李桂钦

【摘要】 目的：研究瘢痕子宫再次妊娠产妇经阴道分娩的可行性，为瘢痕子宫再次妊娠产妇选择分娩方式和降低剖宫产率提供参考。方法：回顾性分析2018年10月-2019年9月笔者所在医院收治的282例瘢痕子宫再次妊娠产妇资料，经剖宫产进行分娩的208例作为对照组，经阴道进行分娩的74例作为观察组，比较两组新生儿Apgar评分、住院时间、产后出血量和并发症情况。结果：两组新生儿Apgar评分、并发症发生率比较，差异均无统计学意义（P>0.05）;对照组产后出血量为（284.46±44.25）ml，多于观察组的（242.87±21.78）ml，差异有统计学意义（P<0.05）;对照组住院时间为（6.14±0.22）d，长于观察组的（3.72±0.19）d，差异有统计学意义（P<0.05）。结论：在严格掌握适应证及试产过程中进行有效监护的条件下，瘢痕子宫再次妊娠产妇行阴道分娩是安全可行的，可显著缩短住院时间，减少产后出血量。

【关键词】 瘢痕子宫 再次妊娠 经阴道分娩 可行性

doi：10.14033/j.cnki.cfmr.2020.19.059 文献标识码 B 文章编号 1674-6805（2020）19-0-02

Feasibility of Transvaginal Delivery in the Second Pregnancy of Cicatricial Uterus/LI Guiqin. //Chinese and Foreign Medical Research， 2020， 18（19）： -146

[Abstract] Objective： To study the feasibility of transvaginal delivery in the second pregnancy of cicatricial uterus， so as to provide reference for the pregnant women with cicatricial uterus to choose delivery mode and reduce the rate of cesarean section. Method： From October 2018 to September 2019， the data of 282 cases of cicatricial uterus in our hospital were retrospective analysis. And 208 cases delivered by cesarean section as the control group， and 74 cases delivered by vagina as the observation group. The Apgar scores， length of hospitalization， amount of postpartum hemorrhage and complications were compared between the two groups. Result： The Apgar scores and incidence of complications of the two groups were compared， and the differences were not statistically significant （P>0.05）. The amount of postpartum hemorrhage in the control group was （284.46±44.25） ml， which was more than （242.87±21.78） ml of the observation group， and the difference was statistically significant （P<0.05）. The length of hospitalization in the control group was （6.14±0.22） days， which was longer than （3.72±0.19） days of the observation group， and the difference was statistically significant （P<0.05）. Conclusion： Under the condition of strictly mastering the indications and effective monitoring during the trial delivery， transvaginal delivery for women with cicatricial uterus is safe and feasible， which can significantly shorten the length of hospitalization and reduce the amount of postpartum hemorrhage.

[Key words] Cicatricial uterus Second pregnancy Transvaginal delivery Feasibility

First-authors address： Fuzhou Changle District Hospital， Fuzhou 350200， China

瘢痕子宮在临床中较为常见，多发生于既往有剖宫产史或子宫手术史女性。近年来，随着医疗技术的发展，剖宫产的安全性逐渐得到提升，因此越来越多的产妇选择剖宫产，导致剖宫产率不断升高，从而使瘢痕子宫发生率也逐年升高。瘢痕子宫产妇再次妊娠可能存在子宫破裂的风险，严重影响产妇和胎儿的生命安全[1]。瘢痕子宫再次妊娠产妇选择二次剖宫产存在一系列近远期并发症，因此，选择科学的分娩方式十分重要[2]。本次研究对瘢痕子宫再次妊娠产妇经阴道分娩的可行性进行探讨，具体报道如下。

1 资料与方法

1.1 一般资料

回顾性分析2018年10月-2019年9月笔者所在医院收治的282例瘢痕子宫再次妊娠产妇资料。纳入标准：仅有1次子宫下段横切口剖宫产手术史。排除标准：（1）重度子痫前期，需胰岛素治疗的妊娠期糖尿病，肝内胆汁淤积综合征等;（2）产前出血或感染;（3）胎儿异常，如胎位异常、胎儿宫内窘迫、巨大儿;（4）距上次剖宫产手术时间<2年。经剖宫产进行分娩的208例作为对照组，经阴道进行分娩的74例作为观察组。对照组年龄22～41岁，平均（32.42±3.18）岁;孕周36～41周，平均（38.45±1.78）周;本次妊娠距上次剖宫产手术时间2～16年，平均（9.13±1.19）年。观察组年龄21～38岁，平均（31.75±3.46）岁;孕周36～41周，平均（37.58±1.57）周;本次妊娠距上次剖宫产手术时间2～14年，平均（9.41±1.21）年。两组一般资料对比，差异均无统计学意义（P>0.05），具有可比性。