孕期风险评估及管理在剖宫产术后再次妊娠分娩方式选择中的指导意义  

Guiding significance of risk assessment and management during pregnancy in the choice of delivery modes after previous cesarean section

作　　者：陈晓燕[1] 邓卉[1] 王瑞 

机构地区：[1]重庆市中医院妇产科,重庆400011 [2]蓬安县妇女儿童医院妇产科,四川蓬安637800

出　　处：《中国妇幼保健》2017年第15期3428-3431,共4页Maternal and Child Health Care of China

基　　金：重庆市卫生计生委医学科研计划项目(20142068)

摘　　要：目的探讨剖宫产术后再次妊娠孕期风险评估及管理方法对分娩方式选择的指导意义。方法采用回顾性分析法选取剖宫产术后再次妊娠的110例产妇作为研究对象,其中23例符合阴道试产的适应证且成功接受阴道分娩为对照组,另87例为观察组。对比两组产妇住院时间、新生儿Apgar评分、产褥病率、产后24 h内出血量、住院费用等指标。结果剖宫产术后再次妊娠分娩产妇中,阴道分娩成功率为85.2%(23/27),无1例发生子宫破裂。两组产妇住院时间、初次哺乳时间、产褥病率、产后大出血发生率、住院费用等指标差异有统计学意义(P<0.05),孕早期(孕45~50 d)hCG、孕酮、孕囊下缘距离子宫前壁瘢痕处距离及孕35~37周时子宫瘢痕处肌层的厚度、新生儿Apgar评分、新生儿体质量、新生儿窒息率、新生儿黄疸发生率及新生儿湿肺发生率等差异无统计学意义(P>0.05)。结论剖宫产术后再次足月妊娠分娩,通过严密进行孕期风险评估及管理,严格掌握阴道分娩适应证,严密观察产程,及时发现难产及处理,多数可经阴道安全分娩,剖宫产术后再次妊娠并非阴道分娩的绝对禁忌证。Objective To explore the guiding significance of risk assessment and management during pregnancy in the choice of delivery modes after previous cesarean section. Methods Retrospective analysis was used to select 110 pregnant women after previous cesarean section,of which 23 pregnant women met the indications of vaginal delivery and successfully accepted vaginal delivery（ control group）; the other 87 pregnant women were enrolled into study group. The hospitalization time,neonatal Apgar scores,puerperal morbidities,postpartum hemorrhage volumes within 24 hours after delivery,and hospitalization expenses were compared between the two groups. Results The successful rate of vaginal delivery was 85. 2%（ 23/27） without uterine rupture. There were statistically significant differences in the hospitalization time,the first lactation time,puerperal morbidity,incidence rate of postpartum hemorrhage,and hospitalization expense between the two groups（ P〈0. 05）. There was no statistically significant difference in human chorionic gonadotrophin（ hCG） level,progesterone level,the distance between the lower edge of gestational sac and uterine scar during early pregnancy（ 45-50 days） between the two groups; there was no statistically significant difference in myometrial thickness of uterine scar,neonatal Apgar score,neonatal weight,incidence rate of neonatal asphyxia,jaundice,wet lung during late pregnancy（ 35-37 gestational weeks）（ P〈0. 05）. Conclusion Most of the full-term pregnant women with previous cesarean section can deliver safely through vagina if the risk assessment and management method is strictly implemented,the indications and contraindications of vaginal delivery are grasped strictly,the labor process is observed closely,and the dystocia is detected and treated timely. What＇s more,a second pregnancy after previous cesarean section is not an absolute contraindication for vaginal delivery.

关 键 词：剖宫产术后再次妊娠 阴道分娩 风险评估 分娩方式 

分 类 号：R17[医药卫生—妇幼卫生保健]