经选择性剖宫产术的单胎分娩【剖宫产术后再次阴道分娩的临床观察】
[摘要] 目的 探讨剖宫产术后再次阴道分娩的可行性。 方法 回顾性分析我院近期收治的76例剖宫产术后再次阴道分娩产妇的临床资料作为观察组，随机选择同期住院的经阴道分娩的初产妇76例为对照组。比较两组阴道分娩成功率、产程时间、Apgar评分和出血量。 结果 观察组产妇阴道分娩成功率为90.8%（69/76），对照组为98.7%（75/76），差异无统计学意义（P ＞ 0.05）；两组产妇的产程时间（第一产程、第二产程及总产程时间）、新生儿Apgar评分（窒息程度及平均分）及出血量（产时出血量和产后出血量）比较，差异均无统计学意义（P ＞ 0.05）。 结论 对符合阴道分娩条件的剖宫产术后再次妊娠产妇，应给予进行阴道分娩机会，提高自然分娩率，减低剖宫产率。
[关键词] 剖宫产；阴道分娩；产妇
[中图分类号] R719.8 [文献标识码] A [文章编号] 1673-7210（2012）07（a）-0072-02
Clinical observation of vaginal delivery after caesarean section
ZHAO Xuehui LI Caihong
Department of Obstetrics, Maternal and Child Health of Baoji City, Shaanxi Province, Baoji 721000, China
[Abstract] Objective To investigate the feasibility of vaginal delivery after cesarean section. Methods The clinical data of 76 cases of multipara admitted to our hospital for vaginal delivery after cesarean section were analyzed retrospectively as the observation group, and 76 cases of primipara with vaginal delivery at the same period were randomly selected as the control group. The vaginal delivery success rate, labor duration, Apgar score and the amount of bleeding were compared between the two groups. Results The vaginal delivery success rate of the observation group was 90.8% (69/76), the control group was 98.7% (75/76), there was no statistically significant difference between the two groups (P > 0.05); the labor time (the first stage of labor and the second stage of labor and total labor time), Apgar score (the degree of asphyxia and the average points) and the amount of bleeding (the amount of bleeding in labor and postpartum hemorrhage volume) of the two groups had no statistically differences (P > 0.05). Conclusion If the multipara meet the conditions of vaginal delivery after cesarean section, should be given and the opportunity, in order to improve the natural birth rate and reduce the rate of cesarean section.
[Key words] Cesarean section; Vaginal delivery; Parturient
剖宫产是目前临床处理高危妊娠的一种重要手段，已被社会广泛接受。随着近年社会发展和医学模式的转变，剖宫产率不断上升，但剖宫产并不是一种符合生理的生育方式，而是一种创伤性手术，术后不仅形成瘢痕子宫，而且易出现切口感染、大出血等并发症[1]；另外，部分妇女面临着再次妊娠，选择何种方式分娩往往困扰着妇科医生。本文回顾性分析了我院近期收治的76例剖宫产术后再次阴道分娩产妇的临床资料，旨在为临床选择提供依据。
1 资料与方法
1.1 一般资料
选择2009年6月～2010年6月我院收治76例剖宫产术后再次阴道分娩的产妇作为观察组，年龄25～33岁，平均（27.3±5.6）岁；孕周36～41周，平均（38.6±1.5）周；两次分娩时间间隔3～6年，平均（4.7±2.1）年。纳入标准[2]：①仅有1次剖宫产史，子宫下段横切口，切口愈合良好；②子宫下段厚度≥3.5 mm；③此次妊娠距离前次剖宫产3年以上；④胎位正常，宫颈成熟良好，无绝对及相对头盆不称，无妊娠合并症及感染史；⑤前次剖宫产指征不存在，且未出现新的剖宫产指征；⑥签署知情同意书。同时随机选择同期住院的经阴道分娩的初产妇76例为对照组，年龄25～33岁，平均（27.1±5.2）岁；孕周36～41周，平均（38.3±1.6）周。两组产妇年龄、孕周等一般情况比较，差异无统计学意义（P > 0.05），具有可比性。