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目的:分析剖宫产后再次妊娠阴道分娩临床实施方法。方法:选取154例剖宫产后疤痕子宫再次妊娠的孕产妇作为研究对象,其中89例孕产妇采取剖宫产分娩,65例孕产妇采取阴道试产分娩,其中经阴道试产的65例孕产妇再分为试产成功组和试产失败组;试产失败组的孕产妇纳入采取剖宫产分娩的孕产妇合并为剖宫产组,分析所有孕产妇的分娩结局,对比剖宫产组与试产成功组的分娩结局及新生儿Apgar评分。结果:在154例剖宫产后疤痕子宫后再次妊娠的孕产妇中,采取剖宫产分娩率57.79%,阴道试产率42.21%,其中试产成功率为73.85%,经阴道分娩率为31.17%,试产失败率为16.15%,试产失败原因:头盆不对称7例、胎儿宫内窘迫6例、宫缩乏力2例、先兆子宫破裂2例;试产成功组孕产妇的围产期出血量显著少于剖宫产组,产褥期感染发生率、新生儿黄疸、湿肺或窒息发生率均显著小于剖宫产组,差异具有统计学意义(P<0.05);而剖宫产组与试产成功组新生儿Apgar评分比较,差异均无统计学意义(P>0.05)。结论:剖宫产疤痕子宫不能作为再次妊娠孕产妇采取剖宫产分娩的绝对指征,在严格掌握阴道试产适应证的基础上,采取经阴道分娩,有利于减少产时出血量,降低剖宫产率,减少剖宫产并发症的发生,改善分娩结局。
Objective: To analyze the clinical implementation of vaginal delivery after cesarean section. Methods: A total of 154 pregnant women with scar uterine uterus after cesarean section were enrolled in this study. Among them, 89 pregnant women adopted cesarean delivery, 65 pregnant women took vaginal trial delivery, of which 65 cases were vaginal trial The mothers were divided into the successful trial group and the failed trial group. The pregnant women who failed the test group were enrolled in the cesarean section group and the cesarean section group. The delivery outcomes of all the pregnant women were analyzed. Compared with the cesarean section group Results of childbirth and neonatal Apgar scores in the successful trial group. Results: Among 154 pregnant women who had recurrent pregnancy after cesarean section, 57.79% were delivered by cesarean section and 42.21% by vaginal test. The trial success rate was 73.85% and the vaginal delivery rate was 31.17 %, Trial production failure rate was 16.15%, pilot production failure causes: 7 cases of head basin asymmetry, fetal distress in 6 cases, uterine inertia in 2 cases, 2 cases of threatened uterine rupture; successful trial group pregnant women perinatal The incidence of bleeding was significantly less than that of cesarean section, the incidence of puerperium infection, neonatal jaundice, wet lung or asphyxia were significantly less than those of cesarean section (P <0.05) Compared with the Apgar score of successful neonatal trial group, there was no significant difference (P> 0.05). Conclusion: Cesarean section scar uterus can not be taken as an absolute indication of cesarean section delivery for pregnant women of the second trimester. On the basis of strictly grasping the indications of vaginal trial, transvaginal delivery is helpful to reduce the amount of bleeding during delivery and to reduce the rate of delivery Palace yield, reduce the incidence of complications of cesarean section, improve delivery outcomes.