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目的分析瘢痕子宫再次妊娠分娩方式及分娩结局,为临床提供指导。方法选择2011年2月—2015年3月分娩的瘢痕子宫再次妊娠产妇320例作为研究对象,根据分娩方式分为剖宫产组237例、阴道分娩组83例。比较两组产妇产后出血量、发热例数、住院时间及总费用。比较两组新生儿Apgar评分、新生儿体重及新生儿感染情况。比较首次剖宫产与再次剖宫产开剖至胎儿娩出时间、产时出血量及术后情况。计量资料采用t检验,计数资料采用χ2检验,P<0.05为差异有统计学意义。结果剖宫产组产后出血量、住院时间、总费用[(359.8±19.7)ml、(7.5±2.0)d、(6 037±872)元]均高于阴道分娩组[(226.2±18.0)ml、(4.3±1.2)d、(2 557±189)元],差异均有统计学意义(均P<0.05)。剖宫产组产后发热发生率为6.33%,高于阴道分娩组的0,差异有统计学意义(P<0.05)。剖宫产组再次剖宫产开剖至胎儿娩出时间、产时出血量[(15.0±2.7)min、(351±21)ml]均高于首次剖宫产[(10.4±1.7)min、(279±19)ml],差异均有统计学意义(均P<0.05)。首次剖宫产严重粘连发生率为0.31%;再次剖宫产为17.72%,两组比较差异有统计学意义(P<0.05)。结论除非有剖宫产指征的瘢痕子宫再次妊娠产妇应选择阴道分娩,以减少产后出血量和住院时间,降低费用,减少切口感染概率。
Objective To analyze the mode of delivery and delivery after scar pregnancy and to provide guidance for clinical application. Methods Two hundred and seventy pregnant women with scar pregnancy and uterus delivered from February 2011 to March 2015 were enrolled in this study. According to mode of delivery, they were divided into cesarean section group (n = 237) and vaginal delivery group (n = 83). Postpartum hemorrhage, fever cases, hospitalization time and total cost were compared between the two groups. Apgar score, neonatal weight and neonatal infection were compared between two groups. Compare the first cesarean section with the second cesarean section to the time of delivery of the fetus, the amount of bleeding during delivery and postoperative conditions. Measurement data using t test, count data using χ2 test, P <0.05 for the difference was statistically significant. Results The rate of postpartum hemorrhage, length of hospital stay and total cost in the cesarean section group [(359.8 ± 19.7) ml, (7.5 ± 2.0) d, (6 037 ± 872)] were significantly higher than those in the vaginal delivery group [(226.2 ± 18.0) ml , (4.3 ± 1.2) d, (2 557 ± 189) yuan], the difference was statistically significant (all P <0.05). The incidence of postpartum fever in cesarean section group was 6.33%, which was higher than that in vaginal delivery group (P <0.05). Cesarean section group cesarean section again until the time of delivery, the amount of bleeding during labor [(15.0 ± 2.7) min, (351 ± 21) ml] were higher than the first cesarean section (10.4 ± 1.7) min, ( 279 ± 19) ml], the difference was statistically significant (all P <0.05). The incidence of severe cesarean section was 0.31% for the first cesarean section and 17.72% for the second cesarean section. The difference between the two groups was statistically significant (P <0.05). Conclusion Unless pregnant women with indications of cesarean scar pregnancy again vaginal delivery should choose vaginal delivery to reduce the amount of postpartum hemorrhage and hospital stay, reduce costs and reduce the probability of wound infection.