标题：剖宫产后疤痕子宫再次妊娠阴道试产的效果及分娩结局分析

      作者：林小磊，张源凤，张媛    阳江市妇幼保健院产科，广东 阳江 529500

      卷次： 2023年34卷2期

      【摘要】 目的 分析剖宫产后疤痕子宫再次妊娠阴道试产的效果及分娩结局，为分娩方式的选择提供依据。方法 回顾性分析2019年1月至2020年12月在阳江市妇幼保健院产科因剖宫产后疤痕子宫再次妊娠阴道试产的126例产妇的临床资料，择同期非疤痕子宫且顺利经阴道分娩产妇80 例纳入对照组。将阴道分娩成功的86例纳入成功组，失败的40例纳入失败组。比较不同组别间产妇的临床资料，以及分娩情况和妊娠结局(包括新生儿体质量、Apgar评分、产后出血及产后发热等)。结果 失败组产妇的年龄、孕前体质量指数(BMI)及孕周分别为(33.02±4.20)岁、(24.07±1.48) kg/m2、(40.88±1.53)周，明显高于成功组的(28.02±5.14)岁、(22.20±1.70) kg/m2、(38.12±2.42)周和对照组的(27.91±3.22)岁、(21.97±1.33) kg/m2、(38.20±2.09)周，差异均有统计学意义(P<0.05)；对照组与成功组的年龄、孕前BMI及孕周比较差异均无统计学意义(P>0.05)；成功组与对照组在新生儿体质量、产后出血发生率及产后出血量、产后发热率方面比较差异均无统计学意义(P>0.05)；失败组产妇产后的出血发生率、产后发热率分别为22.50%、20.00%，产后出血量及新生儿体质量分别为(501.36±98.63) mL、(3.68±0.57) kg，明显高(多)于成功组的5.81%、5.81%、(197.15±35.95) mL、(3.24±0.43) kg和对照组的5.00%、5.00%、(180.53±30.83) mL、(3.31±0.65) kg，差异均有统计学意义(P<0.05)。结论 对于剖宫产后疤痕子宫再次妊娠,在严格把握适应证、严密监测的基础上，经阴道分娩是安全可行的，且经阴道分娩有利于降低剖宫产率，减少产后出血的发生。
      【关键词】 剖宫产；疤痕子宫；阴道分娩；产后出血；分娩结局
      【中图分类号】 R719.8 【文献标识码】 A 【文章编号】 1003—6350（2023）02—0257—04

Effect of vaginal trial delivery and delivery outcome of second pregnancy with scar uterus after cesarean section.LIN Xiao-lei, ZHANG Yuan-feng, ZHANG Yuan.
Department of Obstetrics, Yangjiang Maternal and Child Health Hospital,Yangjiang 529500, Guangdong, CHINA
【Abstract】 Objective To analyze the effect and outcome of vaginal trial delivery of second pregnancy withscar uterus after cesarean section, and to provide basis for the selection of delivery mode. Methods The clinical data of126 pregnant women with scar uterus after cesarean section who underwent vaginal trial delivery during January 2019 toDecember 2020 were retrospectively analyzed, of which 86 of successful vaginal delivery were included into the successgroup and 40 of failure were included into the failure group. Eighty pregnant women with no scar uterus and smooth vag-inal delivery in the same period were selected as the control group. The clinical data, delivery and pregnancy outcome ofpregnant women in different groups were compared, including neonatal weight, Apgar score, postpartum hemorrhage,and postpartum fever. Results The age, pre-pregnancy BMI, and gestational weeks of the failure group were (33.02±4.20) years, (24.07±1.48) kg/m2, (40.88±1.53) weeks, significantly higher than (28.02±5.14) years, (22.20±1.70) kg/m2,(38.12±2.42) weeks of the success group and (27.91±3.22) years, (21.97±1.33) kg/m2, (38.20±2.09) weeks of the controlgroup (P<0.05). There was no significant difference in age, pre-pregnancy BMI, and gestational weeks between the con-trol group and the success group (P>0.05). There was no significant difference in neonatal weight, incidence of postpar-tum hemorrhage, amount of postpartum hemorrhage, and postpartum fever between the success group and the controlgroup (P>0.05). The incidences of postpartum hemorrhage and postpartum fever, postpartum hemorrhage, and neonatalweight in the failure group were 22.50%, 20.00%, (501.36±98.63) mL, (3.68±0.57) kg, which were significantly higherthan 5.81%, 5.81%, (197.15±35.95) mL, (3.24±0.43) kg in the success group and 5.00%, 5.00%, (180.53±30.83) mL,(3.31±0.65) kg in the control group (P<0.05). Conclusion For the second pregnancy of scar uterus after cesarean sec-tion, transvaginal delivery is safe and feasible on the basis of strict grasp of indications and close monitoring, which canreduce the rate of cesarean section and the incidence of postpartum hemorrhage.
      【Key words】 Cesarean section; Scar uterus; Vaginal delivery; Postpartum hemorrhage; Delivery outcome　　　·短篇论著·doi:10.3969/j.issn.1003-6350.2023.02.024