剖宮產(chǎn)術(shù)后疤痕子宮足月妊娠經(jīng)陰道分娩的可行性分析

李德娟

【摘要】 目的 探討剖宮產(chǎn)術(shù)后疤痕子宮再次妊娠生產(chǎn)的安全性。方法 172例剖宮產(chǎn)術(shù)后疤痕子宮孕婦， 按分娩方式不同分為剖宮產(chǎn)亞組（98例）和陰道分娩亞組（74例）。另選取74例經(jīng)陰道分娩的無疤痕子宮孕婦作為對(duì)照組。比較陰道分娩亞組和剖宮產(chǎn)亞組的出血量、新生兒Apgar評(píng)分、新生兒窒息發(fā)生情況、產(chǎn)褥病發(fā)生情況。統(tǒng)計(jì)陰道分娩亞組和對(duì)照組的陰道分娩成功情況、產(chǎn)程時(shí)間、出血量、新生兒Apgar評(píng)分、新生兒窒息發(fā)生情況、產(chǎn)褥病發(fā)生情況。結(jié)果 陰道分娩亞組和剖宮產(chǎn)亞組新生兒Apgar評(píng)分、新生兒窒息發(fā)生率、產(chǎn)褥病發(fā)生率比較差異無統(tǒng)計(jì)學(xué)意義（P>0.05）， 陰道分娩亞組出血量（238±50）ml少于剖宮產(chǎn)亞組的（420±79）ml， 差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。陰道分娩亞組與對(duì)照組的陰道分娩成功率、產(chǎn)程時(shí)間、出血量、新生兒Apgar評(píng)分、新生兒窒息發(fā)生率、產(chǎn)褥病發(fā)生率比較差異無統(tǒng)計(jì)學(xué)意義（P>0.05）。結(jié)論 部分剖宮產(chǎn)術(shù)后疤痕子宮孕婦再次妊娠可選擇陰道分娩， 但應(yīng)嚴(yán)格把握適應(yīng)證， 并需要嚴(yán)密監(jiān)測(cè)產(chǎn)程。

【關(guān)鍵詞】 剖宮產(chǎn)術(shù)后；疤痕子宮；陰道分娩；足月妊娠

DOI：10.14163/j.cnki.11-5547/r.2018.01.008

【Abstract】 Objective To discuss the safety of delivery of scar uterus after cesarean section. Methods A

total of 172 pregnant women with scar uterus after cesarean section were different delivery methods into cesarean section group （98 cases） and vaginal delivery group （74 cases）. Another 74 pregnant women without scar uteri were selected as the control group. Comparison were made on bleeding volume， neonatal Apgar score， and occurrence of neonatal asphyxia and puerperal disease between cesarean section group and vaginal delivery group. Comparison were made on success rate of vaginal delivery， duration of labor， bleeding volume， neonatal Apgar score， and occurrence of neonatal asphyxia and puerperal disease between vaginal delivery group and control group.

Results The vaginal delivery group and cesarean section group had no statistically significant difference in neonatal Apgar score， and incidence of neonatal asphyxia and puerperal disease （P>0.05）. The vaginal delivery group had less bleeding volume as （238±50） ml than （420±79） ml in cesarean section group， and the difference was statistically significant （P<0.05）. The vagincal delivery group had no statistically significant difference in success rate of vaginal delivery， duration of labor， bleeding volume， neonatal Apgar score， and incidence of neonatal asphyxia and puerperal disease （P>0.05）. Conclusion Partial pregnant women with scar uterus after cesarean section can choose vaginal delivery again， but the indications should be strictly grasped and the production process should be closely monitored.

【Key words】 After cesarean section； Scar uterus； Vaginal delivery； Full term pregnancy

疤痕子宮是指患者的子宮因?yàn)槭中g(shù)或者其他因素導(dǎo)致子宮切口處形成疤痕的狀態(tài)， 因剖宮產(chǎn)造成的疤痕子宮占重要比重。最近10年來， 我國剖宮產(chǎn)的數(shù)量和剖宮產(chǎn)率不斷升高， 而在國家的二孩政策開放以來， 剖宮產(chǎn)術(shù)后再次妊娠的孕婦占據(jù)了一定比重。因?yàn)榘毯圩訉m經(jīng)陰道分娩風(fēng)險(xiǎn)可能高于正常陰道分娩， 這種情況能否經(jīng)陰道分娩是孕婦和家屬普遍關(guān)心的問題。基于此， 采取何種方式分娩也受到國內(nèi)廣大產(chǎn)科醫(yī)師的重視。因此， 剖宮產(chǎn)術(shù)后疤痕子宮孕婦陰道分娩的指征、安全性、可行性成為了臨床產(chǎn)科醫(yī)師不得不面對(duì)的問題。因此……