剖宫产术后再次妊娠阴道试产的可行性及安全性分析(1)
【摘要】 目的：探讨剖宫产术后再次妊娠阴道试产的可行性及安全性。方法：选择2014年2月-2015年12月在笔者所在医院妇产科住院的剖宫产术后再次妊娠56例产妇作为观察组，选择同期初次妊娠的45例正常孕产妇为对照组，两组均进行阴道试产方案，观察两组产妇阴道试产成功率及阴道试产失败的原因；比较两组产妇分娩时平均产程时间、先兆子宫破裂、产后出血量、阴道助产和新生儿窒息等情况。结果：观察组阴道试产成功率(76.8%)低于对照组(88.9%)，差异有统计学意义(P<0.05)；观察组阴道试产失败的原因为胎儿窘迫、宫缩乏力、脐带脱垂和先兆子宫破裂。两组产妇平均产程、产后出血量、新生儿窒息和阴道助产发生率分别比较差异无统计学意义(P>0.05)。结论：剖宫产术后再次妊娠分娩时，阴道分娩有相对较高的试产成功率，并且并发症少，有较高的可行性和安全性。
【关键词】 剖宫产； 再次妊娠； 阴道试产
doi：10.14033/j.cnki.cfmr.2017.5.010 文献标识码 B 文章编号 1674-6805(2017)05-0020-03
, 百拇医药
Analysis on the Feasibility and Safety of Vaginal Delivery after Cesarean Section Pregnancy/JU Chun-ling，LIU Xiao-ling.//Chinese and Foreign Medical Research，2017，15(5)：20-22
【Abstract】 Objective：To explore the feasibility and safety of vaginal delivery of pregnancy after cesarean section.Method：From February 2014 to December 2015 in our hospital obstetrics and gynecology，56 cases of pregnant women after cesarean section pregnancy were selected as the observation group，45 cases of normal pregnant women of first pregnancy were selected as the control group，two groups of women taken trial of labor，two groups of maternal success rate of vaginal delivery，reasons of vaginal delivery failure were compared，two groups of maternal average labor time，uterine rupture，postpartum bleeding，vaginal delivery and neonatal asphyxia were compared.Result：In the observation group，the success rated of vaginal delivery(76.8%) was lower than that in the control group(88.9%)，there was statistically significant differenced(P<0.05)；reasons of vaginal delivery failure in the observation group were fetal distress，uterine atony，umbilical cord prolapse and threatened uterine rupture.The average birth process，postpartum hemorrhage，newborn asphyxia and vaginal delivery rate in two groups had no significant differences(P>0.05).Conclusion：Vaginal delivery on subsequent pregnancy after cesarean section pregnancy is relatively higher success rate，and less complications，it has high feasibility and safety.
, 百拇医药
【Key words】 Caesarean section； Re pregnancy； Vaginal delivery
First-author’s address：Baoan District Shiyan People’s Hospital of Shenzhen，Shenzhen 518108，China
孕产妇在施行剖宫产术后便会使子宫形成瘢痕，即通常所指的瘢痕子宫。近年来，随着剖宫产率的逐渐增加，瘢痕子宫的孕产妇也越来越多。长期以来，对于瘢痕子宫采取再次剖宫产还是自然分娩尚存在争议[1]。研究显示，瘢痕子宫者再次行剖宫产术会给母婴带来较多并发症[2]。因此，在严格掌握剖宫产适应证的同时，应尽最大努力提高阴道试产率。为了研究剖宫产术后再次妊娠阴道试产的可行性及安全性，笔者所在医院对56例剖宫产术后再次妊娠并阴道试产的产妇的临床资料进行分析，现报告如下。
1 资料与方法
, http://www.100md.com
1.1 一般资料
选择2014年2月-2015年12月在笔者所在医院妇产科住院的剖宫产术后再次妊娠产妇56例作为研究对象，并作为观察组。纳入标准：(1)距离上次剖宫产时间为3年以上；(2)无妊娠高血压、糖尿病等并发症；(3)胎心率、胎位及胎盘功能正常；(4)具有1～2次剖宫产经历，B超显示子宫瘢痕愈合良好；(5)产妇及产妇家属经充分了解瘢痕子宫妊娠阴道试产的优势与缺点，愿意承擔相关风险，并签署知情同意书。其中，产妇年龄23～38岁，平均(26.9±5.3)岁，孕周37～42周，平均(38.9±1.1)周。选择同期初次妊娠的45例孕产妇为对照组，无妊娠并发症及合并症，胎检正常，具有阴道分娩的条件。其中，产妇年龄21～30岁，平均(22.3±4.5)岁，孕周37～42周，平均(38.6±1.0)周。两组产妇年龄、孕周等一般资料比较差异无统计学意义(P>0.05)，有可比性。, http://www.100md.com(鞠春玲 刘小玲)
【关键词】 剖宫产； 再次妊娠； 阴道试产
doi：10.14033/j.cnki.cfmr.2017.5.010 文献标识码 B 文章编号 1674-6805(2017)05-0020-03
, 百拇医药
Analysis on the Feasibility and Safety of Vaginal Delivery after Cesarean Section Pregnancy/JU Chun-ling，LIU Xiao-ling.//Chinese and Foreign Medical Research，2017，15(5)：20-22
【Abstract】 Objective：To explore the feasibility and safety of vaginal delivery of pregnancy after cesarean section.Method：From February 2014 to December 2015 in our hospital obstetrics and gynecology，56 cases of pregnant women after cesarean section pregnancy were selected as the observation group，45 cases of normal pregnant women of first pregnancy were selected as the control group，two groups of women taken trial of labor，two groups of maternal success rate of vaginal delivery，reasons of vaginal delivery failure were compared，two groups of maternal average labor time，uterine rupture，postpartum bleeding，vaginal delivery and neonatal asphyxia were compared.Result：In the observation group，the success rated of vaginal delivery(76.8%) was lower than that in the control group(88.9%)，there was statistically significant differenced(P<0.05)；reasons of vaginal delivery failure in the observation group were fetal distress，uterine atony，umbilical cord prolapse and threatened uterine rupture.The average birth process，postpartum hemorrhage，newborn asphyxia and vaginal delivery rate in two groups had no significant differences(P>0.05).Conclusion：Vaginal delivery on subsequent pregnancy after cesarean section pregnancy is relatively higher success rate，and less complications，it has high feasibility and safety.
, 百拇医药
【Key words】 Caesarean section； Re pregnancy； Vaginal delivery
First-author’s address：Baoan District Shiyan People’s Hospital of Shenzhen，Shenzhen 518108，China
孕产妇在施行剖宫产术后便会使子宫形成瘢痕，即通常所指的瘢痕子宫。近年来，随着剖宫产率的逐渐增加，瘢痕子宫的孕产妇也越来越多。长期以来，对于瘢痕子宫采取再次剖宫产还是自然分娩尚存在争议[1]。研究显示，瘢痕子宫者再次行剖宫产术会给母婴带来较多并发症[2]。因此，在严格掌握剖宫产适应证的同时，应尽最大努力提高阴道试产率。为了研究剖宫产术后再次妊娠阴道试产的可行性及安全性，笔者所在医院对56例剖宫产术后再次妊娠并阴道试产的产妇的临床资料进行分析，现报告如下。
1 资料与方法
, http://www.100md.com
1.1 一般资料
选择2014年2月-2015年12月在笔者所在医院妇产科住院的剖宫产术后再次妊娠产妇56例作为研究对象，并作为观察组。纳入标准：(1)距离上次剖宫产时间为3年以上；(2)无妊娠高血压、糖尿病等并发症；(3)胎心率、胎位及胎盘功能正常；(4)具有1～2次剖宫产经历，B超显示子宫瘢痕愈合良好；(5)产妇及产妇家属经充分了解瘢痕子宫妊娠阴道试产的优势与缺点，愿意承擔相关风险，并签署知情同意书。其中，产妇年龄23～38岁，平均(26.9±5.3)岁，孕周37～42周，平均(38.9±1.1)周。选择同期初次妊娠的45例孕产妇为对照组，无妊娠并发症及合并症，胎检正常，具有阴道分娩的条件。其中，产妇年龄21～30岁，平均(22.3±4.5)岁，孕周37～42周，平均(38.6±1.0)周。两组产妇年龄、孕周等一般资料比较差异无统计学意义(P>0.05)，有可比性。, http://www.100md.com(鞠春玲 刘小玲)