CAJ | 학술논문

目的：探讨瘢痕子宫再次妊娠分娩方式的选择，及再次妊娠时选择经阴道分娩的安全性分析。方法选择剖宫产术后瘢痕子宫再次妊娠的产妇210例（瘢痕组）及同期非瘢痕子宫选择阴道试产的产妇85例（非瘢痕组），根据瘢痕组产妇所选分娩方式的不同分为瘢痕 A 组（72例）和瘢痕 B 组（138例），比较不同组产妇之间的分娩结局、母婴并发症及平均住院时间等。结果瘢痕 A 组72例产妇中阴道试产成功并顺利进行阴道分娩64例，成功率达88．89％（64／72），另外8例产妇改为剖宫产，占11．11％（8／72），其中3例为持续性枕后位，2例为社会因素放弃阴道试产，2例为胎儿窘迫，1例为出现不完全性子宫破裂。瘢痕 B 组138例产妇均顺利进行剖宫产。非瘢痕组100例产妇中91例产妇阴道试产成功，成功率为91．00％（91／100），另外9例产妇均改为剖宫产，占9．00（9／100），其中3例为胎儿窘迫，2例为巨大胎儿，2例为持续性枕横位，2例为社会因素放弃阴道试产。瘢痕 A 组产妇的平均住院时间较瘢痕 B 组明显缩短，而产后平均出血量则较瘢痕 B 组明显升高，且差异均有统计学意义（t ＝15．87、26．32，均 P ＜0．05）。两组产妇产后出血和新生儿窒息发生率差异无统计学意义（χ2＝0．24、1．05，均 P ＞0．05）。瘢痕 A 组和非瘢痕组产妇的平均住院时间、产后平均出血量、产后出血和新生儿窒息发生率等妊娠结局差异均无统计学意义（χ2＝0．88、1．30、1．03、0．00，均 P ＞0．05）。结论瘢痕子宫再次妊娠选择阴道分娩时，应严格把握剖宫产术后再次妊娠经阴道试产的适应证，严密监护下经阴道分娩安全性较高，值得临床推广。
목적：탐토반흔자궁재차임신분면방식적선택，급재차임신시선택경음도분면적안전성분석。방법선택부궁산술후반흔자궁재차임신적산부210례（반흔조）급동기비반흔자궁선택음도시산적산부85례（비반흔조），근거반흔조산부소선분면방식적불동분위반흔 A 조（72례）화반흔 B 조（138례），비교불동조산부지간적분면결국、모영병발증급평균주원시간등。결과반흔 A 조72례산부중음도시산성공병순리진행음도분면64례，성공솔체88．89％（64／72），령외8례산부개위부궁산，점11．11％（8／72），기중3례위지속성침후위，2례위사회인소방기음도시산，2례위태인군박，1례위출현불완전성자궁파렬。반흔 B 조138례산부균순리진행부궁산。비반흔조100례산부중91례산부음도시산성공，성공솔위91．00％（91／100），령외9례산부균개위부궁산，점9．00（9／100），기중3례위태인군박，2례위거대태인，2례위지속성침횡위，2례위사회인소방기음도시산。반흔 A 조산부적평균주원시간교반흔 B 조명현축단，이산후평균출혈량칙교반흔 B 조명현승고，차차이균유통계학의의（t ＝15．87、26．32，균 P ＜0．05）。량조산부산후출혈화신생인질식발생솔차이무통계학의의（χ2＝0．24、1．05，균 P ＞0．05）。반흔 A 조화비반흔조산부적평균주원시간、산후평균출혈량、산후출혈화신생인질식발생솔등임신결국차이균무통계학의의（χ2＝0．88、1．30、1．03、0．00，균 P ＞0．05）。결론반흔자궁재차임신선택음도분면시，응엄격파악부궁산술후재차임신경음도시산적괄응증，엄밀감호하경음도분면안전성교고，치득림상추엄。
Objective To investigate delivery mode of uterine scar pregnancy and analyze the safety of vagi-nal delivery.Methods 210 delivery women with scar uterus after cesarean section and 85 delivery women with non -scar uterus vaginal delivery of maternal selection were collected.According to the different ways of delivery,the preg-nant women in the scar group were divided into A group (72 cases)and B group (138 cases).Delivery outcome, maternal complications and average hospitalization time between the two groups were compared.Results 72 cases of maternal vaginal delivery in scar A group was successful and smooth vaginal delivery in 64 cases,and success rate was 88.89%(64 /72).8 patients maternal modified cesarean section production,accounted for 11.11%(8 /72),including 3 cases of persistent occiput posterior position,2 cases of social factors give up vaginal delivery,2 cases fetal distress, 1 case for incomplete rupture of uterus.138 cases delivery women in scar B group successfully obtained the cesarean section.100 cases of delivery women in non scar group,91 cases successfully got vaginal delivery,and the success rate was 91.00% (91 /100).Another 9 cases of delivery women were replaced with caesarean birth[9.00%(9 /100)],of which 3 cases of fetal distress,2 cases for fetal macrosomia,2 cases of persistent occiput transverse position,2 cases as social factors give up of vaginal delivery.Scar in group A maternal average hospitalization time was significantly shor-ter than scar in group B,and mean postpartum hemorrhage was significantly increased than scar in group B,and the differences were statistically significant (t =15.87,26.32,all P <0.05).There were no significant differences in the incidence of postpartum hemorrhage and neonatal asphyxia between the two groups (χ2 =0.24,1.05,all P >0.05). The maternal average hospitalization time,mean postpartum hemorrhage,postpartum hemorrhage and incidence rate of neonatal asphyxia between scar group A and non scar group had no significant differences (χ2 =0.88,1.30,1.03, 0.00,all P >0.05).Conclusion When choosing vaginal delivery in scar uterus again pregnancy,we should strictly grasp cesarean section pregnancy after vaginal delivery of the indications.Under strict monitoring,the safety of vaginal delivery was high.It was worth of clinical promotion.