一次剖宫产术后再次妊娠分娩方式的比较

目的 研究一次剖宫产术后再次妊娠的275例孕妇的临床病例回顾性分析,探讨一次剖宫产术后再次妊娠经阴道分娩的可行性及可能相关因素。 方法 选取2015年1月-2017年12月之间于安徽医科大学第二附属医院剖宫产术后再次妊娠的275例产妇为研究对象,其中133例经阴道分娩成功,作为VBAC组(vaginal birth after previous cesarean section),即观察组,阴道分娩失败29例作为TOLAC (trial of labor after cesarean delivery)失败组,入院后直接选择二次剖宫产113例作为ERCS(elective repeat cesarean section)组。比较分析3组间孕妇的年龄、孕周、身高、入院体重、孕期体重变化、宫颈Bishop评分、产时出血量、产后24小时出血量、新生儿体重等指标。 结果 VBAC组与TOLAC失败组相比,体重增加数及Bishop评分相比差异有统计学意义(均P<0.05),VBAC组的体重增加数相对较小,Bishop评分相对较高。其余指标相比差异无统计学意义(均P>0.05)。VBAC组与ERCS组相比,Bishop评分、产时出血量、产后24小时出血量相比差异有统计学意义(均P<0.05),VBAC组的Bishop评分相对较高,产时出血量及产后24小时出血量相对较少。其余指标相比差异无统计学意义(均P>0.05)。 结论 对一次剖宫产术后再次妊娠的孕妇,经过合理孕期管理,分娩前充分评估后实施VBAC是可行的,可适当降低剖宫产率。 

A comparison of delivery modes for subsequent pregnancy after the first cesarean section

Objective To evaluate the feasibility of vaginal delivery for subsequent pregnancy after the first cesarean section and investigate the related factors. Methods The clinical data of 275 subsequent pregnancy after the first cesarean section in our hospital between January, 2015 and December, 2017 were reviewed. 133 cases of successfully vaginal delivery were assigned into vaginal birth after the first cesarean section group (VBAC group, observation group); 29 cases of failed vaginal delivery were assigned into failed trial of labor after the first cesarean section group (TOLAC group, failure group); 113 patients underwent directly the secondary cesarean section after admission were assigned into elective repeat cesarean section group (ERCS group). The age, gestational age, height, admission weight, weight change during pregnancy, cervical bishop score, amount of intrapartum hemorrhage, amount of postpartum hemorrhage at 24 hours and weight of newborn infants were compared among the three groups. Results Compared with the failed group, the weight gain and bishop score of the VBAC group were significant, however, there was no significance in the other indicators. The VBAC group had a relatively smaller weight gain and higher bishop score. There was significant difference in the bishop score, the amount of intrapartum hemorrhage and the amount of postpartum hemorrhage at 24 hours between ERCS group and VBAC group, and the rest of the indicators were not significant. The VBAC group had a relatively high bishop score, a relatively small amount of intrapartum hemorrhage and amount of postpartum hemorrhage at 24 hours. Conclusion The vaginal delivery can be conducted in women with subsequent pregnancy after the first cesarean section on the base of reasonable management during pregnancy and adequate assessment before delivery, which will appropriately decrease the rate of the cesarean section.