剖宫产术后瘢痕子宫妊娠分娩方式及结局分析

夏熙云河南省鹤壁浚县人民医院妇产科，河南浚县　458000

剖宫产术后瘢痕子宫妊娠分娩方式及结局分析

夏熙云
河南省鹤壁浚县人民医院妇产科，河南浚县458000

目的探究剖宫产术后瘢痕子宫妊娠分娩方式及结局。方法将浚县人民医院妇产科2014年8月—2015年8月收治的91例剖宫产术后瘢痕子宫再次妊娠分娩产妇，按其意愿及分娩指征分为剖宫产组45例和阴道试产组46例，观察对比两组分娩结局。结果阴道试产分娩成功率为76.1%，中转剖宫产率为23.9%；阴道试产组平均产程时间 （9.89±0.85）h高于剖宫产组 （9.52±0.83）h、产后出血量 （234.56±32.71）mL低于剖宫产组 （329.41± 33.45）mL、1 min Apgar评分（9.11±0.23）分低于剖宫产组（9.32±0.22）分，P＜0.05；阴道试产组先兆子宫破裂发生率8.70%高于剖宫产组，而产后发热率6.52%、新生儿窒息率4.35%略低于剖宫产组15.55%、6.67%，P＞0.05。结论阴道试产可降低剖宫产术后瘢痕子宫患者的出血量和1 min Apgar评分，降低产后并发症的发生，建议临床推广使用。

剖宫产；瘢痕子宫；妊娠；分娩方式；分娩结局

［Abstract］Objective To explore the cesarean uterine scar pregnancy and delivery mode and ending.Methods Xun County People's Hospital in August 2014-August 2015 were treated 91 cases of uterine scar after cesarean section again maternal pregnancy and delivery，according to their wishes and indications are divided into 45 cases of cesarean delivery group and vaginal pilot group of 46 patients was observed compared two groups of birth outcomes.Results The success rate of vaginal delivery trial production 76.1%，transit cesarean section rate was 23.9%；trial of labor group，the average labor time（9.89±0.85）h higher than cesarean group（9.52±0.83）h，postpartum hemorrhage（234.56±32.71）mL lower than cesarean group（329.41±33.45）mL，1 minute Apgar score（9.11±0.23）points lower than cesarean group（9.32± 0.22）min，P＜0.05；trial of labor group threatened uterine rupture rate of 8.70%higher than cesarean group，and postpartum fever rate 6.52%，slightly lower than the 4.35%rate of neonatal asphyxia cesarean group 15.55%，6.67%，P＞0.05. Conclusion The trial of labor after cesarean section can reduce the amount of bleeding in patients with uterine scar and one minute Apgar score，reduce the incidence of postpartum complications，it is recommended clinical use.

［Key words］Cesarean section；Uterine scar；Pregnancy；Delivery；Delivery outcome

近年来，随着剖宫产技术的不断提高及手术指征的扩宽，剖宫产率呈逐年递增趋势，且随着国家二胎政策的放开，继之而来的再次妊娠分娩方式的选择则成为临床医师重点研究课题。一般研究认为［1］，剖宫产后再次妊娠行阴道试产，常易使瘢痕子宫发生子宫破裂，危及母婴安全，而若再次性剖宫产也会对母体造成创伤［2］。为此，该文将对2014年8月—2015年8月期间浚县人民院院妇产科收治的91例剖宫产术后瘢痕子宫再次妊娠分娩的产妇作为研究对象，分析不同分娩方式及其妊娠结局，为临床选择合理分娩方式及获得良好妊娠结局提供理论依据，现报道如下。……