由明学　敖明珠　冯去非

[摘要] 目的 探讨瘢痕子宫再次妊娠产科处理方式的选择。 方法 回顾性分析2014年3月～2015年2月我院收治的剖宫产术后或子宫肌瘤核除术后的瘢痕子宫再次妊娠的产妇112例的临床资料，同期选择再次剖宫产瘢痕子宫产妇981例，分析瘢痕子宫再次妊娠产科处理方式的选择。 结果 112例阴道试产患者中有107例试产成功，成功率为95.5%，其中自然分娩者97例，阴道助产10例（其中产钳3例，胎头吸引5例，臀助产2例），剖宫产5例，再次剖宫产分娩为986例。瘢痕子宫阴道分娩与再次剖宫产两组分娩方式的孕妇在年龄、孕周、新生儿血气、产褥病率方面比较，差异无统计学意义（P>0.05）；阴道分娩的产妇产后出血量、新生儿体重、住院天数明显低于剖宫产分娩产妇，差异有统计学意义（P<0.05）。 结论 瘢痕子宫再次妊娠，符合阴道分娩条件的孕妇，应给予阴道试产机会。阴道试产利大于弊，且不增加子宫破裂风险。

[关键词] 瘢痕子宫；妊娠；阴道分娩；再次剖宫产

[中图分类号] R719.8 [文献标识码] B [文章编号] 1673-9701（2015）35-0052-03

[Abstract] Objective To explore the selection of obstetrical management approach for repeated pregnancy with scarred uterus. Methods Clinical data of 112 puerpera with scarred uterus for repeated pregnancy were retrospectively analyzed. They were admitted to our hospital and were given cesarean section or myomectomy from March 2014 to February 2015. 981 cases with repeated cesarean section were collected at the same time. The selection of obstetrical management approach for repeated pregnancy with scarred uterus was analyzed. Results Among 112 patients with vaginal trial labor， 107 patients were successful， and the successful rate was 95.5%. Among them， 97 patients were natural delivery， 10 patients were vaginal assistant delivery （3 cases of obstetrics forceps， 5 cases of vacuum extractor of fetal head and 2 cases of breech delivery）， and 5 patients were cesarean section， there were 986 cases with repeated cesarean section. There were no statistically significant differences of pregnant women's age， gestational weeks， neonatal blood gas and morbidity rate of puerperium compared between the two groups of delivery modes of repeated pregnancy with scarred uterus and repeated cesarean section（P>0.05）； the amount of bleeding， neonatal body weight and length of stay in the puerpera with vaginal delivery were all significantly lower than those in the puerpera with cesarean section， and the differences were statistically significant（P<0.05）. Conclusion The pregnant women with repeated pregnancy in scarred uterus who meet the criteria of vaginal delivery should be given the opportunity of vaginal trial delivery. The advantages of vaginal trial delivery are more than disadvantages， and the risk of uterine rupture is not higher.

[Key words] Scarred uterus； Pregnancy； Vaginal delivery； Repeated cesarean section

剖宫产是解决难产及产科合并症和并发症，挽救产妇和围生儿生命的有效手段。剖宫产术后、子宫肌瘤核除术及人工流产子宫穿孔等都可形成瘢痕子宫。近十年来，由于剖宫产技术的不断提高，剖宫产术相对安全，故剖宫产率也不断上升，由于二胎政策的开放，瘢痕子宫再次妊娠也有所增加，如何正确选择瘢痕子宫再次妊娠的分娩方式，以及瘢痕子宫选择阴道分娩（vaginal birth after cesarean section，VBAC）的恰当处理越来越受到产科医师的关注。本文选择2014年3月～2015年2月我院收治的112例瘢痕子宫选择阴道分娩的产妇进行回顾性分析，探讨瘢痕子宫再次妊娠分娩方式的选择，旨在最大程度地改善母婴结局。现……