论文部分内容阅读
目的探讨剖宫产术后再次妊娠的合理分娩方式。方法对新乡市妇幼保健院2009年1月至2013年12月收治的剖宫产术后再次足月妊娠的192例孕妇的临床资料进行回顾性分析,根据剖宫产术后再次妊娠合并的各种高危因素(如子宫切口愈合不良、胎盘附着位置异常、妊娠合并重度子痫前期等)将患者分为高危组和低危组,高危组瘢痕子宫妊娠孕妇全部选择再次剖宫产术,低危组瘢痕子宫孕妇分娩方式分为再次剖宫产术(RCS)和阴道分娩(VBAC),对低危组瘢痕妊娠再次分娩方式选择、分娩结局、医疗费用及新生儿窒息情况等进行对照分析。结果 192例剖宫产术后再次妊娠孕妇中高危组58例,低危组134例,其中29例阴道试产,21例试产成功,成功率为72.41%;RCS 113例,再次手术产率为84.33%。VBAC组的产时出血量、住院时间与住院费用及产褥病率均低于RCS组(P<0.05),先兆子宫破裂发生率与新生儿窒息率相比较差异无统计学意义(P>0.05)。结论剖宫产史并非阴道分娩的绝对禁忌证,对再次妊娠者进行仔细产前评估,符合阴道分娩条件的瘢痕子宫妊娠孕妇可在严密监护下阴道试产。
Objective To investigate the reasonable mode of delivery for the second pregnancy after cesarean section. Methods A retrospective analysis was conducted on the clinical data of 192 pregnant women with full-term pregnancy after cesarean section in Xinxiang Maternal and Child Health Hospital from January 2009 to December 2013. According to the data of the pregnant women High-risk factors (such as poor healing of uterine incision, abnormal placenta accreta, severe preeclampsia in pregnancy, etc.) were divided into high-risk group and low-risk group. All pregnant women in high risk group had cesarean section, Group cesarean delivery methods were divided into two groups: re-cesarean section (RCS) and vaginal delivery (VBAC). The methods of delivery mode, delivery outcome, medical costs and neonatal asphyxia were analyzed. Results Among 192 pregnant women with cesarean section, 58 were pregnant with high risk group and 134 with low risk pregnancy group. Among them, 29 were vaginal trial, 21 were successful trial, with a success rate of 72.41%. In 113 RCS cases, the rate of reoperation 84.33%. The amount of blood transfusion, length of hospital stay, hospitalization costs and puerperal morbidity in VBAC group were significantly lower than those in RCS group (P <0.05). There was no significant difference in incidence of threatened uterine rupture and neonatal asphyxia (P> 0.05 ). Conclusion The history of cesarean section is not the absolute contraindication of vaginal delivery. Careful prenatal assessment of the second trimester pregnancy is feasible.