CAJ | 학술논문

目的：探讨剖宫产术后再次足月妊娠分娩方式的选择。方法选取石家庄市第四医院2012年1月至2013年5月瘢痕子宫再次足月妊娠188例患者完整的临床资料，就分娩方式及妊娠结局进行回顾性分析，随机选取同期非瘢痕子宫阴道分娩（VBNC）患者70例与瘢痕子宫阴道分娩（VBAC）59例进行对照研究；同时随机选取同期首次剖宫产（PCS）患者120例与再次剖宫产组（ RCS）120例进行比较。结果①选择阴道试产68例，成功59例，成功率86．76％；②VBNC组与VBAC组总产程、产后出血量、新生儿体重、住院费用及助产率比较均无统计学差异（t值分别为0．44、0．08、0．74、0．16，χ2＝0．38，均P＞0．05）；③VBAC组的产后出血量、住院时间及医疗费用明显低于RCS组（t值分别为6．43、7．30、11．50，均P＜0．05）；④RCS组的产后出血量、手术时间、盆腹腔粘连和前置胎盘的发生率均率均高于PCS组，差异有统计学意义（t值分别为6．10、4．75，χ2值分别为5．11、5．66，均P＜0．05），但两组脏器损伤、切口乙级愈合率及胎盘植入的发生率相比无统计学差异（χ2值分别为1．00、2．74、2．02，均P＞0．05）。结论剖宫产术后再次足月妊娠经阴道分娩具有必要性及可行性，只要掌握好阴道试产的适应症，严密监测，可在减少母婴并发症的同时降低再次剖宫产率。
목적：탐토부궁산술후재차족월임신분면방식적선택。방법선취석가장시제사의원2012년1월지2013년5월반흔자궁재차족월임신188례환자완정적림상자료，취분면방식급임신결국진행회고성분석，수궤선취동기비반흔자궁음도분면（VBNC）환자70례여반흔자궁음도분면（VBAC）59례진행대조연구；동시수궤선취동기수차부궁산（PCS）환자120례여재차부궁산조（ RCS）120례진행비교。결과①선택음도시산68례，성공59례，성공솔86．76％；②VBNC조여VBAC조총산정、산후출혈량、신생인체중、주원비용급조산솔비교균무통계학차이（t치분별위0．44、0．08、0．74、0．16，χ2＝0．38，균P＞0．05）；③VBAC조적산후출혈량、주원시간급의료비용명현저우RCS조（t치분별위6．43、7．30、11．50，균P＜0．05）；④RCS조적산후출혈량、수술시간、분복강점련화전치태반적발생솔균솔균고우PCS조，차이유통계학의의（t치분별위6．10、4．75，χ2치분별위5．11、5．66，균P＜0．05），단량조장기손상、절구을급유합솔급태반식입적발생솔상비무통계학차이（χ2치분별위1．00、2．74、2．02，균P＞0．05）。결론부궁산술후재차족월임신경음도분면구유필요성급가행성，지요장악호음도시산적괄응증，엄밀감측，가재감소모영병발증적동시강저재차부궁산솔。
Objective To investigate the delivery mode for full-term re-pregnant women after cesarean section.Methods From January 2012 to May 2013, 188 cases hospitalized in Fourth Hospital of Shijiazhuang giving birth again after cesarean section were retrospectively analyzed in terms of delivery mode and pregnancy outcomes.Fifty-nine cases of vaginal birth after cesarean section ( VBAC) and 70 cases of vaginal birth never cesarean ( VBNC) selected over the same period were compared and analyzed.Meanwhile, 120 cases of primary cesarean section ( PCS) were compared with 120 cases of repeat cesarean section ( RCS) over the same period.Results Sixty-eight cases selected vaginal trial production, and 59 cases were successful.The successful rate was 86.76%.There were no significant differences between VBAC group and VBNC group in duration of labor, amount of postpartum hemorrhage, birth weight, hospitalization expenses and midwifery rate (t value was 0.44, 0.08, 0.74 and 0.16,respectively,χ2 =0.38, all P>0.05).The amount of postpartum hemorrhage, length of hospital stay and hospitalization expenses of VBAC group were significantly less than PCS group ( t value was 6.43, 7.30 and 11.50, respectively, all P<0.05).The amount of postpartum hemorrhage, operation duration, the incidence of abdominal adhesion and placenta previa of RCS group were significantly more than PCS group ( t value was 6.10 and 4.75, χ2 value was 5.11 and 5.66, respectively, all P<0.05), but there were no significant differences between two groups in organ injury rate, surgical incision healing of B degree and placenta increta (χ2 value was 1.00, 2.74 and 2.02, respectively, all P>0.05).Conclusion Vaginal birth for full-term re-pregnant women after cesarean section is necessary and feasible.With trial production conditions and close monitoring, it can reduce cesarean section rate and reduce complications of cesarean section.