瘢痕子宫孕妇阴道试产对母儿结局的影响

目的 探讨瘢痕子宫孕妇不同分娩方式的选择以及对母儿结局的影响。方法 选择2017年1月至2018年12月在合肥市第一人民医院产科住院且符合剖宫产后阴道试产纳入标准的产妇160例，依据医生评估结果及产妇意愿选择分娩方式，按实际分娩结果分为剖宫产后阴道分娩（简称阴道分娩）组68例，再次剖宫产（简称剖宫产）组80例，12例因阴道试产失败急诊行子宫下段剖宫产术（简称阴道试产失败组）。同时选择同期住院分娩的40例单胎顺产初产妇作为对照组。比较各组产妇的临床特征以及分娩信息，分析影响瘢痕子宫产妇阴道试产成功的相关因素。结果 在瘢痕子宫患者中，阴道分娩成功率为85%。阴道分娩组与阴道试产失败组相比，孕妇体质量、体质量指数、距上次剖宫产时间、新生儿体质量、产时出血量、产后24 h出血量差异均有统计学意义（P<0.05），而孕妇年龄、孕次、产次、瘢痕厚度、新生儿Apgar评分差异无统计学意义（P>0.05）。阴道分娩组孕妇体质量、体质量指数、孕周、距上次剖宫产时间、新生儿体质量、产后24 h出血量、住院时间均小于剖宫产组，差异有统计学意义（P<0.05），孕妇年龄、孕次、产次、瘢痕厚度、新生儿Apgar评分差异均无统计学意义（P>0.05）。阴道分娩组与对照组相比，分娩时出血量、产后24 h出血量、新生儿Apgar评分、产后住院时间差异均无统计学意义（P>0.05）。结论 瘢痕子宫孕妇在严格的操作规程以及孕期控制体质量指数、胎儿体质量可鼓励阴道试产。

Effect of vaginal trial delivery on maternal and fetal outcome in pregnant women with scar uterus

Objective To analyze the choice of different delivery modes and its effect on maternal and fetal outcome in pregnant women with scarred uterus. Methods From January 2017 to December 2018, 160 parturients who met the criteria for vaginal trials after cesarean section were included in the Department of Obstetrics and Gynecology of Hefei First People''s Hospital. The delivery methods were selected based on the results of doctors'' evaluation and the wishes of mothers. They were divided into vaginal birth after cesarean group and elective repeat caesarean section group, and vaginal trial failed to emergency cesarean section. At the same time, 40 parturients who delivered in hospital at the same time were selected as the control group. The clinical data and delivery situation of scar uterine parturients in each group were compared, and the factors affecting the success of vaginal trial delivery of scar uterine parturients were analyzed. Results In scar parturients, the success rate of VBAC trial production was 85%. There were significant differences in maternal weight, BMI, time from the last cesarean section, neonatal weight, blood loss during delivery and 24h postpartum blood loss between VBAC group and failed vaginal delivery group (P<0.05). There was no significant difference in age, times of pregnancy, times of delivery, scar thickness and neonatal Apgar score between VBAC group and failed vaginal delivery group. Body weight, BMI, gestational week, time from the last cesarean section, birth weight,postpartum hospital stay and postpartum hemorrhage in VBAC group were significantly lower than those in ERCS group (P<0.05), but there was no significant difference in age, times of pregnancy, times of delivery, scar thickness, and neonatal Apgar score (P>0.05). Compared with control group, there was no significant difference in the amount of bleeding during delivery, 24 hours after delivery, neonatal Apgar score and postpartum hospital stay between VBAC group and control group. (P>0.05). Conclusions Pregnant women with scar uterus can encourage trial delivery and improve maternal and fetal outcome with strict operating procedures and control of BMI and fetal weight during pregnancy.