剖宫产术后再次妊娠者阴道分娩与再次剖宫产的对照分析

目的探讨剖富产术后再次妊娠分娩方式的选择。方法随机抽取2008-01～2009-09收治剖宫产术后再次妊娠孕妇156例，对其分娩方式、分娩结局及医疗费用进行回顾性分析评价。结果156例剖宫产术后再次妊娠者，行再次剖宫产（RCS）125例（其中择期剖宫产112例，阴道试产改行剖宫产13例），占80．13％；阴道试产（TOL）44例，占28．21％，试产成功率为70．45％；阴道分娩（VBAC）31例，占19．87％。RCS组较VBAC组出血量大，分别为（175．7±4．0）ml和（85．5±8．5）ml，平均住院天数RCS组较VBAC组相对较长，分别为（8．20±1．58）d和（3．20±0．42）d，医疗费用RCS组较VBAC组为高。结论有剖宫产史再次妊娠者，不一定选择剖宫产作为绝对指征，如无试产禁忌者可在严密监护下先行阴道试产。

A control study between the vaginal birth after cesarean section and the repeated cesarean section

Objective To discuss the delivery way of the re-pregnaey after cesarean section. Methods From January 2008 to September 2009, the ways of childbirth ,the results of childbirth and the cost in the 156 cases of re-pregnacy after cesarean section randomly selected were retrospectively analyzd. Results Among 156 cases of repregnacy after cesarean section, 125 cases received repeated cesarean section （RCS） （ 112 cases received selective cesarean section, 13 cases received cesarean section after failure of trial of vaginal labor） ,accounted for 80. 13% ;the trial of vaginal labor were adopted in 44 cases, accounted for 28.21% ;the VBAC 31 cases, accounted for 19. 87% ; the success rate of trial of vaginal labor was 70. 45 %. The quantity of postpartum hemorrhage of RCS was more than that of VBAC, [ （85.5 ± 8.5 ）ml, （175.7 ±4.0）ml ], and the average days of hospitalization were more than that of VBAC,[（8.20±1.58）d,（3.20 ±0.42）d],and the cost of RCS was higher than that of VBAC. Conclusion Cesarean section history is not the absolute indication of cesarean section, vaginal birth is possible under intensive monitoring.