疤痕子宫阴道分娩的临床分析  

Clinical Analysis of Vaginal Delivery after Previous Caesarean Section

作　　者：陶艳萍[1,2] 张步振[1,3] 

机构地区：[1]第三军医大学 [2]昆明医科大学第一附属医院,云南昆明650032 [3]成都军区昆明总医院,云南昆明650032

出　　处：《昆明医科大学学报》2015年第12期131-133,共3页Journal of Kunming Medical University

摘　　要：目的分析疤痕子宫阴道分娩的可行性及母婴的安全性,以降低剖宫产率;对于试产失败的病例分析原因,探讨产程中的注意事项,为规范疤痕子宫阴道试产的产程监测提供依据.方法查阅病例资料,选取2014年1月至2014年12月昆明医科大学第一附属医院收治的疤痕子宫再次妊娠病例487例,其中142例进行阴道试产的病例作为研究对象,将阴道试产成功的113例产妇设为观察组,按照随机抽样的原则,选取昆明医科大学第一附属医院同期收治的非疤痕子宫再次妊娠阴道分娩的产妇113例作为对照组,将2组产妇的临床资料进行回顾性的对比分析;对阴道试产失败而改行剖宫产的病例分析原因,探讨监护措施及如何规避风险.结果疤痕子宫再次妊娠病例487例,其中142例行阴道试产,试产率29.2%,成功阴道分娩的有113例,成功率为79.6%,其余29例产妇试产失败改行剖宫产手术,手术指征分别为胎儿宫内窘迫9例,可疑子宫破裂3例,头盆不称5例,母亲要求8例,宫缩乏力1例.观察组和对照组的2组产妇分析结果显示:2组产妇在产程、出血量、住院时间、住院费用、新生儿Apgar评分等方面的差异无统计学意义(P>0.05).结论在充分评估后,疤痕子宫阴道分娩是可行的,母婴预后良好.产程中规范严密的监测和做好即刻剖宫产的准备是保障母婴安全的必要措施.疤痕子宫孕产妇进行阴道分娩可降低剖宫产率,值得推广应用.Objective To investigate the possibility and safety of vaginal delivery after previous caesarean section so as to reduce the rate of caesarean section; and to analyze the causes of failure in vaginal delivery, discuss the precautions during labor, and provide an evidence for vaginal delivery after previous caesarean section. Methods We selected 487 cases of uterine scar pregnancy admitted in our hospital from January to December in 2014 in this study. 142 of 487 cases tried for vaginal delivery. The clinical data of successful vaginal delivery were compared with those of 113 women of maternal pregnancy non-uterine scar in the same period. For the cases of failed vaginal delivery, the causes of failure were analyzed, and the monitoring measures and risk aversion were discussed. Results Of 142 cases （29.16%） who tried vaginal delivery, 113 （79.6%） succeeded and 29 cases （20.4%） converted to caesarean section after a failure vaginal delivery. The indications of caesarean section included fetal distress in 9 cases, cephalo-pelvic disproportion in 3 cases, suspicious of uterine rupture in 5 cases, mother required in 8 cases, and uterine atony in 1 case. There were no significant differences in stages of labor, amount of postpartum hemorrhage, hospital stays, hospitalization costs and new born Apgar scores between the two groups（P 〉 0.05） Conclusion Vaginal delivery after previous caesarean section is feasible and has good outcome for mother and baby on the basis of enough evaluation. Close monitoring and enough preparation for immediate cesarean delivery during labor are necessary to protect the maternal and infant safety. Vaginal delivery after previous caesarean section is a method to reducing the caesarean section rate, and should be popularized.

关 键 词：疤痕子宫 瘢痕子宫阴道分娩 产程监测 

分 类 号：R714.3[医药卫生—妇产科学]