350例剖宫产术后再次足月妊娠分娩方式临床分析

目的:探讨剖宫产术后再次足月妊娠者的不同分娩方式、分娩结局对母婴的影响。方法:对350例剖宫产术后再次足月(单胎头先露)妊娠分娩方式、分娩结局及并发症进行回顾性分析,将阴道分娩75例与随机抽取非剖宫产阴道分娩75例进行对照分析,再次剖宫产275例与随机抽取同期首次剖宫产275例进行对照分析。结果:350例孕妇择期再次剖宫产238例,阴道试产112例,75例成功阴道分娩,占67%。阴道试产失败37例,占33%。再次手术产率79%。剖宫产史阴道分娩组在总产程、产后出血、新生儿窒息发生率与对照组比较差异无统计学意义(P>0.05),再次剖宫产组在手术时间术中出血及产后出血等方面与首次剖宫产相比有统计学意义(P<0.05)。在新生儿窒息及切口愈合不良方面无统计学意义。结论:剖宫产史不是再次剖宫产绝对指征,结合前次剖宫产指征、手术方式、术后情况及本次妊娠情况B超监测结果进行综合考虑,符合试产条件,严密监护下可阴道试产。

Clinical analysis of mode of delivery on 350 cases full-term pregnancy again after cesarean section

Objective To investigate the impact of different mode of delivery and birth outcomes of full- term pregnancy after cesarean section for maternal and child. Methods Mode of delivery, birth outcomes and complications of 350 eases who were full - term pregnancy after cesarean section were analyzed retrospectively. 75 cases Va~nal delivery who were afar cesarean and 75 eases va~nal delivery who were randomly selected non - caesarean section were made control analysis. At the same time ,2＂75 cases repeat cesarean section and 275 ea- ses primary cesarean section who were randomly selected over the same period were made control analysis. Results 238 pregnant women choose cesarean section again,and the rate of reoperation was 79%. Tile other 112 pregnant women choose vaginal trial production,75 of them （67%） succeed and 37 of them （33 % ） were unsuccessful. The difference of total labor, postpartum hemorrhage, neonatal asphyxia of the two groups were not statistically significant, P 〉 0. 05. The difference of operative time, blood loss, and postpartum hemorrhage between the Repeat cesarean section group and primary cesarean section group were statistically significant （P 〈 0. 05）. Not statistically significant in the neonatal asphyxia and poor wound healing. Conclusion The history of cesarean section is not absolute indications for cesarean section again. Combined with previous indications of cesarean section, surgical approach, postoperative conditions and the pregnancy conditions of B -mode,the pregnant women who interest of trial production conditions can try vaginal delivery under intensive care.