剖宫产后再次妊娠产科处理方式的探究

目的探讨剖宫产术后再次妊娠的适宜产科处理方式。方法对民航总医院妇产科2005年至2008年收治的237例剖宫产术后再次妊娠分娩患者的临床资料进行回顾性分析。对选择再次剖宫产与急诊再次剖宫产、再次剖宫产与阴道分娩患者的相关情况进行比较。结果237例剖宫产术后再次妊娠分娩者中有158例阴道试产,其中121例阴道分娩,试产成功率为76.6%(121/158),行急诊再次剖宫产者37例;选择再次剖宫产者79例。比较选择再次剖宫产患者与急诊再次剖宫产患者产后出血量、手术时间、术中子宫切口延裂、术后感染、产褥病率和新生儿窒息的差异均无统计学意义(P>0.05)。再次剖宫产患者与阴道分娩患者相比,产后出血量、产后出血、术后感染、产褥病率和住院天数的差异均有统计学意义(P<0.05)。2组患者分娩的新生儿窒息率差异无统计学意义。结论对剖宫产术后再次妊娠者应作详尽的产前检查、良好的医患沟通,并应严格掌握再次剖宫产指征、选择适宜分娩方式。剖宫产术后再次妊娠选择阴道试产利多弊少,试产并不增加再次剖宫产手术的难度及风险。初次剖宫产后子宫切口的愈合情况影响再次妊娠的安全性。距前次剖宫产≥2年可以不作为阴道试产的必需条件。

Studies on the Appropriate Obstetric Managment of Secondary Pregnancy after Cesarean Section

Objective To investigate the appropriate obstetric managment of secondary pregnancy after cesarean section. Methods A total of 237 cases with secondary pregnancy after cesarean section from 2005 to 2008 were retrospectively studied. The relevant circumstances of two forms that made up two categories in each form selective re-cesarean section and emergency re-cesarean section; re-cesarean section and vaginal labor had been cautiously compared. Results In 237 labors of secondary pregnancy after cesarean section, there were 158 cases of attempted vaginal labor and 121 cases of vaginal delivery. Hence, the successful rate of attempted vaginal labor was 76.6%(121/158). There were 79 cases with selective re-cesarean section. In emergency re-cesarean section, 31 cases had unrestrictive indication, while was 39.2%(31/79). Consequently it can be said that selective re-cesarean section is strongly related to the psychological elements of the patients and their families. Comparing with volume of delivery blood loss, operation time, dehiscence of uterus incision during operation, postpartum infection, rate of puerperalism and neonatal apnea, there was no significant difference between selective re-cesarean section and emergency re-cesarean section. However, volume of delivery blood loss, postpartum hemorrhage, postpartum infection, rate of puerperalism and days of hospitalization between re-cesarean section and vaginal labor showed significant differences(P<0.05). Conversely, there was no significant difference of neonatal apnea in these two categories(P>0.05). Conclusion It is very important to choose an appropriate labor managment of secondary pregnancy after cesarean section, including meticulous prenatal checkups, good doctor-patient communications, strict handing of restrictive re-cesarean section indications scientifically choosing labor managment and proficient obstetric skills. Attempted vaginal labor in secondary pregnancy after cesarean section is more profitable. Labor trials would not add difficulties and risks in re-cesarean section. The operative skills of primary cesarean section directly affect healing of uterus incision and directly relate to the safety of re-cesarean section. It is not essential to have more than two years apart from the previous cesarean section.