瘢痕子宫再次妊娠不同分娩方式近远期并发症比较

目的:探讨瘢痕子宫再次妊娠不同分娩方式的近远期并发症。方法:选择2002年2月至2017年12月苏州大学附属第一医院妇产科收治的瘢痕子宫孕妇2617例,其中择期再次剖宫产2246例(ERCD组),阴道试产成功334例(VBAC组),阴道试产失败转急诊剖宫产37例(TOLAC失败组)。对3组患者的妊娠结局及产后近远期并发症进行比较分析。结果:3组患者中,TOLAC失败组剖宫产患者并发症发生率最高(18. 92%),其次是ERCD组患者(6. 99%),而VBAC组患者并发症发生率最低(3. 29%)。VBAC组出现输血、产后发热和尿潴留的比例明显低于ERCD组(分别为0 vs 1. 65%、1. 20%vs 4. 14%、0. 30%vs 2. 98%,P <0. 05);发生子宫破裂、输血、尿潴留、肠梗阻的比例低于TOLAC失败组(分别为0 vs 10. 81%、0 vs 8. 11%、0. 30%vs 5. 41%、0 vs 5. 41%,P <0. 05); TOLAC失败组发生子宫破裂、输血、肠梗阻的比例显著高于ERCD组(分别为10. 81%vs 0. 31%、8....

Comparison of Short-term and Long-term Complications of Different Delivery Modes after Prior Cesarean Section

Objective:To study the short-term and long-term complications of different delivery modes after prior cesarean section.Methods:2617 pregnant women with scar uterus were enrolled in obstetrics department in the First Hospital of Soochow University from February 2002 to December 2017,among them 2246 cases with elective repeated cesarean section(ERCD group),334 cases with successful trial of vaginal birth(VBAC group),and 37 cases with emergent cesarean section because failure of vaginal birth(TOLAC failure group).The pregnant outcomes,short-term and long-term complications after delivery were compared in three groups.Results:Among three groups,the highest rate of complication was in TOLAC failure group(18.92%),then was in ERCD group(6.99%),the lowest was in VBAC group(3.29%).The proportion of blood transfusion,puerperal fever and urinary retention in VBAC group was significantly lower than that in ERCD group(0 vs.1.65%,1.20%vs.4.14%,0.30%vs.2.98%respectively,P<0.05).The incidence of uterine rupture,blood transfusion,urinary retention and intestinal obstruction in VBAC group was lower than that in TOLAC failure group(0 vs.10.81%,0 vs.8.11%,0.30%vs.5.41%,0 vs.5.41%respectively,P<0.05).The proportion of uterine rupture,blood transfusion and intestinal obstruction in TOLAC failure group was significantly higher than that in ERCD group(10.81%vs.0.31%、8.11%vs.1.65%、5.41%vs.0.40%,respectively,P<0.05).The incidence of lumbago,intestinal adhesions,anemia and endometriosis at incision site in VBAC group was significantly lower than that in ERCD group(0 vs.5.25%、0 vs.4.69%、2.80%vs.7.93%、0 vs.3.91%,respectively,P<0.05).There was no severe neonatal asphyxia in three groups.The incidence of mild neonatal asphyxia in TOLAC failure group(8.11%)was significantly higher than that in ERCD group(1.02%)and VBAC group(1.20%)(P<0.05).The Apgar scores in TOLAC failure group at 1 minute and 5 minutes were lower than those in ERCD group and VBAC group(1 min9.43±1.65,9.92±0.38 and 9.96±0.39;5 min 9.64±1.34,9.98±0.28 and 9.99±0.10).There was statistically significant difference(P<0.05).The follow-up showed that brain injury occurred in 1 newborn with mild asphyxia and poor prognosis in TOLAC failure group.Conclusions:Patients with successfully trial of labor after prior cesarean section have the lowest complications,the second was selective re-cesarean section,but those who failed in trial of vaginal labor and transferred to emergency operation have the highest rate of complications of mother and newborn.Patients with scar uterus can try to vaginal birth under strict supervision when conditions permit,but it is necessary to pay attention to those patients who failed trial of labor in order to improve the outcome of mother and newborn.