth after cesarean section

Objective To analyze the characteristics of labor process and maternal and infant outcome of vaginal birth after cesarean section. Methods A retrospective study was performed on the clinical data of 30 pregnant women, who underwent trial of labor after cesarean section (TOLAC) at Taizhou People''s Hospital from March 1, 2019 to February 29, 2020. In addition, 30 cases of primiparae and 30 cases of multiparae, who had full-term pregnancy and vaginal delivery during the same period, were randomly selected. The parturient features, neonatal outcome and postpartum hemorrhage were compared among the three groups. Results The delivery success rate of scarred uterine group was 90% (27/30). The first and second stages of labor in scarred uterine group were shorter than those in primiparous group(P<0.05)and longer than those in multiparous group (P<0.05). There were no significant differences among the three groups in the third stage of labor, newborn birth weight, Apgar score and postpartum hospital stay (P>0.05). The blood loss at 2 h and 24 h postpartum in scarred uterine group was more than that in primiparous group and multiparous group with significant differences (P<0.05). The postpartum hemorrhage at 2 h in multiparous group was more than that in primiparous group (P<0.05), however, there was no significant difference in the blood loss at 24 h postpartum between the two groups (P>0.05). Conclusions It is safe and feasible for trial of labor after cesarean section (TOLAC). It is necessary to strictly control the conditions of trial production, strictly monitor during the process of delivery, and take preventive measures for postpartum hemorrhage.