CAJ | 학술논문

目的：探讨瘢痕子宫再次妊娠剖宫产对母婴的影响及并发症情况。方法选择南京医科大学附属江宁医院2010年4月至2013年6月收治的瘢痕子宫再次妊娠孕妇160例，行再次剖宫产；选择同期初次剖宫产孕妇160例进行对照研究，分析瘢痕子宫再次妊娠剖宫产对母婴结局的影响。结果瘢痕子宫再次剖宫产组手术时间、产时出血量、住院时间显著高于对照组（t值分别为5．843、6．494、3．961，均P＜0．05），而切口甲级愈合率显著低于对照组（χ2＝3．983，P＜0．05）。两组新生儿Apgar评分差异无统计学意义（t＝0．034，P＞0．05），且新生儿窒息和感染情况差异无统计学意义（χ2值分别为0．196、0．904，均P＞0．05）。但术后观察显示再次剖宫产组产后出血、胎盘植入、盆腔粘连等并发症发生率明显高于初次剖宫产组（χ2值分别为4．214、3．865、16．483，均P＜0．05）。结论瘢痕子宫再次妊娠剖宫产并发症明显增多，尤其对产妇影响较大，临床应加强剖宫产指征的控制，对于瘢痕子宫再次妊娠要慎重选择剖宫产，以减少再次剖宫产的远期并发症。
목적：탐토반흔자궁재차임신부궁산대모영적영향급병발증정황。방법선택남경의과대학부속강저의원2010년4월지2013년6월수치적반흔자궁재차임신잉부160례，행재차부궁산；선택동기초차부궁산잉부160례진행대조연구，분석반흔자궁재차임신부궁산대모영결국적영향。결과반흔자궁재차부궁산조수술시간、산시출혈량、주원시간현저고우대조조（t치분별위5．843、6．494、3．961，균P＜0．05），이절구갑급유합솔현저저우대조조（χ2＝3．983，P＜0．05）。량조신생인Apgar평분차이무통계학의의（t＝0．034，P＞0．05），차신생인질식화감염정황차이무통계학의의（χ2치분별위0．196、0．904，균P＞0．05）。단술후관찰현시재차부궁산조산후출혈、태반식입、분강점련등병발증발생솔명현고우초차부궁산조（χ2치분별위4．214、3．865、16．483，균P＜0．05）。결론반흔자궁재차임신부궁산병발증명현증다，우기대산부영향교대，림상응가강부궁산지정적공제，대우반흔자궁재차임신요신중선택부궁산，이감소재차부궁산적원기병발증。
Objective To investigate the influence of uterine scar re-pregnancy caesarean section on maternal and neonatal outcomes and its complications.Methods From April 2010 to June 2013 160 cases of women with uterine scar re-pregnancy hospitalized in Jiangning Affiliated Hospital of Nanjing Medical University were selected, and they underwent caesarean section.Another 160 pregnant women undergoing initial cesarean in corresponding period were selected for control study.The influence of repeated caesarean section on maternal and neonatal outcomes was analyzed.Results The operation time, intrapartum hemorrhage, hospitalization time of re-caesarean group were significantly more than the control group (t value was 5.843, 6.494 and 3.961, respectively, all P<0.05), but class A healing rate of incision was significantly lower than the control group (χ2 =3.983,P <0.05).The Neonatal Apgar scores of two groups were not significantly different (t =0.034,P>0.05), and there were no significant differences in neonatal asphyxia and infection rate between two groups (χ2 value was 0.196 and 0.904, respectively, both P>0.05).But the incidence of postpartum hemorrhage, placenta accrete and pelvic adhesions of re-caesarean group was significantly higher than the control group (χ2 value was 4.214, 3.865 and 16.483, respectively, all P<0.05).Conclusion Complications caused by re-caesarean in uterine scar re-pregnancy women increase, and they have large impact on mothers.Clinical indications for cesarean section should be controlled in order to control uterine scar re-pregnancy.And for uterine scar re-pregnancy women, cesarean section should be selected carefully to reduce long-term complications of cesarean section.