瘢痕子宫再次妊娠足月后不同分娩方式的临床结局
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摘要
目的探讨瘢痕子宫再次妊娠足月后不同分娩方式的临床结局,为其合理选择分娩方式提供依据。方法回顾性分析本院2014年10月～2016年12月113例有剖宫产史孕妇不同分娩方式的临床资料,经阴道分娩者48例设为A组,经阴道试产失败后转剖宫产者19例设为B组,剖宫产46例设为C组,另选取同期非瘢痕子宫再次妊娠阴道分娩51例设为D组,对比分析四组分娩出血量、住院时间、产褥热发生率、新生儿一般情况、Apgar评分等。结果瘢痕子宫再次妊娠经阴道分娩成功率为46.6%(48/113),入院时宫颈容受程度越高(宫颈长度越短)、子宫前壁肌层厚度测值越大,经阴道分娩成功率越高。A组产时或术中出血量、平均住院日与D组相比较差异均无统计学意义(P>0.05);B、C组出血量、平均住院日与A组比较显著增加(P<0.01);四组产褥热发病率、新生儿一般情况、Apgar评分比较差异均无统计学意义(P>0.05)。结论以严格监控临床风险为前提,瘢痕子宫再次妊娠经阴道分娩在出血、住院日等方面优于剖宫产,具有一定可行性。
Objective To study the clinical outcomes of different delivery modes for secondary pregnancy of women with cicatricial uterus, and provide the basis for the reasonable choice of delivery mode. Methods 113 cases of clinical data of cesarean section in pregnant women with different delivery modes in our hospital form October 2014 to December 2016 were divided into vaginal delivery group(group A, 48 cases), vaginal delivery failure after cesarean section group(group B, 19 cases) and cesarean section group(C group, 46 cases), the other selected non uterine scar pregnancy vaginal delivery group(group D, 51 cases). The child birth bleeding, hospitalization time, the incidence of puerperal fever, and neonatal Apgar score were observed. Results The results of uterine scar pregnancy vaginal delivery success rate was 46.6%(48/113). The higher the degree of cervical receptivity at admission(cervical length) and anterior uterine wall muscle layer thickness value, the higher the success rate of vaginal delivery was. There was no significant difference between group A and D in the amount of blood loss during labor or during operation and the average hospital stay. Compared with group A, blood loss and average hospital stay in group B and C were significantly increased(P<0.01). Compared with A group, B group, C group and D group had no significant difference(P>0.05) in the incidence of puerperal fever, neonatal general situation and Apgar score. Conclusion On the premise of strict monitoring of clinical risk, to some extent, vaginal delivery of scar uterus is better than cesarean section in vaginal bleeding and hospitalization days.
Objective To study the clinical outcomes of different delivery modes for secondary pregnancy of women with cicatricial uterus, and provide the basis for the reasonable choice of delivery mode. Methods 113 cases of clinical data of cesarean section in pregnant women with different delivery modes in our hospital form October 2014 to December 2016 were divided into vaginal delivery group(group A, 48 cases), vaginal delivery failure after cesarean section group(group B, 19 cases) and cesarean section group(C group, 46 cases), the other selected non uterine scar pregnancy vaginal delivery group(group D, 51 cases). The child birth bleeding, hospitalization time, the incidence of puerperal fever, and neonatal Apgar score were observed. Results The results of uterine scar pregnancy vaginal delivery success rate was 46.6%(48/113). The higher the degree of cervical receptivity at admission(cervical length) and anterior uterine wall muscle layer thickness value, the higher the success rate of vaginal delivery was. There was no significant difference between group A and D in the amount of blood loss during labor or during operation and the average hospital stay. Compared with group A, blood loss and average hospital stay in group B and C were significantly increased(P<0.01). Compared with A group, B group, C group and D group had no significant difference(P>0.05) in the incidence of puerperal fever, neonatal general situation and Apgar score. Conclusion On the premise of strict monitoring of clinical risk, to some extent, vaginal delivery of scar uterus is better than cesarean section in vaginal bleeding and hospitalization days.
引文
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[19] Peng P,Liu XY,Li L,et al.Clinical analyses of 66 cases of mid-trimester pregnancy termination in women with prior cesarean [J].Chin Med J (Engl),2015,128(4):450-454.
[20] Vlemminx MW,de Lau H,Oei SG.Tocogram characteristics of uterine rupture:a systematic review[J].Arch Gynecol Obstet[J],2017,295(1):17-26.
[21] 储小磊.瘢痕子宫再次妊娠母儿结局及分娩方式选择的临床研究[D].扬州:扬州大学,2016.
[22] 刘星,刘俊丽.瘢痕子宫再次妊娠分娩方式临床分析[J].陕西医学杂志,2015,44(12):1639-1641.
[23] 石书霞.瘢痕子宫再次妊娠不同分娩方式对孕产妇及新生儿的影响研究[J].中国妇幼保健,2014,29(19):3059-3060.
[2] Sabol B,Denman MA,Guise JM.Vaginal birth after cesarean:an effective method to reduce cesarean [J].Clin Obstet Gynecol,2015,58(2):309-319.
[3] Borahay MA,Fang X,Baillargeon JG,et al.Statin use and uterine fibroid risk in hyperlipidemia patients:a nested case-control study [J].Am J Obstet Gynecol,2016,215(6):751-758.
[4] Gao L,Huang Z,Zhang X,et al.Reproductive outcomes following cesarean scar pregnancy-a case series and review of the literature [J].Eur J Obstet Gynecol Reprod Biol,2016,200:102-107.
[5] Tsai HT,Wu CH.Vaginal birth after cesarean section-The world trend and local experience in Taiwan [J].Taiwan J Obstet Gynecol,2017,56(1):41-45.
[6] Vitale SG,Marilli I,Cignini P,et al.Comparison between modified Misgav-Ladach and Pfannenstiel-Kerr techniques for Cesarean section:review of literature [J].J Prenat Med,2014,8(3-4):36.
[7] Rogers AJ,Rogers NG,Kilgore ML,et al.Economic Evaluations Comparing a Trial of Labor with an Elective Repeat Cesarean Delivery:A Systematic Review [J].Value Health,2017,20(1):163-173.
[8] 贾书方,李静,杨春华.瘢痕子宫产妇二次剖宫产并发症发生情况及与非瘢痕子宫剖宫产的对照研究[J].中国妇幼保健,2016,31(1):65-66.
[9] Yee LM,Liu LY,Grobman WA.Obstetrician call schedule and obstetric outcomes among women eligible for a trial of labor after cesarean [J].Am J Obstet Gynecol,2017,216(1):751-756.
[10] d'Ercole C,Sentilhes L,Vayssière C,et al.Delivery in women with previous cesarean section or other uterine surgery:guidelines for clinical practice-introduction J Gynecol Obstet Biol Reprod (Paris),2012,41(8):692-694.
[11] Ituk US,Habib AS,Polin CM,et al.Anesthetic management and outcomes of parturients with dilated cardiomyopathy in an academic centre [J].Can J Anaesth,2015,62(3):278-288.
[12] 单丹,胡雅毅.瘢痕子宫妊娠引产及促宫颈成熟的研究进展[J].中华妇幼临床医学杂志(电子版),2016,12(2):228-231.
[13] Stoperka F,Karger C,Beige J.Limited Accuracy of Colour Doppler Ultrasound Dynamic Tissue Perfusion Measurement in Diabetic Adults[J].PLoS One,2016,11(12):0168905.
[14] Grotegut CA,Mao L,Pierce SL,et al.Enhanced Uterine Contractility and Stillbirth in Mice Lacking G Protein-Coupled Receptor Kinase 6 (GRK6):Implications for Oxytocin Receptor Desensitization [J].Mol Endocrinol,2016,30(4):455-468.
[15] 吕斌,刘兴会,陈锰.二孩难题:瘢痕子宫再次妊娠[J].实用医院临床杂志,2016,13(6):6-9.
[16] Ali RA,Camick C,Wiles K,et al.Nicotinic Acid Adenine Dinucleotide Phosphate Plays a Critical Role in Naive and Effector Murine T Cells but Not Natural Regulatory T Cells[J].J Biol Chem,2016,291(9):4503-4522.
[17] Indraccolo U,Scutiero G,Matteo M,et al.Correlations between sonographically measured and actual incision site thickness of lower uterine segment after repeated caesarean section [J].Minerva Ginecol,2015,67(3):225-229.
[18] 屈在卿,马润玫,杜明钰,等.剖宫产瘢痕子宫妊娠孕中期引产方法的探讨[J].实用妇产科杂志,2016,32(1):77-79.
[19] Peng P,Liu XY,Li L,et al.Clinical analyses of 66 cases of mid-trimester pregnancy termination in women with prior cesarean [J].Chin Med J (Engl),2015,128(4):450-454.
[20] Vlemminx MW,de Lau H,Oei SG.Tocogram characteristics of uterine rupture:a systematic review[J].Arch Gynecol Obstet[J],2017,295(1):17-26.
[21] 储小磊.瘢痕子宫再次妊娠母儿结局及分娩方式选择的临床研究[D].扬州:扬州大学,2016.
[22] 刘星,刘俊丽.瘢痕子宫再次妊娠分娩方式临床分析[J].陕西医学杂志,2015,44(12):1639-1641.
[23] 石书霞.瘢痕子宫再次妊娠不同分娩方式对孕产妇及新生儿的影响研究[J].中国妇幼保健,2014,29(19):3059-3060.