瘢痕子宫再次妊娠自然临产分娩方式的探讨

目的 探讨瘢痕子宫再次妊娠自然临产分娩方式的选择.方法 采用回顾性分析,连续选择剖宫产术后再次妊娠自然临产患者60例,同期非瘢痕子宫阴道分娩（VBNC）患者60例,瘢痕子宫再次剖宫产（RCS）患者50例,首次剖宫产（PCS）患者50例的临床资料,对瘢痕子宫经阴道分娩（VBAC）组与VBNC组、VBAC组与RCS组、RCS组与PCS在分娩方式、分娩结局、母婴并发症进行比较.结果 60例患者中,VBAC 24例,成功率40％.VBAC组在产时出血量、新生儿窒息比例、住院天数上与VBNC组比较,差异无统计学意义（P＞0.05）,但VBAC组的产时出血量、新生儿窒息比例、住院天数均低于RCS组,差异有统计学意义（P ＜0.05）;RCS组产时出血量、腹腔粘连比例、愈合不良比例均高于PCS组,差异有统计学差异（P＜0.05）.结论 瘢痕子宫再次妊娠自然临产后,通过严密观察产程,给予充分阴道试产的机会,经阴道分娩是安全可行的.

Exploration of Delivery Ways of Repregnant Women in Labor with Scar Uterus

Objective To discuss the selection of delivery modes in re-pregnancy women in labor with scar uterus.Methods The delivery modes,delivery outcomes in pregnant women and the effect on maternal and infant were retrospectively analyzed.There were 24 cases of vaginal birth after cesarean （VBAC） from 60 patients with a history of cesarean section.Delivery modes,delivery outcomes,maternal infection in VBAC group were compared with 60 cases of non-scar uterus women with vaginal delivery （VBNC）.Twenty four cases （VBAC） were compared with 50 cases received cesarean section （RCS） again and 50 cases（RCS） were compared with randomly selected 50 patients with cesarean section （PCS） for the first time.Results Sixty cases were vaginal trial-produce,24 patients of whom were successful,and the success rate was 40％.There was no statistically significant difference in blood loss,in-hospital day and asphyxia neonatorum when comparing VBAC group with VBNC group （P ＞ 0.05）.But there were statistical differences between VBAC group and RCS group in the above items（P ＜0.05）.While the blood loss,incidence of abdomen adherence in RCS group were significantly higher than PCS group,and the difference between two groups was statistically significant （P ＜ 0.05）.Conclusion Vaginal delivery is a feasible and safe mode selection under the close guardianship for those women in labor who underwent cesarean section while given sufficient opportunity to vaginal trial delivery.