子宫下段横切口剖宫产史(1次)足月妊娠分娩方式选择对母儿安全性的研究  

Safety Analysis of Mother and Child in the Delivery Method Choice of Term Pregnancy after Cesarean Section by Transverse Incision in the Lower Uterus(One Time)

作　　者：刘山[1] 曹广慧 谢海娟 谢含芳 许林珺 LIU Shan;CAO Guanghui;XIE Haijuan(Tongling Maternal and Children Health Care Hospital,Tongling City,Anhui Province 244000)

机构地区：[1]安徽省铜陵市妇幼保健院妇产科,244000

出　　处：《医学理论与实践》2022年第4期565-568,共4页The Journal of Medical Theory and Practice

摘　　要：目的:探讨子宫下段横切口剖宫产史(1次)足月妊娠试产条件和选择不同分娩方式对母儿安全性。方法:选取2017年1月—2019年12月在本院住院分娩138例子宫下段横切口剖宫产史(1次)足月妊娠产妇,符合规定的阴道试产条件,选择阴道试产45例、再次剖宫产93例。比较两种不同分娩方式产后出血量、产后体温、产褥感染、切口感染率、抗生素使用率、新生儿Apger评分1min≤7分和5min≤7分、新生儿湿肺、新生儿出生体重、住院时间及费用等母儿产后安全及费用指标。结果:选择阴道试产组阴道分娩成功率84.4%,中途转剖宫产占15.6%,无子宫破裂发生。与阴道试产组比较,再次剖宫产组在产后24h出血量、产后体温>37.2℃发生率、切口感染率、抗生素使用率、新生儿湿肺发生率方面均显著高(P<0.05);新生儿1min Apgar评分≤7分占比更低,5min Apgar评分≤7分占比和新生儿出生体重更高,但差异无统计学意义(P>0.05)。与阴道试产成功(阴道分娩)相比,再次剖宫产住院费用高(P<0.05),平均住院时间长(P>0.05);与阴道试产失败(行剖宫产术)相比,再次剖宫产住院费用少和住院时间短(P>0.05)。结论:相对再次剖宫产分娩方式,阴道试产对子宫下段横切口剖宫产史(1次)足月妊娠产妇和新生儿不良影响较小,具有显著的选择优势,临床应首先选择阴道试产。Objective:To analyze the term pregnancy delivery condition after crosscut on the lower uterus of cesarean section(one time)and safety of mother and child in the delivery method choice.Methods:138 cases of term pregnancy women with history of cesarean section by transverse incision in the lower segment(one time)and giving birth in our hospital from January 2017 to December 2019 were included.All pregnant women met the requirements of vaginal trial production,in which 45 cases chose vaginal trial production,and the other 93 cases still chose cesarean section.Two different delivery options was compared in the aspects of the amount of postpartum hemorrhage,postpartum fever,puerperal infection,incisional infection rate,antibiotic utilization,neonatal 1 min≤7 score and 5 min≤7 score Apger score,wet lung and birth weight of the newborn,hospital stays and fees,and other postpartum safety and cost indicators.Results:The success rate of vaginal delivery was 84.4%.And the rate of midway turns into cesarean section was 15.6%.No uterine rupture occurred.Compared with vaginal delivery group,repeated cesarean section group had more amount of postpartum hemorrhage 24 hours after delivery,higher rate of postpartum fever,incisional infection,antibiotic utilization and wet lung of newborn(P<0.05).Newborns of those with repeated cesarean section had lower 1 min Apgar score≤7 score,higher 5 min Apgar score≤7 score and weight of the newborn,but there was no statistical significance between the two groups(P>0.05).Repeated cesarean section had higher hospital fees(P<0.05)and longer hospitalization than successful vaginal delivery(P>0.05),but had lower hospital fees and shorter hospitalization than failure vaginal delivery then cesarean section(P>0.05).Conclusion:For pregnancy women with history of cesarean section by transverse incision in the lower uterus(one time)who could meet the requirements of vaginal trial production,vaginal birth was a safe and economical delivery choice relative to repeated cesarean section.

关 键 词：子宫下段横切口剖宫产 阴道试产 再次剖宫产 

分 类 号：R719.82[医药卫生—妇产科学]