剖宫产术后再次妊娠270例分娩方式的选择(1)
中图分类号：R714.3文献标识码：A文章编号：1672-3783(2008)-5-0003-03
【摘 要】目的 探讨剖宫产术后再次妊娠的分娩方式。方法 对2005年1月~2007年12月我院270例剖宫产术后再次妊娠孕妇的分娩方式、分娩结局及母婴并发症进行回顾性分析。并将其中再次剖宫产(RCS)182例与随机抽取同期首次剖宫产(PCS)182例进行对照，将其中剖宫产术后阴道分娩(VBAC)88例与随机抽取同期非瘢痕子宫阴道分娩(VBNC)88例进行对照。结果 270例中119例阴道试产，88例试产成功，成功率73.9%；RCS 182例，手术产率67.41%。VBAC组新生儿窒息、产后出血量、先兆子宫破裂发生率与对照组比较，差异无显著性。RCS组较VBAC组产后出血量高，平均住院天数多，经济费用高。RCS组产后出血率较PCS组高，差异有显著性(P<0.05)。结论 剖宫产术后再次妊娠分娩并非是剖宫产绝对指征，符合试产条件者在严密监护下阴道试产是安全的。
, http://www.100md.com 【关键词】剖宫产术后再次妊娠 分娩
Pregnant Again after Cesarean Section Delivery Mode of Choice of 270 Cases
SHAO Tong-hua
Langfang Guang Yang District Maternal
and Child Health Centre，Langfang ，Hebei，China
【Abstract】Objective Inquire into the ways of once more pregnant childbirth after a caesarean operation.Methods Back-lookingly analyse the ways of childbirth，the results of childbirth and the complicating disease of the morther and baby for 270 pregnant women of once more pregnant childbirth in the N0.1 people’s Hospital of leiyang city，on January 1，2005 and December 12，2007At the same time，compare the 182cases of once more caesarean birth with the 182 cases of the same time caesarean birth (PCS) with a machine to extract for the first time and compare the 88cases of vagina delivery after a caesarean opertion with the same time 88 no-scar uterus vagina childirth with a machine to extract.Results In the119 vegina trial-birthgivings out of 270 cases，88 cases are successful ones.The success ratio is 73.9%.In 182RCS cases，the success ratio of birthgiving of operation is 67.41%.There is no different marked significance according to the comparision between the newborn suffocating，the quantity of postpartum hemorrhage and the sub-bursting rate of the threatened rupture of uterus in VBAC group and comparative group.The quantity of postpartum hemorrhage of RCA is higher than that of VBAC，the equally hospitalized days are more and the cost is higher.The ratio of postpartum hemorrhage in RCS group is higher than that of postpartam hemorrhage in PCS.The difference of them has a striking meaning (P<0.05).Conclusion Once more pregnant childbirth after a caesarean operation is by no means the only proof of a caesarean birth.If you are fit for trial-birthgiving，it is safe to trial-birthgive in vagina under iutensive care.
, 百拇医药
【Key words】Pregnant after a caesarean operation；Childbirth
剖宫产是解决难产和某些产科合并症、抢救孕产妇和围生儿生命的有效手段.然而，近年来，随着剖宫产手术指征的放宽，剖宫产率有所上升，在围产儿死亡率并未明显下降的前提下，产妇手术死亡率及并发症却明显高于阴道分娩者，而反复剖宫产率增加是引起剖宫产率增加的一个原因。因此，首次剖宫产后经阴道分娩(VBAC)已成为妇产科学界试图降低剖宫产率的焦点问题。本文对我院近2年剖宫产术后再次妊娠270例临床资料进行回顾性分析，以探讨剖宫产术后再次妊娠分娩方式的选择。
1 资料与方法
1.1 一般资料 我院2005年1月~2007年12月剖宫产术后再次妊娠分娩者270例，占同期分娩总数19286例的1.4%(270/19286)，再次剖宫产183例，剖宫产术后阴道分娩88例。产妇年龄23~45岁，孕次2~10次，产次1~5次，孕周34+4~42+3周，距上次剖宫产时间17个月~11年，其中<2年28例，2~5年232例，6~11年10例。前次手术全部为子宫下段横切口(腹壁纵切口175例，横切口95例)。B超测定子宫下段瘢痕厚度为(0.48±0.16)cm，最薄者为0.26cm，最厚者0.93cm。术后无切口感染及晚期产后出血史。有两次剖宫产手术史者6例。经阴道试产(试产组)119例，均自然临产，并符合以下多数学者认可的条件：(1)前次手术指征已不存在；(2)前次手术距本次妊娠时间超过2年；(3)本次妊娠无新的剖宫产指征；(4)孕妇愿意试产[1]。未经试产即行剖宫产(剖宫产组)151例。, 百拇医药(邵彤华)
【摘 要】目的 探讨剖宫产术后再次妊娠的分娩方式。方法 对2005年1月~2007年12月我院270例剖宫产术后再次妊娠孕妇的分娩方式、分娩结局及母婴并发症进行回顾性分析。并将其中再次剖宫产(RCS)182例与随机抽取同期首次剖宫产(PCS)182例进行对照，将其中剖宫产术后阴道分娩(VBAC)88例与随机抽取同期非瘢痕子宫阴道分娩(VBNC)88例进行对照。结果 270例中119例阴道试产，88例试产成功，成功率73.9%；RCS 182例，手术产率67.41%。VBAC组新生儿窒息、产后出血量、先兆子宫破裂发生率与对照组比较，差异无显著性。RCS组较VBAC组产后出血量高，平均住院天数多，经济费用高。RCS组产后出血率较PCS组高，差异有显著性(P<0.05)。结论 剖宫产术后再次妊娠分娩并非是剖宫产绝对指征，符合试产条件者在严密监护下阴道试产是安全的。
, http://www.100md.com 【关键词】剖宫产术后再次妊娠 分娩
Pregnant Again after Cesarean Section Delivery Mode of Choice of 270 Cases
SHAO Tong-hua
Langfang Guang Yang District Maternal
and Child Health Centre，Langfang ，Hebei，China
【Abstract】Objective Inquire into the ways of once more pregnant childbirth after a caesarean operation.Methods Back-lookingly analyse the ways of childbirth，the results of childbirth and the complicating disease of the morther and baby for 270 pregnant women of once more pregnant childbirth in the N0.1 people’s Hospital of leiyang city，on January 1，2005 and December 12，2007At the same time，compare the 182cases of once more caesarean birth with the 182 cases of the same time caesarean birth (PCS) with a machine to extract for the first time and compare the 88cases of vagina delivery after a caesarean opertion with the same time 88 no-scar uterus vagina childirth with a machine to extract.Results In the119 vegina trial-birthgivings out of 270 cases，88 cases are successful ones.The success ratio is 73.9%.In 182RCS cases，the success ratio of birthgiving of operation is 67.41%.There is no different marked significance according to the comparision between the newborn suffocating，the quantity of postpartum hemorrhage and the sub-bursting rate of the threatened rupture of uterus in VBAC group and comparative group.The quantity of postpartum hemorrhage of RCA is higher than that of VBAC，the equally hospitalized days are more and the cost is higher.The ratio of postpartum hemorrhage in RCS group is higher than that of postpartam hemorrhage in PCS.The difference of them has a striking meaning (P<0.05).Conclusion Once more pregnant childbirth after a caesarean operation is by no means the only proof of a caesarean birth.If you are fit for trial-birthgiving，it is safe to trial-birthgive in vagina under iutensive care.
, 百拇医药
【Key words】Pregnant after a caesarean operation；Childbirth
剖宫产是解决难产和某些产科合并症、抢救孕产妇和围生儿生命的有效手段.然而，近年来，随着剖宫产手术指征的放宽，剖宫产率有所上升，在围产儿死亡率并未明显下降的前提下，产妇手术死亡率及并发症却明显高于阴道分娩者，而反复剖宫产率增加是引起剖宫产率增加的一个原因。因此，首次剖宫产后经阴道分娩(VBAC)已成为妇产科学界试图降低剖宫产率的焦点问题。本文对我院近2年剖宫产术后再次妊娠270例临床资料进行回顾性分析，以探讨剖宫产术后再次妊娠分娩方式的选择。
1 资料与方法
1.1 一般资料 我院2005年1月~2007年12月剖宫产术后再次妊娠分娩者270例，占同期分娩总数19286例的1.4%(270/19286)，再次剖宫产183例，剖宫产术后阴道分娩88例。产妇年龄23~45岁，孕次2~10次，产次1~5次，孕周34+4~42+3周，距上次剖宫产时间17个月~11年，其中<2年28例，2~5年232例，6~11年10例。前次手术全部为子宫下段横切口(腹壁纵切口175例，横切口95例)。B超测定子宫下段瘢痕厚度为(0.48±0.16)cm，最薄者为0.26cm，最厚者0.93cm。术后无切口感染及晚期产后出血史。有两次剖宫产手术史者6例。经阴道试产(试产组)119例，均自然临产，并符合以下多数学者认可的条件：(1)前次手术指征已不存在；(2)前次手术距本次妊娠时间超过2年；(3)本次妊娠无新的剖宫产指征；(4)孕妇愿意试产[1]。未经试产即行剖宫产(剖宫产组)151例。, 百拇医药(邵彤华)