瘢痕子宫再次妊娠182例分娩结局分析

Analysis of 182 Delivery Outcomes in Scarred Uterine Re-Pregnancy

摘要: 目的：研究瘢痕子宫再次妊娠经阴道分娩和剖宫产结束分娩对母婴结局的影响，分析瘢痕子宫再次妊娠经阴道分娩的可行性及安全性。方法：回顾性收集2021年7月~2022年12月西南医科大学附属医院产科收治的瘢痕子宫再次妊娠足月病人182例，依据试产结局分为剖宫产组(120例)和瘢痕子宫再次妊娠阴道试产组(62例)，比较两组产妇母婴结局，包括：产后出血量、新生儿Apgar评分、新生儿科住院率，分析瘢痕子宫再次妊娠阴道分娩组的产程时间以及会阴伤口情况。结果：62例瘢痕子宫再次妊娠阴道试产组成功60例(96.77%)，2例(2.23%)试产失败转为剖宫产组。瘢痕子宫再次妊娠阴道试产的产后出血量少于剖宫产组，差异有统计学意义(P < 0.05)，瘢痕子宫再次妊娠阴道试产组的产后恶露持续时间少于剖宫产组，差异有统计学意义(P < 0.05)，瘢痕子宫再次妊娠阴道试产组的产褥期纯母乳喂养率高于剖宫产组，差异有统计学意义(P < 0.05)。结论：瘢痕子宫再次妊娠者经充分评估后，无阴道试产禁忌症应提倡阴道试产，阴道分娩不仅可以降低产后出血等母婴并发症的发生率，而且可以缩短住院时间，降低剖宫产率，提高自然分娩率和母乳喂养率。

Abstract: Objective: To investigate the effects of vaginal delivery and cesarean section on maternal and infant outcomes in scar uterine reconception, and to analyze the feasibility and safety of vaginal delivery in scar uterus re-pregnancy. Methods: A total of 182 full-term patients with scarred uterus re-pregnancy admitted to the Department of Obstetrics of the Affiliated Hospital of Southwest Medical University from July 2021~December 2022 were retrospectively collected, and were divided into cesarean section group (120 cases) and scarred uterine re-pregnancy vaginal trial labor group (62 cases) according to the outcome of labor trial, and the maternal and infant outcomes of the two groups were compared, including: postpartum bleeding, neonatal Apgar score, neonatal hospitalization rate, and the duration of labor and perineal wound in the vaginal delivery group of scarred uterus re-pregnancy were analyzed. Results: 62 cases with scarred uterine re-pregnancy were successfully transferred to the cesarean section group in the vaginal trial group, and 2 cases (2.23%) were converted to the cesar-ean section group after failed the trial labor. The amount of postpartum bleeding in the cesarean uterine re-pregnancy vaginal trial was less than in the cesarean section group (P < 0.05), the duration of postpartum lochia in the scar uterine re-pregnancy vaginal trial group was less than in the cesarean section group (P < 0.05), and the rate of exclusive breastfeeding during the puerperium in the scarred uterine re-pregnancy vaginal trial group was higher than in the cesarean section group, and the difference was statistically significant (P < 0.05). Conclusion: After full evaluation, vaginal trial should be advocated for patients with scarred uterine re-pregnancy, which can not only reduce the incidence of maternal and infant complications such as postpartum hemorrhage, but also shorten the hospital stay, reduce the cesarean section rate, and improve the rate of spontaneous delivery and breastfeeding.