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目的讨论剖宫产术后再次妊娠分娩合理方式的选择。方法分析我院2010年6月至2012年12月收治的剖宫产术后妊娠分娩者146例的临床资料,并将再次剖宫产者(RCS)与同阶段首次剖宫产(PCS)者90例行比对分析。结果 146孕妇中47例行阴道试产,试产成功32例,成功率68.1%;RCS114例,均顺利生产,剖宫产率78.1%。RCS组的术后出血量比剖宫产后阴道分娩(VBAC)组大,平均住院时间较VBAC组长,差异有显著意义(P<0.05)。RCS组出血量、住院时间及粘连率均高于PCS组,差异有显著意义(P<0.05)。VBAC组与RCS组在新生儿窒息率及1 minApgar评分方面比较无显著性差异(P>0.05)。结论剖宫产术后再次妊娠分娩并不是剖宫产的绝对指征,严格评估产妇情况,符合阴道试产条件者,严密监护下行阴道试产是安全的。
Objective To discuss the rational choice of pregnancy after cesarean delivery. Methods The clinical data of 146 cases of pregnancy and childbirth after cesarean section in our hospital from June 2010 to December 2012 were analyzed. The patients with re-cesarean section (RCS) and the first stage of cesarean section (PCS) 90 routine comparison analysis. Results Among the 146 pregnant women, 47 patients underwent vaginal trial production, 32 cases were successful trial, the success rate was 68.1%. All RCS114 cases were successfully produced, and the rate of cesarean section was 78.1%. The postoperative bleeding in RCS group was larger than that in VBAC group and the average length of hospital stay was significantly longer than that in VBAC group (P <0.05). The amount of bleeding, length of hospital stay and rate of adhesion in RCS group were higher than those in PCS group, the difference was significant (P <0.05). VBAC group and RCS group had no significant difference in neonatal asphyxia rate and 1 minApgar score (P> 0.05). Conclusion Reproductive pregnancy after cesarean section is not an absolute indication of cesarean section, strict assessment of maternal conditions, in line with vaginal trial production conditions, closely monitoring the vaginal trial production is safe.