剖宫产术后再次妊娠阴道分娩妊娠结局的分析  

Analysis of the outcome of labor after cesarean section

作　　者：刘霞 陈宇清[1,2] 刘佳华[3] 陈豪[2] 江亚涛[2] 黄瑜[2] 周云[2] 林丽珍[2] 赵月明[2] LIU Xia;CHEN Yu-qing;LIU Jia-hua;CHEN Hao;JIANG Ya-tao;HUANG Yu;ZHOU Yun;LIN Li-zhen;ZHAO Yue-ming(Clinical Medical School of Fujian Provincial Hospital, Fujian Medical University, Fuzhou 350001, China;Department of Obstetrics, Fujian Provincial Hospital, Fuzhou 350001, China;Department of Gynecology, Fujian Provincial Hospital, Fuzhou 350001, China)

机构地区：[1]福建医科大学省立临床医学院,福州350001 [2]福建省立医院产科,福州350001 [3]福建省立医院妇科,福州350001

出　　处：《创伤与急诊电子杂志》2017年第4期185-188,共4页Journal of Trauma and Emergency(Electronic Version)

摘　　要：目的探讨剖宫产术后再次妊娠阴道试产(trial of labor after cesarean section,TOLAC)的妊娠结局。方法 2015年12月至2016年11月在本院分娩的孕周≥28周孕妇共2805例,其中既往一次剖宫产术史、再次妊娠单活胎、头先露、排除前置胎盘行TOLAC的孕妇共41例,最终剖宫产术后再次妊娠阴道分娩(vaginal birth after cesarean section,VBAC)孕妇36例纳入VBAC组;选择同期孕周≥28周、单活胎、排除前置胎盘、既往一次剖宫产术史再次妊娠行选择性再次剖宫产(elective repeat cesarean section,ERCS)447例孕妇为ERCS组,比较两组孕妇一般情况及妊娠结局。结果 (1)VBAC组孕妇年龄(31.0±4.5)岁,ERCS组(32.5±4.1)岁,差异有统计学意义(P<0.05);VBAC组孕期体质量增长(13.2±3.8)kg,ERCS组体质量增长(13.7±3.8)kg,差异无统计学意义(P>0.05)。(2)母儿结局:VBAC组孕妇产后出血量为(264±144)ml,新生儿出生体质量为(3026±693)g,住院天数(2.61±1.23)天,均低于ERCS组(P<0.05);VBAC组新生儿窒息率11.1%(4/36),高于ERCS组(7/447)(P<0.05);VBAC组子宫破裂0%,与ERCS组差异无统计学意义(P>0.05)。结论有1次剖宫产术史后再次妊娠阴道试产是可行的。Objective To discuss the outcome of trial of labor after cesarean section（TOLAC）. Methods A total of 2805 women delivered in our hospital from December 2015 to November 2016. Among them, 41 cases with one prior cesarean section（gestational age≤28 weeks, singleton, cephalic presentation, no placenta previa） were studied. Thirty-six cases with vaginal birth after cesarean section（VBAC） were allocated to VBAC group, while 447 with elective repeat cesarean section（ERCS） were allocated to ERCS group. The maternal and neonatal outcomes were compared between the two groups. Results（1） The age of VBAC group was（31.0±4.5） years old, which was younger than ERCS group with（32.5±4.1） years old（P0.05）. There was no significant difference about weight gain during pregnancy between the two groups, with（13.2±3.8） kg in VBAC group and（13.7±3.8） kg in ERCS group（P0.05）.（2） The comparison of the maternal and neonatal outcomes： in the VBAC group, the postpartum hemorrhage volume was（264±144） ml; the birth weight of the neonates was（3026±693） g; the hospitalization duration was（2.61±1.23）d, and there were significant differences between the two groups（P0.05）. Rate of newborn asphyxia in VBAC group（11.1%）（4/36） was higher than that in ERCS group（7/447）（P0.05）. There was no statistical difference about the uterine rupture rate between two groups（P0.05）, which was 0% in VBAC group. Conclusion It is a safe and feasible way of labor in women with only one prior cesarean section history.

关 键 词：剖宫产后阴道分娩 试分娩 妊娠结局 瘢痕 子宫 

分 类 号：R714.4[医药卫生—妇产科学]