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目的探讨剖宫产术后再次妊娠孕期风险评估及管理方法对分娩方式选择的指导意义。方法采用回顾性分析法选取剖宫产术后再次妊娠的110例产妇作为研究对象,其中23例符合阴道试产的适应证且成功接受阴道分娩为对照组,另87例为观察组。对比两组产妇住院时间、新生儿Apgar评分、产褥病率、产后24 h内出血量、住院费用等指标。结果剖宫产术后再次妊娠分娩产妇中,阴道分娩成功率为85.2%(23/27),无1例发生子宫破裂。两组产妇住院时间、初次哺乳时间、产褥病率、产后大出血发生率、住院费用等指标差异有统计学意义(P<0.05),孕早期(孕45~50 d)hCG、孕酮、孕囊下缘距离子宫前壁瘢痕处距离及孕35~37周时子宫瘢痕处肌层的厚度、新生儿Apgar评分、新生儿体质量、新生儿窒息率、新生儿黄疸发生率及新生儿湿肺发生率等差异无统计学意义(P>0.05)。结论剖宫产术后再次足月妊娠分娩,通过严密进行孕期风险评估及管理,严格掌握阴道分娩适应证,严密观察产程,及时发现难产及处理,多数可经阴道安全分娩,剖宫产术后再次妊娠并非阴道分娩的绝对禁忌证。
Objective To investigate the risk assessment of pregnant women after cesarean section and the guiding methods of management on the choice of mode of delivery. Methods Retrospective analysis of selected pregnant women after cesarean section 110 pregnancies again as the study object, of which 23 cases consistent with vaginal trial indications and successfully accepted vaginal delivery as the control group, and the other 87 cases were observed. Comparing the two groups of maternal hospitalization time, neonatal Apgar score, the rate of puerperal, postpartum hemorrhage within 24 hours, hospitalization costs and other indicators. Results After cesarean delivery, the success rate of vaginal delivery was 85.2% (23/27), and none of the cases had uterine rupture. The maternal hospitalization time, initial nursing time, puerperal morbidity, the incidence of postpartum hemorrhage, hospitalization and other indicators were significantly different between the two groups (P <0.05). In the first trimester (45 ~ 50 d of pregnancy), hCG, progesterone, The distance of the lower edge of the capsule from the anterior uterine scar and the thickness of the muscular layer at the uterine scar between 35-37 weeks of gestation, Apgar score of neonates, neonatal body weight, neonatal asphyxia, neonatal jaundice and neonatal wet lung There was no significant difference in incidence (P> 0.05). Conclusion Cesarean section after full-term pregnancy and childbirth, through rigorous pregnancy risk assessment and management, strict indications for vaginal delivery, strict observation of labor, timely detection and treatment of dystocia, the majority of vaginal delivery can be safe, after cesarean section Re-pregnancy is not an absolute contraindication to vaginal delivery.