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目的:探讨剖宫产术后再次妊娠分娩的最佳方式。方法:回顾分析上海交通大学医学院附属瑞金医院2004年1月—2012年9月剖宫产术后再次妊娠的286例孕妇的分娩方式,其中剖宫产234例,阴道试产52例,并随机抽取同期首次行剖宫产术300例孕妇为对照组。结果:286例孕妇中258例(90.2%)再次行剖宫产术,28例阴道分娩,试产成功率53.9%。阴道分娩组无大出血发生,再次剖宫产组发生10例(3.88%),对照组发生2例(0.67%),差异有统计学意义(P<0.05)。再次剖宫产组术中出血量(325.4±12.5)mL,高于对照组(225.6±26.8)mL及阴道分娩组(148.4±15.7)mL,差异有统计学意义(P<0.05)。再次剖宫产组平均手术时间(59.2±20.5)min,高于对照组(30.9±14.6)min;腹腔粘连146例(56.59%),高于对照组0例,差异均有统计学意义(P<0.05和0.01)。再次剖宫产组住院时间(7.2±0.9)d,与对照组(6.8±1.2)d和阴道分娩组(3.5±1.8)d比较,差异有统计学意义(P<0.05)。结论:瘢痕子宫再次妊娠不是剖宫产的绝对指征。有剖宫产史孕妇再次妊娠后,若无剖宫产指征,应增加阴道试产机会;而提高剖宫产手术水平,是降低剖宫产史孕妇再次剖宫产并发症的关键。
Objective: To explore the best way to re-deliver pregnancy after cesarean section. Methods: A retrospective analysis was conducted on the mode of delivery in 286 pregnant women who underwent re-pregnancy after cesarean section from January 2004 to September 2012 at Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine. Among them, 234 were cesarean and 52 were vaginal Three hundred pregnant women of the first cesarean section were randomly selected as the control group during the same period. Results: Among 286 pregnant women, 258 cases (90.2%) underwent cesarean section again and 28 cases were delivered vaginally. The success rate of trial production was 53.9%. There was no major bleeding in the vaginal delivery group. There were 10 cases (3.88%) in the cesarean section again and 2 cases (0.67%) in the control group, the difference was statistically significant (P <0.05). In the cesarean section group, the intraoperative blood loss was (325.4 ± 12.5) mL, which was significantly higher than that of the control group (225.6 ± 26.8) mL and the vaginal delivery group (148.4 ± 15.7) mL (P <0.05). In the second cesarean section group, the average operation time was 59.2 ± 20.5 min, higher than that of the control group (30.9 ± 14.6) min; 146 cases (56.59%) of the abdominal adhesions were higher than the control group (P0.05), the difference was statistically significant (P <0.05 and 0.01). In the second cesarean section, the length of hospital stay was (7.2 ± 0.9) days, which was significantly different from that in the control group (6.8 ± 1.2 days) and the vaginal delivery group (3.5 ± 1.8 days) (P <0.05). Conclusion: The second uterine scar pregnancy is not an absolute indication of cesarean section. Have a history of cesarean pregnancy pregnant women again, if there is no indication of cesarean section should increase the chance of vaginal trial; and improve the level of cesarean section is to reduce the history of cesarean section pregnant women again cesarean section complications.