剖宫产术后再次妊娠分娩方式的探讨

目的:探讨剖宫产术后再次妊娠合理的分娩方式,以期降低再次剖宫产率.方法:收集我院产科2007 ～ 2010年收治的342例剖宫产术后再次妊娠孕妇的临床资料进行回顾性分析,根据妊娠合并的高危因素(胎盘位置异常或子宫切口异常等),分为“高危”瘢痕子宫妊娠组和“普通”瘢痕子宫妊娠组,同时将“普通”瘢痕子宫妊娠组孕妇按照分娩方式分为经阴道分娩组(VBAC组)和再次剖宫产组(RCS组),并对两组的分娩结局、母婴并发症及医疗费用等进行分析.结果:342例孕妇中,“高危”瘢痕子宫妊娠组86例,“普通”瘢痕子宫妊娠组256例,其中VBAC组12例,RCS组244例.RCS组中因社会因素手术者117例,占47.95％；VBAC组孕妇平均出血量、住院时间和住院费用均低于RCS组(P＜0.05).RCS组新生儿因RDS转NICU的发生率、NICU住院时间和平均住院费用均高于VBAC组(P＜0.05).结论:对剖宫产术后再次妊娠者孕期应行详尽检查,筛选出胎盘位置异常或子宫切口异常等“高危”瘢痕子宫妊娠孕妇；其余应合理选择阴道试产,降低因社会因素导致的再次剖宫产率.

Delivery Mode of Repeated Pregnancy after Cesarean Section

Objective:To investigate the appropriate delivery mode of repeated pregnancy after cesarean section,and decrease the rate of the second operation.Methods:342 Patients pregnancy again after cesarean section from 2007 to 2010,were retrospectively analyzed.All patients were divided to 2 groups:the high-risk and low-risk group according to the high-risk factors(abnormal site of placenta or cesarean scar abnormal et al);and low-risk group were divided to vaginal birth after caesarean(VBAC)and re-cesarean section(RCS)group.Results:Among 342 patients,86 cases were in high-risk group and 256 cases were in low-risk group,12 cases were in VBAC group and 244 cases were in RCS group In RCS group,117 cases underwent cesarean section because of social factors,accounting for 47.95%.The VBAC group has less blood loss,days and costs of hospitalization compared with the RCS group(P<0.05).Meanwhile,the NICU transfer rate because of RDS,time in NICU and average costs of hospitalization in RCS group was higher than that in VBAC group(P<0.05).Conclusions:Pregnancy after cesarean section should be examed carefully,and screen out the high risk factors such as abnormal site of placenta or cesarean scar abnormal,the other pregnancies should be appropriate chosen vaginal delivery as to decrease the rate of caesarean section again for the social factors.