CAJ | 학술논문

目的：探讨瘢痕子宫再次妊娠分娩方式的选择和可行性，降低剖宫产率。方法对本院2011年1月～2013年12月瘢痕子宫再次妊娠的615例产妇临床资料进行回顾性分析，按分娩方式的不同分为再次剖宫产组536例，经阴道试产分娩组79例，并选取同期非瘢痕子宫经阴道试产产妇3470例与瘢痕子宫经阴道试产产妇117例及首次剖宫产的产妇2274例与再次剖宫产的产妇536例进行分析比较。结果再次剖宫产组和阴道分娩组在新生儿 Apgar 评分、体重方面比较差异均无统计学意义（P>0.05）；瘢痕子宫经阴道分娩产后出血发生率小于再次剖宫产产后出血率，具有显著差异（P＜0.05）；瘢痕子宫经阴道分娩成功率及顺产率均小于非瘢痕子宫阴道试产产妇，均具有显著差异（P＜0.05）；瘢痕子宫阴道试产的孕妇在侧切、产钳使用、产后出血方面与非瘢痕子宫阴道试产的孕妇比较，均无显著差异（P＞0.05）；再次剖宫产产妇在切口感染、介入、羊水栓塞方面与首次剖宫产产妇比较，均无显著差异（P＞0.05）；再次剖宫产产妇子宫切除率、产后出血率大于首次剖宫产产妇，均有显著差异（P＜0.05）。结论对瘢痕子宫再次妊娠分娩孕妇应进行综合评估，采取合适的分娩方式，另外需严格掌握首次剖宫产指征。
목적：탐토반흔자궁재차임신분면방식적선택화가행성，강저부궁산솔。방법대본원2011년1월～2013년12월반흔자궁재차임신적615례산부림상자료진행회고성분석，안분면방식적불동분위재차부궁산조536례，경음도시산분면조79례，병선취동기비반흔자궁경음도시산산부3470례여반흔자궁경음도시산산부117례급수차부궁산적산부2274례여재차부궁산적산부536례진행분석비교。결과재차부궁산조화음도분면조재신생인 Apgar 평분、체중방면비교차이균무통계학의의（P>0.05）；반흔자궁경음도분면산후출혈발생솔소우재차부궁산산후출혈솔，구유현저차이（P＜0.05）；반흔자궁경음도분면성공솔급순산솔균소우비반흔자궁음도시산산부，균구유현저차이（P＜0.05）；반흔자궁음도시산적잉부재측절、산겸사용、산후출혈방면여비반흔자궁음도시산적잉부비교，균무현저차이（P＞0.05）；재차부궁산산부재절구감염、개입、양수전새방면여수차부궁산산부비교，균무현저차이（P＞0.05）；재차부궁산산부자궁절제솔、산후출혈솔대우수차부궁산산부，균유현저차이（P＜0.05）。결론대반흔자궁재차임신분면잉부응진행종합평고，채취합괄적분면방식，령외수엄격장악수차부궁산지정。
Objective To explore the option and feasibility of the uterine scar pregnancy again and reduce the rate of cesarean delivery. Methods A total of 615 cases of puerperal clinical patients in the hospital from January 2011 to De-cember 2013 were analyzed. According to the pregnancy type, cesarean section again included 536 cases and vaginal delivery included 79 cases. And 3470 cases of vaginal delivery were selected by compared 117 cases uterine scar vagi-nal delivery, plus 2274 cases of cesarean delivery for the first time were selected by compared 536 cases of cesarean section again. Results Cesarean section again group and vaginal delivery group in the Apgar score, weight, the differ-ence was not statistically significant(P>0.05); The postpartum hemorrhage rate in uterine scar vaginal delivery group were significantly smaller than the cesarean sections again group (P<0.05);Success ratio and natural delivery in uterine scar vaginal delivery group were smaller than the vaginal delivery group (P<0.05); The episiotomy, the use of for-ceps and the postpartum hemorrhage were no significantly between uterine scar vaginal delivery group and vaginal de-livery group (P>0.05); Incision infection, interventional surgery and amniotic fluid embolism were no significantly be-tween cesarean sections again group and cesarean delivery for the first time group (P>0.05); The uterus resection rate and the postpartum hemorrhage of cesarean sections again group were significantly higher than the cesarean deliv-ery for the first time group (P<0.05). Conclusion It has to master the indications of uterine scar pregnancy again vagi-nal delivery, and keep to closely watch over the situation that meets the conditions for the trial production, in addition, the first cesarean section should be strictly controlled.