剖宫产术后瘢痕子宫足月妊娠阴道试产的临床观察.docxVIP

剖宫产术后瘢痕子宫足月妊娠阴道试产的临床观察 [摘要 ] 目的探讨剖宫产术后瘢痕子宫再次妊娠足月产 妇阴道试产的安全性及可行性。 方法方便选取 2012 年 1 月― 2015  年  1 月，郑州大学第五附属医院产科收治的  70 例剖宫 产术后瘢痕子宫再次足月妊娠产妇及同时间段 70 例非瘢痕 子宫足月妊娠初产妇行回顾性分析，观察比较妊娠结局相关 指标。结果剖宫产术后瘢痕子宫足月妊娠中阴道分娩成功 40 例， 30 例剖宫产， 1 例先兆子宫破裂，与非瘢痕子宫组阴道 试产成功率比较，差异无统计学意义（ P0.05）。两组产程时间及新生儿 Apgar 评分比较，差异无统计学意义（ P0.05），产时出血量比较的差异有统计学意义（ P0.05）。两组产妇积 极治疗后预后均良好。结论目前剖宫产术后瘢痕子宫再次足月妊娠中，阴道试产是可行的，鉴于相关风险，应严格掌握适应症，做好沟通工作，严观产程进展，做好急诊手术、输血及急救准备，以尽可能保证母婴安全。 [关键词 ] 剖宫产术后瘢痕子宫；足月妊娠；分娩方式； 阴道试产 [中图分类号 ] R719.8 [文献标识码 ] A [文章编号 ] 1674-0742（ 2016） 04（a） -0010-03 [Abstract] Objective To observe the safety and feasibility of vaginal trial production of full-term pregnancy with scar uterus after cesarean section. Methods 70 cases of puerperas with full-term repregnancy with scar uterus after cesarean section admitted and treated in our hospital from January 2012 to January 2015 and 70 cases of primiparas with full-term pregnancy with non-scar uterus were retrospectively analyzed ， and the relevant indexes of pregnancy outcome were observed and compared. Results In the full-term pregnancy with scar uterus after cesarean section group ， successful vaginal delivery occurred to 40 cases ， cesarean section occurred to 30 cases， threatened uterine rupture occurred to 1 case ， and the difference in the successful rate of vaginal trial production had no statistical significance compared with the non-scar uterus group （ P0.05）， the differences in the birth process time and Apgar score in newborns between the two groups had no statistical significance（ P0.05）， the difference in the blood loss at birth had statistical significance（ P0.05）， the prognoses of both group were good after active treatment. Conclusion At present ， the vaginal trial production is feasible in the full-term repregnancy with scar uterus after cesarean section. Considering the relevant risks ， we should strictly master indication ， do a good job in communication ， strictly observe the evaluation of birth process ， do a good job in emerge