赵学文

摘 要 目的：探讨瘢痕子宫再次足月妊娠阴道分娩的可行性和安全性。方法：选取尝试阴道分娩的瘢痕子宫再次足月妊娠孕妇60例作为观察组，同期选取尝试阴道分娩的初产妇60例作为对照组，分析两组临床资料，比较两组剖宫产率、分娩结局。结果：观察组剖宫产率显著高于对照组（15.0% vs 3.3%，P<0.05）；观察组阴道助产例数显著高于对照组（P<0.05），两组总产程、产后24 h出血量、新生儿体重、新生儿Apgar评分、新生儿窒息例数、住院时间比较差异不显著（P>0.05）。结论：对于无剖宫产指征且具有阴道分娩条件的瘢痕子宫再次足月单胎妊娠孕妇进行阴道分娩，安全可行，临床实践中可依据孕妇具体情况尝试进行阴道分娩。

关键词 瘢痕子宫 妊娠 阴道分娩 剖宫产

中图分类号：R714.422 文献标志码：A 文章编号：1006-1533（2019）01-0047-03

Safety analysis of vaginal delivery in full-term pregnancy with scarred uterus

ZHAO Xuewen*

（Department of Gynaecology and Obstetrics， the Peoples Hospital of Jizhou District， Tianjin 301900， China）

ABSTRACT Objective： To discuss the feasibility and safety of vaginal delivery for full-term pregnancy of scarred uterus. Methods： Sixty pregnant women with scarred uterus who attempted vaginal delivery were selected as an observation group and another 60 primipara undergoing vaginal delivery were selected as a control group. The clinical data from two groups were analyzed and the cesarean section rate and delivery outcome were compared between the two groups. Results： The rate of cesarean section （15.0% vs 3.3%） and the cases required for vaginal midwifery were significantly higher in the observation group than the control group （P<0.05）. There were no significant differences in the total stage of labor， 24 hours postpartum hemorrhage volume， neonatal weight and Apgar score， neonatal asphyxia cases and hospitalization time between the two groups （P>0.05）. Conclusion： It is safe and feasible to give vaginal delivery to pregnant women with scarred uterus who have no indication of cesarean section and vaginal delivery conditions. In clinical practice， vaginal delivery can be attempted according to the specific conditions of pregnant women.

KEy WORDS scarred uterus； pregnancy； vaginal delivery； caesarean birth

剖宮产是保障高危妊娠孕妇、异常分娩等情况下产妇和新生儿生命安全的重要手段，近年来，剖宫产率也随着医疗水平和生活水平的提升而升高。剖宫产后再次妊娠无论选择哪种方式生产，瘢痕子宫均会增加发生并发症的风险。因此，如何选择瘢痕子宫再次妊娠的分娩方式备受医学界关注[1-2]。瘢痕子宫再妊娠再次进行剖宫产分娩不仅损伤产妇子宫，且可能发生并发症，增加分娩风险，而尝试阴道分娩虽有发生子宫破裂的风险，但严格控制分娩适应证，并非不可取。本研究对我院尝试阴道分娩的瘢痕子宫再次足月妊娠孕妇的分娩结局进行分析，旨在探讨瘢痕子宫再次足月妊娠孕妇采用阴道分娩的可行性和安全性，为瘢痕子宫再妊娠孕妇的分娩途径选择提供更多依据。

1 资料与方法

1.1 一般资料

本研究选取2017年5月—2018年8月在我院尝试阴道分娩的60例瘢痕子宫再次足月妊娠孕妇作为观察组。……