86例再次剖宫产术评价

目的探讨前次剖宫产术后再次剖宫产的并发症及影响。方法回顾了86例再次剖宫产术对其年龄、孕周、两次剖宫产术间隔时间、两次剖宫产术指证以及前次剖宫产的术式进行了分析。结果再次剖宫产中子宫破裂1例,较严重的粘连15例;损伤膀胱1例。术中出血超过500 ml者11例,占12.8%;同期产后出血率为1.5%,差异有显著性(P<0.01)。腹壁横切口粘连发生率与腹壁纵切口下段剖宫产相比粘连发生率明显增高(P<0.01)。结论在决定剖宫产术式时应综合考虑孕妇的产科情况选择腹壁切口及子宫切口;前次手术的质量决定再次手术的并发症。

Evaluation on repeat cesarean section of 86 cases

Aim To explore the complications and influence of repeat cesarean section after previous cesarean delivery.Methods The styles of the total 86 cases of repeat cesarean section were reviewed,and the maternal ages,gestational weeks,time intervals between the two times of delivery,indications of the cesarean section and the styles of the previous cesarean section were analyzed.Results Of the total 86 cases of repeat cesarean section,there were 1 case with uterine rupture,15 cases with relatively severe adhesion and 1 case with bladder injury.There were 11 cases with intraoperative blood loss over 500 ml(12.8%),while in the meantime,the rate of postpartum hemorrhage was 1.5%,therefore,there was a significant difference between them(P<0.01).The rate of adhesion induced by abdominal transverse incision of cesarean section was significantly higher than that of abdominal longitudinal incision of low cesarean section(P<0.01).Conclusion When we determine a style of cesarean section,we shoud comprehensively consider the obstetrical conditions of the pregnant woman to select abdominal incision style and uterine incision style.The quality of previous cesarean delivery determines the complications of repeat cesarean section.