瘢痕子宫再次剖宫产的相关问题

目的:探讨瘢痕子宫再次剖宫产的并发症及预防措施。方法:单胎剖宫产数为2392例,其中134例为再次剖宫产,分析这些患者的临床资料。结果:①再次剖宫产组的盆腹腔粘连率、子宫破裂率、前置胎盘率、胎盘植入率、宫缩乏力率、产后出血率分别为41.04%、8.21%、10.45%、3.73%、2.99%、2.99%,均比初次剖宫产组显著升高(前5项P<0.01,最后一项P<0.05);有2例子宫切除均为再次剖宫产者。②术后间隔时间≤2年的发生子宫破裂率明显高于间隔时间>2年的(P=0.01)。③再次剖宫产组手术开始至胎儿娩出平均时间、总手术平均时间分别比初次剖宫产组延长4.82、9.69min(P<0.01)。结论:再次剖宫产易发生盆腹腔粘连、子宫破裂、前置胎盘、胎盘植入、产后出血,使手术难度加大、手术时间延长,甚至切除子宫,故应降低剖宫产率,并积极预防并发症的发生。

The related problems of repeated cesarean section of uterus with scar

Objective:To explore the complications and preventive measures of repeated cesarean section of uterus with scar.Methods:The clinical data of 134 cases undergoing repeated cesarean section of uterus with scar were analyzed among 2 392 cases of cesarean section.Results:①The rates of peritoneal adhesion,hysterorrhexis,placenta praevia,placenta implantation,uterine inertia and postpartum hemorrhage in repeated cesarean section group were 41.04%,8.21%,10.45%,3.73%,2.99% and 2.99%,respectively,which were higher than those in the first cesarean section group (all P<0.01 except the fifth P<0.05). Hysterectomy was carried out on two cases of repeated caesarean section. ②If the interval after previous caesarean section was less than 2 years,the rate of hysterorrhexis was higher (P=0.01).③The average delivery time and total operation time in repeated cesarean section group were longer than those in the first cesarean section group (P<0.01).Conclusion:Peritoneal adhesion,hysterorrhexis,placenta praevia,placenta implantation and postpartum hemorrhage have more chance to happen in cases of repeated cesarean section,which enlarge the operation difficulty,prolong the operation time and induce hysterectomy. So it's important to decrease the rate of cesarean section and prevent the complications.