疤痕子宫孕妇晚期妊娠阴道分娩临床结局分析

目的探讨孕晚期疤痕子宫孕妇经阴道分娩的影响因素并分析其可行性。方法回顾性分析80例孕晚期疤痕子宫孕妇经阴道分娩的临床资料,将其分为疤痕子宫自然临产组（n=38）、疤痕子宫计划分娩组（n=42）,并设定对照组（n=50）。比较3组间的分娩结局如产后出血量、胎盘胎膜滞留率、是否存在子宫破裂、急产率及钳产率等情况。结果自然临产组有9例（23.68%）孕妇以钳产术缩短第二产程终止妊娠,而计划分娩组则有8例（19.05%）,均高于对照组3例（6.00%）,两两比较差异有统计学意义（P〈0.01）。自然临产组孕妇钳产率又稍高于计划分娩组,但两组比较差异无统计学意义（P〉0.05）。自然临产组总产程〈3h者有9人（23.68%）,急产率高于计划分娩组（2.38%）及对照组（10.00%）,差异有统计学意义（P〈0.01）。3组孕妇产后出血量、胎盘胎膜滞留率以及非计生引产胎儿评分比较,差异均无统计学意义（P〉0.05）。3组均无子宫破裂及新生儿重度窒息等不良事件发生。结论疤痕子宫并非阴道试产的绝对禁忌,产前超声检查子宫下段疤痕区域的良好连续性及低位钳产术是其阴道试产的有利因素。

Clinical analysis of vaginal birth of the third trimester in women with scarred uterus

Objective To investigate the influencing factors and feasibility of vaginal birth for women with scared uterus in the third trimester. Methods Retrospectively analyzed the clinical data of 80 cases of vaginal birth of pregnant women with scarred uterus of third trimester in the past five years. The subjects were divided into spontaneous labor group, planned delivery group, and the control group. Three groups were compared for postpartum hemorrhage, placenta or fetal membrane retention rate, the existence of uterine rupture, precipitate delivery and the forceps surgery rate. Results 9 pregnant women （23.68%） in the spontaneous labor group had their pregnancy terminated by forceps technique, and the percentage was not significantly higher than the planned delivery group （19.05%, P〉0.05）. There was only 6.00% of cases in the controlled group and the difference was statistically significant （P〈0.01）. 9 pregnant women （23.68%） in the spontaneous labor group had a total delivery time of less than 3 hours. There were only 2.38% （planned delivery group） and 10.00% of subjects （controlled group） had a total delivery time of less than 3 hours. The differences were significant （P〈0.01）. There was no significant difference （P〉0.05） between the three groups in postpartum hemorrhage, placenta and fetal membrane retention rate, and fetus Apgar score. No uterine rupture and severe neonatal asphyxia were detected. Conclusion Scarred uterus is not an absolute contraindication to vaginal birth, and good continuity of the lower segment uterine scar region in prenatal ultrasound examination as well as low forceps surgery are favorable factors for vaginal birth of the third trimester in women with scarred uterus.