163例剖宫产术后再次妊娠分娩方式的临床分析

目的:探讨剖宫产后再次妊娠分娩方式的选择。方法:收集2008年8月—2011年8月剖宫产术后再次妊娠的孕妇163例,对其分娩方式、分娩结局及母婴并发症进行回顾性分析。结果:163例病例中,51例经阴道试产,33例分娩成功,阴道分娩成功率64.7%;剖宫产术后阴道分娩与同期非瘢痕子宫阴道分娩情况相比,产程时间、产时出血量、新生儿窒息、会阴裂伤、宫颈裂伤发生情况比较差异无统计学意义(P>0.05);再次剖宫产与首次剖宫产相比,平均手术时间长、术中出血量大、腹腔粘连多、先兆子宫破裂多、甲级切口愈合率低;新生儿窒息方面比较差异无统计学意义。结论:只要掌握阴道试产的条件以及严密监护试产过程,阴道分娩是剖宫产后再次妊娠一种可选的分娩方式。

Clinical analysis on 163 cases of the mode of delivery for secondary pregnancy after cesarean section

Objective:To evaluate the mode of delivery for secondary pregnancy after cesarean section.Methods:Approaches to trospective case analyses on delivery mode,pregnant outcomes and perinatal complication for 163 gravidas who deliver successfully after their husterotomy in our hospital from August 2008 to August 2011.Results:Among the group of 163 gravidas who deliver successfully after their husterotomy,51 cases with vagina property,33 cases were succeeded in the vagina delivery trial,the rate of successful labor was 64.7%.Compared with the vaginal delivery with non cicatricial ulterus,there was no significant differences(P>0.05) in the labor time,volume of bleeding,neonatal asphyxia,incidence of perineal laceration and cervical laceration for the vaginal delivery after cesarean section.Compared to the primary cesarean section,the disadvantages of the repeated cesarean section mainly consist of the following aspects.The mean operation time was longer,the volume of bleeding was larger,the peritoneal adhesion and the threatened uterine rupture were more popular,and the first class incision healing rate was lower.But no significant differences existed in the incidences of neonatal asphyxia.Conclusion:If natural-delivery conditions is obeyed by,and under tight guardianship,the vaginal delivery is a feasible delivery mode to women who had the history of cesarean section.