197例瘢痕子宫分娩方式及围生结局分析

目的：探讨瘢痕子宫再次妊娠分娩方式的选择及围生结局。方法：对我院2014年9月—2015年4月就诊的197例瘢痕子宫分娩的产妇及新生儿结局等因素进行分析。结果：①197例瘢痕子宫的产妇中147例剖宫产分娩（剖宫产率为74.62%），其中选择性重复剖宫产（elective repeat cesarean delivery，ERCD）129例；68例剖宫产术后再次妊娠阴道试产（trial of labor after previous cesarean delivery，TOLAC），其中成功经阴道分娩（vaginal birth after cesarean delivery，VBAC）50例，成功率73.53%。②ERCD组手术指征：患者意愿41例（31.78%），巨大儿21例（16.28%），高龄9例（6.98%），漏斗骨盆9例（6.98%），中央型前置胎盘6例（4.65%），其他因素43例（33.33%）。③VBAC组胎儿估计体质量较小、产后出血量多、骨盆出口直径宽、宫颈评分高、住院天数少、新生儿转儿科率高，与ERCD组比较差异有统计学意义（均P＜0.05）。④比较VBAC与TOLAC失败转剖宫产2组，此次分娩距上次剖宫产时间VBAC组较短，自然临产率稍高，但2组差异无统计学意义（均P＞0.05）；2组患者的年龄、孕周、产后出血率、新生儿体质量及转儿科率差异均无统计学意义（均P＞0.05）。⑤VBAC组第一产程（6.37±2.12）h，第二产程（26.95±15.00）min，第三产程（5.17±1.41）min，均在正常产程范围内。结论：严格选择适应证，充分的沟通，产程中严密的监测和做好手术准备，瘢痕子宫产妇阴道试产是可行且安全的，自然临产及宫颈评分高的患者更容易阴道分娩成功，且产程是正常的。

Delivery Mode and Perinatal Outcome of 197 Pregnancies after a Prior Cesarean Section

Objective: To observe the delivery mode and the perinatal outcome of pregnancies after a prior cesarean section. Methods：The clinical data of 197 pregnancies after a prior cesarean section between September 2014 and April 2015 in our Hospital were retrospectively analyzed. Results：①In 197 cases, 147 cases had the second cesarean section（the rate of cesarean section was 74.62%）, in which 129 cases had the selected elective repeat cesarean delivery（ERCD）. 68 cases had the trial of labor after previous cesarean delivery（TOLAC）, in which 50 cases had successfully the vaginal birth after cesarean delivery （ＶＢＡＣ）, the success rate of vaginal delivery was 73.53%. ②Surgical indications of ERCD included: maternal request after a prior cesarean section was the most common indication （31.78%, 41/129）, followed by macrosomia （16.28%, 21/129）, maternal advanced age （6.98%, 9/129）, funnel pelvis （6.98%, 9/129）, central placenta previa （4.65%, 6/129） and others（43/129, 33.33%）. ③There were smaller estimated fetal weight, more bleeding, wider pelvic outlet, higer B ship score, fewer inhospital days and higer turn pediatrics rate in the VBAC group, when compared with the ERCD group（P＜0.05）. ④There were more spontaneous labor and shorter interval between the first and subsequent delivery in the VBAC group when compared with the group that TOLAC cases who had unsuccessful vaginal birth and then changed to the emergency cesarean section (although P＞0.05). The differences of maternal age, pregnancy week, postpartum hemorrhage, NICU admission and birth weight between two above groups were not significant（P＞0.05）. ⑤The times of three delivery stages were normal in women who had a successful TOLAC: the first stage （6.37±2.12） hours, the second stage（26.95±15.00） minutes, the third stage（5.17±1.41） minutes. Conclusions：It is feasible for those pregnant women with the history of cesarean section to try vaginal delivery, with the strict indications, the informed consent, the meticulously monitoring labor and the full preparation for operation.