517例剖宫产术后再次妊娠结局分析  

Analysis of 517 cases of re-pregnancy after cesarean section

作　　者：王燕[1] 

机构地区：[1]西安市中心医院妇产科,西安710003

出　　处：《西南国防医药》2016年第12期1481-1484,共4页Medical Journal of National Defending Forces in Southwest China

摘　　要：目的探讨剖宫产术后再次妊娠的分娩方式及相关影响因素。方法收集2012年1月-2015年6月入住我院的剖宫产术后再次妊娠的孕妇517例临床资料，总结分析其分娩方式、选择性重复剖宫产的指征、阴道试产结局的影响因素、产后出血量、新生儿窒息等指标。结果本组517例中，行选择性剖宫产的382例（73．9％），急诊剖宫产82例（15．8％）；阴道试产84例（16．2％），成功53例，试产成功率63．1％，阴道试产失败行急诊剖宫产31例（36．9％）。成功阴道分娩的相关因素：前次剖宫产指征为“胎位异常”16例（19％），前次剖宫产指征不明16例（19％），既往有阴道分娩史10例（11．9％），入院时已临产且宫颈Bishop评分〉5分的11例（13．1％）；剖宫产术后阴道分娩（VBAC）产后出血量（210±25）ml，选择性重复剖宫产（ERCS）后出血量（260±40）ml，二者间有统计学差异（P〈0．05）。VBAC中发生新生儿窒息4例（7．4％）（其中轻度窒息3例，重度窒息1例）；ERCS中发生新生儿窒息3例（0．6％），有统计学差异（P〈0．05）。结论剖宫产导致的瘢痕子宫不再是再次剖宫产的绝对手术指征，剖宫产后再次妊娠的阴道分娩有一定成功率，因此，符合阴道试产者应在严密监护下给予试产，从而降低剖宫产率。Objective To explore the mode of delivery and related influencing factors of re-pregnancy after cesarean section. Methods The clinical data on a total of 517 pregnant women who got pregnancy again after cesarean section and were admitted to our hospital from 2012 to 2015 were collected to summarize and analyze the mode of delivery, indications for elective repeated cesarean section, factors affecting the outcome of vaginal delivery, postpartum hemorrhage, neonatal asphyxia and other indicators. Results Among the 517 pregnant women, 382 （73.9%） received elective caesarean section and 82 emergency cesarean section （15.8%）; there were 84 cases （16.2%） of vaginal trial delivery, 53 （63.1%） of which succeeded; 31 pregnant women （36.9%） received emergency cesarean section after the failure of vaginal trial delivery. Factors relevant to successful vaginal delivery： 16 （19%） had indications of ＂abnormal fetal position＂ for previous cesarean section; 16（19%） had unknown indications for previous cesarean section; 10（11.9%） had history of vaginal delivery; 11 （13.1%） was about to give birth upon the admission and the cervical Bishop scoreshigher than five points. The hemorrhage volume after VBAC was 210±25 ml, and 260±40 ml after ERCS, showing no significant difference （P 〈 0.05）. There were four cases （7.4%） of asphyxia neonatorum （three minor cases and one severe case） in VBAC and three cases （0.6%） in ERCS, showing a significant difference（P 〈 0.05）. Conclusion There is certain success rate of VBAC. Scarred uterus of cesarean section is not an absolute indication. Re-pregnancy after cesarean section has a certain success rate of vaginal delivery, too. Therefore, trial delivery should be allowed for patients who meet the criteria of trial delivery under strict monitoring to reduce cesarean section rate.

关 键 词：剖宫产 再次妊娠 分娩方式 结局 新生儿窒息 

分 类 号：R714.23[医药卫生—妇产科学]