剖宫产后再次妊娠不同分娩方式及分娩结局分析

An analysis of different delivery modes and outcomes of re-pregnancy after cesarean section

摘要:

目的：调查剖宫产后再次妊娠分娩方式、临产情况及其对分娩结局的影响。方法：回顾性分析2015年1月至2017年12月我院剖宫产后再次妊娠产妇630例临床资料，记录630例产妇择期再次剖宫产（elective cesarean section，ERCS）及再次妊娠阴道试产（trial of labor after cesarean section，TOLAC）分娩方式选择情况，将选择ERCS分娩的产妇纳入ERCS组，并根据TOLAC分娩方式分为经阴道分娩（vaginal birth after cesarean section ，VBAC）组（A组）及阴道试产失败转为剖宫产组（B组）。记录A组、B组、ERCS组一般资料（年龄、分娩前体质指数、孕周、孕次、产次），并分析TOLAC组不同临产方式阴道试产失败原因，比较3组母儿结局差异。结果：630例产妇中选择ERCS分娩465例（73.81%），纳入ERCS组；选择TOLAC分娩165例（26.19%），其中成功124例（75.15%），纳入A组；失败41例（24.85%），纳入B组。3组年龄、孕周、孕次、产次比较，差异无统计学意义（P＞0.05）；B组与ERCS组分娩前BMI比较，差异无统计学意义（P＞0.05），但均高于A组（P＜0.05）。165例TOLAC分娩中，自然临产98例（59.39%），缩宫素引产18例（10.91%），双球囊引产49例（29.70%）；其中自然临产失败10例（10.20%），缩宫素引产失败8例（44.44%），双球囊引产失败23例（46.94%），且失败主要原因均为要求剖宫产。3组子宫破裂、新生儿呼吸窘迫综合征发生率比较，差异无统计学意义（P＞0.05）；A组与ERCS组先兆子宫破裂、新生儿入住重症监护室发生率比较，差异无统计学意义（P＞0.05），但均低于B组（P＜0.05）；B组与ERCS组产后发热发生率比较，差异无统计学意义（P＞0.05），但均高于A组（P＜0.05）；3组新生儿体质量比较，A组＜ERCS组＜B组（P＜0.05）。结论：剖宫产后再次妊娠倾向于选择ERCS分娩，但选择TOLAC分娩对我国母婴保健更有利。

Abstract:

Objective：To investigate the delivery modes，parturition，and outcomes of re-pregnancy after cesarean section. Methods：The clinical data of 630 puerperae of re-pregnancy after cesarean section were retrospectively analyzed，who were admitted to our hospital from January 2015 to December 2017. All the cases were recorded regarding their selections of delivery modes，either elective repeat cesarean section（ERCS） or trial of labor after cesarean section（TOLAC）. The women who chose ERCS delivery were classified as ERCS group，while the women choosing TOLAC were further divided into vaginal birth after cesarean section（VBAC） group（group A） and cesarean section group after failure of vaginal delivery（group B）. The general information（age，body mass index before delivery，gestational weeks，gravidity and parity） was recorded for group A，group B，and the ERCS group. The causes of delivery failure in different modes were analyzed for the TOLAC group，and maternal-infant outcomes were also compared between group A，group B，and the ERCS group. Results：Of the 630 cases，465（73.81%） choosing ERCS were enrolled in the ERCS group，and the remaining 165（26.19%） selected TOLAC，of which 124（75.15%） were enrolled in group A，and 41（24.85%） in group B. There were no significant differences in age，gestational weeks，gravidity，and parity between the three groups（P>0.05）. The BMI before delivery in group B was not significantly different from that in the ERCS group（P>0.05），but the BMIs in group B and the ERCS group were significantly higher than that in group A（P<0.05）. In 165 cases of TOLAC，98（59.39%） underwent spontaneous labor，18（10.91%） received oxytocin induction，and 49（29.70%） were treated with double balloon induction. Among these TOLAC cases，10（10.20%） failed in spontaneous labor，8（44.44%） in oxytocin induction，and 23（46.94%） in double balloon induction. The main reason for failure was that cesarean section was required by the puer－perae. There were no significant differences in the incidence rates of uterine rupture and neonatal respiratory distress syndrome among the three groups(P>0.05). There were no significant differences in the incidence rates of threatened uterine rupture and neonatal admission to intensive care unit between group A and ERCS group（P>0.05），and they were lower than those in group B（P<0.05）. There was no significant difference in the inci－dence rate of postpartum fever between group B and the ERCS group（P>0.05），but the rates in the two groups were both significantly higher than that in group A（P<0.05）. The body mass of neonates was lowest in group A and highest in group B（P<0.05）. Conclusion：ERCS is preferred for re-pregnancy after cesarean section，but TOLAC is more beneficial to maternal-infant health care in China.