疤痕子宫再次分娩78例临床分析

目的：探讨疤痕子宫再次妊娠阴道分娩的安全性。方法整群选取2015年6月—2016年2月笔者援助的非洲桑给巴尔奔巴地区Abdalla Mzee医院疤痕子宫产妇78例的临床资料,分析疤痕子宫足月分娩方式的选择。结果①78例孕妇中有35例行阴道试产,试产率为44.87%(35/78),成功阴道分娩的31例,试产成功率为88.57%(31/35),4例因产程停滞行剖宫产,剖宫产率为60.26%(47/78),其中1例因子宫破裂行剖宫产。②既往有阴道分娩史的孕妇阴道试产率及阴道分娩率均明显高于无阴道分娩史者,差异有统计学意义(P<0.01)；③阴道分娩组及剖宫产组孕妇在年龄、孕周、新生儿窒息发生率、产褥感染方面比较,差异无统计学意义(P>0.05)；阴道分娩组产后2 h出血量、新生儿出生体重均明显低于剖宫产组,差异有统计学意义(P<0.01)。结论对符合试产条件的疤痕子宫给予阴道试产是可行的,但须严密观察产程进展,同时做好急诊手术准备。

Clinical Analysis of 78 Cases with Uterine Scar Re-pregnancy

Objective To discuss the safety of uterine scar re-pregnancy vaginal delivery. Methods The clinical data of 78 cases of delivery women with uterine scar in Abdalla Mzee hospital in Zanzibar Pemba area in Africa assisted by the writer from June 2015 to February 2016 were selected, and the choice of uterine scar full-term delivery methods was analyzed. Results ①Of the 78 cases of delivery women, 35 cases received vaginal trial production, and the trial production rate was 44.87% (35/78), successful vaginal delivery occurred to 31 cases, and the trial production success rate was 88.57% (31/35), 4 cases received caesarean section due to arrested labor, and the caesarean section rate was 60.26% (47/78), and 1 case re-ceived caesarean section due to uterine rupture. ②The vaginal trial production rate and vaginal delivery rate in patients with vaginal delivery history were obviously higher than those in patients without vaginal delivery history, and the difference had statistical significance(P<0.01).③The differences in the age, pregnant week, incidence rate of asphyxia neonatorum and puerperal infection between the vaginal delivery group and the caesarean section group had no statistical significance(P>0.05), the blood loss in postpartum 2 hours and neonatal birth weight in the vaginal delivery group were obviously lower than those in the caesarean section group, and the difference had statistical significance (P<0.01). Conclusion Vaginal trial production is feasible for the uterine scar meeting the trial production conditions, but we must closely observe the develop-ment of the delivery process, and make good preparation for the emergency operation at the same time.