瘢痕子宫再次妊娠阴道分娩的临床观察
2022-06-09
[摘要] 目的 探讨瘢痕子宫再次妊娠选择阴道分娩的临床效果。 方法 回顾性分析我院产科2010年1月～2014年1月收治瘢痕子宫阴道试产患者32例分娩资料。另选取我院同期收治的瘢痕子宫妊娠剖宫产患者25例作为对照组，并对两组患者产程时间、子宫破裂、出血、新生儿窒息、平均住院时间等情况进行临床观察。 结果 瘢痕子宫阴道试产患者32例中阴道分娩24例，阴道分娩率为79.17%;两组患者产程时间、Apger 评分比较差异无统计学意义（P >0.05），观察组术中出血量、产后出血量、平均住院时间与对照组比较均存在显著差异（P< 0.05）;两组患者并发症发生率比较差异有统计学意义（P <0.05）。 结论 通过严密产程观察，瘢痕子宫患者行阴道分娩是安全、方便的，能够有效减少手术痛苦，减少并发症发生。
[关键词] 瘢痕子宫;阴道分娩;产程;观察
[中图分类号] R714.4 [文献标识码] B [文章编号] 2095-0616（2015）02-61-03
Clinical observation of vaginal delivery of subsequent pregnancy in patients with scarred uterus
YANG Juan YANG Yonghua
Dalian City Maternity Hospital and Maternal and Child Health Hospital， Dalian 116033，China
[Abstract] Objective To study the clinical effect of vaginal delivery of subsequent pregnancy in patients with scarred uterus. Methods 32 patients with scarred uterus who were treated with trial of labor were randomLy analyzed， while the other 25 patients with scarred uterus who were treated with cesarean section were selected as the control groups， in our hospital from January 2010 to January 2014. To observe the labor time， uterine rupture， hemorrhage， neonatal asphyxia， and the average hospital stay and other situation of the two groups. Results Of the 32 patients with scarred uterus who were treated with trial of labor， the vaginal delivery rate was 79.17% with 24 patients treated with vaginal delivery. The labor time and Apger score was no statistical significance compared with the two groups （P>0.05）. The intraoperative blood loss， the amount of postpartum bleeding， and the average hospital stay was statistical significance in treatment group compared with which in control group（P<0.05）. The complication rate between the two groups was statistical significance（P<0.05）. Conclusion Under close monitoring of duration of labor， vaginal delivery in patients with scarred uterus is safe and convenient， could effectively reduce the operative pains and complications.
[Key words] Scarred uterus; Vaginal delivery; Duration of labor; Observation
瘢痕子宫多见于行剖宫产术女性，其他诸如子宫肌瘤剔除术等妇科手术也会造成瘢痕子宫形成[1-2];近年来随着我国剖宫产率及妇科手术例数不断上升，瘢痕子宫产妇人数亦呈逐年增高趋势[3];此类产妇基本上是选择再次剖宫产，这样不但给患者增加了更多的经济负担，而且也给她们带来诸多并发症。本研究回顾性分析我院产科2010年1月～ 2014年1月收治瘢痕子宫阴道试产患者32例分娩临床资料，探讨瘢痕子宫再次妊娠患者采用阴道分娩的可行性，现报道如下。
1 资料与方法
1.1 一般资料
本研究资料来自于我院产科2010年1月～ 2014年1月收治瘢痕子宫阴道试产患者32例，年龄27 ～ 36岁，平均（29.7±4.3）岁;孕次1～6次，平均（3.26±2.01）次;孕周36～41周，平均（35.69±4.11）周;本次妊娠距上次剖宫产手术时间2 ～ 7年，平均（4.32±3.66）年。另选择我院同期收治的瘢痕子宫妊娠剖宫产患者25例作为对照组，年龄23～40岁，平均（28.2±5.8）岁，孕次1～5次，平均（3.05±2.00）次;孕周37～40周，平均（36.53±4.26）周;距离上次子宫手术时间2年或者2年以上，平均（4.12±3.59）年;两组患者前次手术均为子宫下段剖宫产术，均采用横切口。两组患者年龄、孕次、孕周等一般资料比较差异无统计学意义（P>0.05），具有可比性。
1.2 瘢痕子宫阴道试产指征
入选产妇均符合瘢痕子宫阴道试产指证且签
表1 两组患者产程时间、术中出血量、术后出血量、住院时间、Apger评分、并发症发生率比较分析
组别 n 产程时间
（h） 术中出血量
（mL） 产后出血量
（mL） 住院时间
（d） Apger评分
（分） 并发症发生情况
[关键词] 瘢痕子宫;阴道分娩;产程;观察
[中图分类号] R714.4 [文献标识码] B [文章编号] 2095-0616（2015）02-61-03
Clinical observation of vaginal delivery of subsequent pregnancy in patients with scarred uterus
YANG Juan YANG Yonghua
Dalian City Maternity Hospital and Maternal and Child Health Hospital， Dalian 116033，China
[Abstract] Objective To study the clinical effect of vaginal delivery of subsequent pregnancy in patients with scarred uterus. Methods 32 patients with scarred uterus who were treated with trial of labor were randomLy analyzed， while the other 25 patients with scarred uterus who were treated with cesarean section were selected as the control groups， in our hospital from January 2010 to January 2014. To observe the labor time， uterine rupture， hemorrhage， neonatal asphyxia， and the average hospital stay and other situation of the two groups. Results Of the 32 patients with scarred uterus who were treated with trial of labor， the vaginal delivery rate was 79.17% with 24 patients treated with vaginal delivery. The labor time and Apger score was no statistical significance compared with the two groups （P>0.05）. The intraoperative blood loss， the amount of postpartum bleeding， and the average hospital stay was statistical significance in treatment group compared with which in control group（P<0.05）. The complication rate between the two groups was statistical significance（P<0.05）. Conclusion Under close monitoring of duration of labor， vaginal delivery in patients with scarred uterus is safe and convenient， could effectively reduce the operative pains and complications.
[Key words] Scarred uterus; Vaginal delivery; Duration of labor; Observation
瘢痕子宫多见于行剖宫产术女性，其他诸如子宫肌瘤剔除术等妇科手术也会造成瘢痕子宫形成[1-2];近年来随着我国剖宫产率及妇科手术例数不断上升，瘢痕子宫产妇人数亦呈逐年增高趋势[3];此类产妇基本上是选择再次剖宫产，这样不但给患者增加了更多的经济负担，而且也给她们带来诸多并发症。本研究回顾性分析我院产科2010年1月～ 2014年1月收治瘢痕子宫阴道试产患者32例分娩临床资料，探讨瘢痕子宫再次妊娠患者采用阴道分娩的可行性，现报道如下。
1 资料与方法
1.1 一般资料
本研究资料来自于我院产科2010年1月～ 2014年1月收治瘢痕子宫阴道试产患者32例，年龄27 ～ 36岁，平均（29.7±4.3）岁;孕次1～6次，平均（3.26±2.01）次;孕周36～41周，平均（35.69±4.11）周;本次妊娠距上次剖宫产手术时间2 ～ 7年，平均（4.32±3.66）年。另选择我院同期收治的瘢痕子宫妊娠剖宫产患者25例作为对照组，年龄23～40岁，平均（28.2±5.8）岁，孕次1～5次，平均（3.05±2.00）次;孕周37～40周，平均（36.53±4.26）周;距离上次子宫手术时间2年或者2年以上，平均（4.12±3.59）年;两组患者前次手术均为子宫下段剖宫产术，均采用横切口。两组患者年龄、孕次、孕周等一般资料比较差异无统计学意义（P>0.05），具有可比性。
1.2 瘢痕子宫阴道试产指征
入选产妇均符合瘢痕子宫阴道试产指证且签
表1 两组患者产程时间、术中出血量、术后出血量、住院时间、Apger评分、并发症发生率比较分析
组别 n 产程时间
（h） 术中出血量
（mL） 产后出血量
（mL） 住院时间
（d） Apger评分
（分） 并发症发生情况