剖宫产术后再次妊娠分娩方式的选择

目的:探讨剖宫产术后再次妊娠分娩方式的选择。方法:剖宫产术后再次妊娠晚期分娩孕妇614例为观察组,分4组:A组为剖宫产术后阴道分娩组;B组为具备阴道试产条件但选择重复剖宫产分娩组;C组为第二次剖宫产分娩组(包括B组);D组为第三次及四次剖宫产分娩组。选择无剖宫产史晚期分娩孕妇376例为对照组,分为2组:阴道分娩组(E组)和首次剖宫产组(F组)。将A组与B组,A组与E组,C、D组与F组配对比较,对母婴并发症、手术时间及住院时间等进行回顾性分析。结果:A组产后出血量和住院时间均明显少于B组(P<0.01),2组产褥病率及新生儿窒息率差异均无统计学意义(P>0.05);A组与E组产后出血量、产褥病率、住院时间、新生儿窒息率及阴道助产率差异均无统计学意义(P>0.05),A组会阴切开率较E组明显升高(P<0.01);C组、D组与F组产后出血量、产褥病率、住院时间及新生儿窒息率差异均无统计学意义(P>0.05),F组手术时间和盆腹腔粘连率均明显少于C组(P<0.01),C组和F组手术时间和盆腹腔粘连率亦显著小于D组(P<0.01)。结论:剖宫产术后再次妊娠,经过严格评估、筛选,对符合阴道分娩条件的孕妇实施阴道试产是安全的,与再次剖宫产相比可明显缩短住院时间,减少母婴并发症。

The choice of delivery mode of secondary pregnancy after cesarean section

Objective:To investigate the choice of delivery mode of secondary pregnancy after cesarean section. Methods:Six hundred and fourteen late pregnancy women with cesarean section were set as the observation group,and divided into group A( vaginal birth after cesarean section),group B(who could vaginal delivery,but choosing to cesarean section),group C(secondary cesarean delivery) and group D( third and fourth cesarean delivery) . Three hundred and seventy-six late pregnancy women without cesarean section were set as the control group, and divided into group E ( vaginal delivery ) and group F ( first cesarean delivery ) . The maternal and infant complications,operation time and hospital stay between group A and group B,between group A and group E,and between group C &group D and F group were analyzed. Results:The bleeding volume and time of hospitalization in group A after delivery were significantly less than that in group B(P<0. 01). The differences of the rates of puerperal morbidity and neonatal asphyxia between group A and group B were not statistically significant(P>0. 05). The differences of the postpartum bleeding volume,puerperal morbidity,time of hospitalization,neonatal asphyxia and rate of vaginal delivery between group A and group E were not statistically significant(P>0. 05). The rate of perineal incision in group A was significantly higher than that in group E(P<0. 01). The differences of the postpartum bleeding volume,puerperal morbidity,time of hospitalization and neonatal asphyxia between group C,group D and group E were not statistically significant(P>0. 05). The operation time and abdominopelvic cavity adhesions rate in group F were significantly less than those in group C(P<0. 01). The operation time and abdominopelvic cavity adhesions rate in group C and F were significantly less than those in group D(P<0. 01). Conclusions:The vaginal trial production in the pregnant women with repregnance after cesarean section is safe according to the rigorous evaluation and selection, which can short hospitalization days and reduce maternal and infant complications.