剖宫产后再次妊娠分娩方式的选择及经阴道分娩安全性研究

钱程; 刘芳; 闫华; 柏妍槟; 田玲

doi:10.13898/j.cnki.issn.1000-2200.2021.07.015

剖宫产后再次妊娠分娩方式的选择及经阴道分娩安全性研究

The choice of delivery modes for the second pregnancy after cesarean section and safety of vaginal delivery

摘要

摘要:
目的探讨剖宫产后再次妊娠分娩方式的选择及经阴道分娩的安全性。
方法选择剖宫产后再次妊娠产妇80例作为研究对象，其中选择阴道试产分娩产妇38例作为观察组，选择再次剖宫产分娩产妇42例为对照A组，另选取同时期收治的首次妊娠阴道分娩产妇50例作为对照B组。比较不同分娩方式产妇的分娩结局及临床一般情况。
结果观察组试产成功率低于对照B组，阴道助产率高于对照B组（P < 0.05）。观察组产妇产时、产后出血量、住院时间及术后并发症发生率均少于对照A组（P < 0.05~P < 0.01）。观察组产妇和对照B组产妇产后出血量、产程时间及住院时间和新生儿Apgar评分比较差异无统计学意义（P>0.05）。不同组别子宫下段厚度和盆腔粘连比较差异均有统计学意义（P < 0.01），其中剖宫产术后7~10年妊娠者子宫下段明显变薄，与术后2~6年内妊娠组及对照B组剖宫产者比较差异均有统计学意义（P < 0.01），对照B组剖宫产者较术后2~6年内妊娠组子宫下段更薄（P < 0.01）。术后7~10年和2~6年妊娠者，盆腔粘连比例均较对照B组增加（P < 0.05~P < 0.01）。
结论剖宫产后再次妊娠产妇选择阴道分娩，相比实施剖宫产在术中出血量、术后康复方面有明显优势，但也存在一定风险。因此，应加强产前监护，严格控制阴道试产的适应证与临床指征，以提高阴道分娩的成功率及安全性。

Abstract:
ObjectiveTo explore the choice of delivery mode and safety of vaginal delivery in the second pregnancy after cesarean section.
MethodsEighty women with second pregnancy after cesarean section were studied.Thirty-eight pregnant women with vaginal delivery and 42 pregnant women with cesarean section were divided into the observation group and control group A, respectively.Fifty primiparas in the same period were set as the control group B.The delivery outcome and general clinical situation among three groups were compared.
ResultsThe success rate of trial delivery in observation group was lower than that in control group B, and the vaginal delivery rate in observation group was higher than that in control group B(P < 0.05).The amount of bleeding during delivery and postpartum, length of hospital stay and incidence rate of postoperative complications in observation group were lower than those in control group A(P < 0.05 to P < 0.01).The differences of the postpartum blood loss, length of labor, length of hospital stay and Apgar score between the observation group and control group B were not statistically significant(P>0.05).The differences of the lower uterine thickness and pelvic adhesion among three groups were statistically significant(P < 0.01).After 7-10 years of cesarean section, the lower uterine segment of pregnant women became significantly thin, and the difference of the lower uterine segment between the pregnant woman with cesarean section for 7-10 years and pregnant woman with cesarean section for 2-6 years, control group B were statistically significant(P < 0.01).The lower uterine segment in the control group B became significantly thinner compared with pregnant woman with cesarean section for 2-6 years(P < 0.01).The pelvic adhesion ratios in the pregnant woman with cesarean section for 7-10 and 2-6 years increased compared with the control group B(P < 0.05 to P < 0.01).
ConclusionsCompared with the cesarean section, vaginal delivery for the second pregnancy in pregnant women with cesarean section have obvious advantages in the amount of intraoperative blood loss and postoperative recovery.Therefore, the prenatal monitoring should be strengthened, and the indications and clinical indications of vaginal delivery should be strictly controlled in order to improve the success rate and safety of vaginal delivery.

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