瘢痕子宫再次妊娠早产经阴道分娩的可行性以及对母婴结局的影响(1)
[摘要]目的 探讨瘢痕子宫(SU)再次妊娠早产经阴道分娩的可行性及对母婴结局的影响。方法 选取2015年1月～2018年1月我院收治的剖宫产SU再次妊娠早产产妇68例(进行阴道分娩)作为观察组，对照组为同期选取的50例经阴道分娩后再次妊娠进行阴道分娩的早产产妇，比较两组分娩情况及母婴结局情况。结果 观察组产程时间为(15.11±0.69)h、住院时间为(6.32±1.63)d，明显长于对照组的(4.43±0.32)h、(2.35±1.12)d，(P<0.05)。观察组产后2 h出血量为(213.27±30.05)ml，明显多于对照组的(150.43±20.04)ml，差异有统计学意义(P<0.05);两组新生儿出生后神经行为功能评分、Apgar评分、新生儿体重及并发症发生情况比较，差异无统计学意义(P>0.05)。结论 SU再次妊娠早产经阴道分娩的安全性较高，值得大力推广使用。
[关键词]瘢痕子宫;再次妊娠;阴道分娩;可行性;母婴结局
[中图分类号] R714 [文献标识码] A [文章编号] 1674-4721(2019)9(a)-0140-03
Feasibility of vaginal delivery of preterm labor with scarred uterus and its impact on maternal and infant outcomes
KONG Zhi-wei ZHOU Mei-juan QUAN Xiao-guang
Department of Obstetrics and Gynecology， Foshan Nanhai District Maternal and Child Health Hospital， Guangdong Province， Foshan 528200， China
[Abstract] Objective To analyze the feasibility of vaginal delivery of premature delivery in scar uterus (SU) with second pregnancy and its effect on maternal and infant outcomes. Methods A total of 68 cases of premature women with cesarean SU who treated in our hospital from January 2015 to January 2018 were selected as the observation group， and 50 cases of premature women who pregnant again after vaginal delivery were selected as the control group during the same period. The delivery situation and maternal and infant outcomes of the two groups were compared. Results The duration of labor and hospitalization in the observation group were (15.11±0.69) h and (6.32±1.63) d， which were significantly longer than those in the control group ([4.43±0.32] h) and ([2.35±1.12] d) (P<0.05). The amount of postpartum bleeding in the observation group ([213.27±30.05] ml) was significantly more than that in the control group ([150.43±20.04] ml)， the difference was statistically significant (P<0.05). There was no significant difference in neurobehavioral function score， Apgar score， neonatal weight and complications after birth (P>0.05). Conclusion The safety of vaginal delivery of preterm labor with SU is high， and it is worth popularizing.
[Key words] Scarred uterus; Second pregnancy; Vaginal delivery; Feasibility; Maternal and infant outcomes
剖宮产术是产科领域中的重要手术，是经腹切开母体子宫分娩胎儿，一般是阴道分娩对母体或胎儿生命健康有影响时采用。医学水平的提升使剖宫产技术更加完善，分娩痛苦低，因此越来越多的产妇选择剖宫产，临床瘢痕子宫(SU)率逐渐提高[1]。SU再次妊娠容易出现产后出血异常、胎盘前置、子宫破裂等情况，若合并严重盆腹腔粘连，再次行剖宫产会增加盆腔重要脏器损伤风险，从而引发不良后果[2]，同时剖宫产新生儿并发呼吸系统异常及发生弱视的概率高于阴道分娩新生儿，其抵抗力远低于阴道分娩新生儿。传统的观念中，SU再次妊娠的孕妇在试产过程中出现子宫破裂风险较高，这也是SU孕妇能否安全试产的焦点所在。国外有大量文献报道足月SU自然分娩病例，研究结果表明严格掌握SU经阴道分娩指征，子宫破裂风险可能性低，而符合试产条件孕妇可行阴道试产。为了进一步研究SU再次妊娠早产经阴道分娩的可行性及对母婴结局的影响，特选取68例剖宫产SU再次妊娠早产产妇进行研究，现报道如下。, 百拇医药(孔志伟 周美娟 全晓广)
[关键词]瘢痕子宫;再次妊娠;阴道分娩;可行性;母婴结局
[中图分类号] R714 [文献标识码] A [文章编号] 1674-4721(2019)9(a)-0140-03
Feasibility of vaginal delivery of preterm labor with scarred uterus and its impact on maternal and infant outcomes
KONG Zhi-wei ZHOU Mei-juan QUAN Xiao-guang
Department of Obstetrics and Gynecology， Foshan Nanhai District Maternal and Child Health Hospital， Guangdong Province， Foshan 528200， China
[Abstract] Objective To analyze the feasibility of vaginal delivery of premature delivery in scar uterus (SU) with second pregnancy and its effect on maternal and infant outcomes. Methods A total of 68 cases of premature women with cesarean SU who treated in our hospital from January 2015 to January 2018 were selected as the observation group， and 50 cases of premature women who pregnant again after vaginal delivery were selected as the control group during the same period. The delivery situation and maternal and infant outcomes of the two groups were compared. Results The duration of labor and hospitalization in the observation group were (15.11±0.69) h and (6.32±1.63) d， which were significantly longer than those in the control group ([4.43±0.32] h) and ([2.35±1.12] d) (P<0.05). The amount of postpartum bleeding in the observation group ([213.27±30.05] ml) was significantly more than that in the control group ([150.43±20.04] ml)， the difference was statistically significant (P<0.05). There was no significant difference in neurobehavioral function score， Apgar score， neonatal weight and complications after birth (P>0.05). Conclusion The safety of vaginal delivery of preterm labor with SU is high， and it is worth popularizing.
[Key words] Scarred uterus; Second pregnancy; Vaginal delivery; Feasibility; Maternal and infant outcomes
剖宮产术是产科领域中的重要手术，是经腹切开母体子宫分娩胎儿，一般是阴道分娩对母体或胎儿生命健康有影响时采用。医学水平的提升使剖宫产技术更加完善，分娩痛苦低，因此越来越多的产妇选择剖宫产，临床瘢痕子宫(SU)率逐渐提高[1]。SU再次妊娠容易出现产后出血异常、胎盘前置、子宫破裂等情况，若合并严重盆腹腔粘连，再次行剖宫产会增加盆腔重要脏器损伤风险，从而引发不良后果[2]，同时剖宫产新生儿并发呼吸系统异常及发生弱视的概率高于阴道分娩新生儿，其抵抗力远低于阴道分娩新生儿。传统的观念中，SU再次妊娠的孕妇在试产过程中出现子宫破裂风险较高，这也是SU孕妇能否安全试产的焦点所在。国外有大量文献报道足月SU自然分娩病例，研究结果表明严格掌握SU经阴道分娩指征，子宫破裂风险可能性低，而符合试产条件孕妇可行阴道试产。为了进一步研究SU再次妊娠早产经阴道分娩的可行性及对母婴结局的影响，特选取68例剖宫产SU再次妊娠早产产妇进行研究，现报道如下。, 百拇医药(孔志伟 周美娟 全晓广)