剖宫产后阴道试产的产时及产后评估  

Intrapartum Assessment of Trail of Labor after Cesarean Section in Women with Scarred Uterus

作　　者：单丹[1] 胡雅毅[1] 

机构地区：[1]四川大学华西第二医院,四川成都610041

出　　处：《实用妇产科杂志》2016年第8期605-608,共4页Journal of Practical Obstetrics and Gynecology

基　　金：国家自然科学基金青年科学基金(编号:81200452);四川省科技支撑计划项目(编号:2015SZ0139)

摘　　要：目的：探讨剖宫产后阴道试产（TOLAC）患者自然临产时及产后的评估及监测。方法：选择四川大学华西第二医院产科就诊的成功剖宫产后阴道分娩的患者42例（VBAC组）,及同期就诊的瘢痕子宫急诊剖宫产患者50例（CS组）和阴道分娩的初产妇50例（正常分娩组）为研究对象,对3组患者的母儿相关情况进行比较。结果：3组患者的年龄、孕周、孕前体质量指数（BMI）及妊娠合并症情况比较,差异无统计学意义（P〉0.05）,VBAC组胎儿双顶径（BPD）小于其他两组（P〈0.05）,宫颈Bishop评分高于其他两组（P〈0.05）。与正常分娩组比较,VBAC组产后2小时内出血量多（P〈0.05）,但产后2-24小时内出血量和新生儿5分钟Apgar评分差异无统计学意义（P〉0.05）。与CS组比较,VBAC组患者24小时出血量少且住院天数短（P〈0.05）,而新生儿5分钟Apgar评分差异无统计学意义（P〉0.05）。结论：自然临产后,胎儿双顶径较小且宫颈成熟度较高的瘢痕子宫患者可以进行阴道试产,与再次剖宫产相比可以减少产后出血量及住院天数。在TOLAC过程中需要动态观察,严密监护,尤其要注意预防产时和产后2小时出血。Objective：To explore the assessment and monitoring of trail of labor after cesarean section（TO- LAC） in pregnant women of scarred uterus with spontaneous onset of labor. Methods： Retrospective analysis of maternal and fetal outcomes was performed in 42 patients with successful vaginal birth after prior cesarean section（VBAC group）,50 patients who experienced repeated cesarean section with prior cesarean （CS group） and another 50 primiparas with successful vaginal deliveries were also analyzed（ natural birth group）. Results：There was no significant difference on the discrepancies of age, gestational weeks, pregestation body mass index and pregnancy related complications among the three groups（ P 〉 0.05）. Patients in the VBAC group had a smaller average fetal biparietal diameter（BPD） via ultrasound measurement than the other two groups（ P 〈 0. 05）. Bish- op scores of the uterus cervix in VBAC group were higher than the other two groups（ P 〈 0.05）. Compared with natural birth group, postpartum blood loss in the first 2 hours after delivery was greater in VBAC group （ P 〈 0. 05）,while the amount of bleeding hereafter was not significantly different （P 〉 0.05）. Compared with CS group,patients in the VBAC group experienced shorter hospitalization days and less postpartum blood loss（ P 〈 0.05）. The average 5 minute Apgar score of the newborns in VBAC group was not significantly different from the other two groups（ P 〉 0.05）. Conclusions：In spontaneous labor, women with a comparatively smaller fetal bipa- rietal diameter and a favorable cervix could have a try on trail of labor after cesarean section （TOLAC）. VBAC has advantages in reducing blood loss and shortening the length of hospitalization in comparison with repeated cesar- ean in women with scarred uterus. Dynamic observation and close monitoring are needed during trail of labor in these patients to prevent postpartum hemorrhage,especially in the first 2 hours after delivery.

关 键 词：剖宫产后阴道试产 再次剖宫产 产时监护 

分 类 号：R714.4[医药卫生—妇产科学]