目的 探讨前次剖宫产再次妊娠,不同的分娩方式和母婴并发症的情况.方法 本研究采用回顾性病例对照分析,选择产科待产,前次剖宫产再次妊娠的单胎、孕周≥34周的产妇379例为研究对象,均为子宫下段横切口.其中再次剖宫产327例为试验1组,经阴道分娩52例为试验2组;随机选择同期非瘢痕子宫剖宫产352例为对照1组,非瘢痕子宫顺娩109例为对照2组,比较4组的分娩情况.结果 试验1组与对照1组比较,产妇年龄、孕周、新生儿体重、1 min Apgar评分、脐血pH值差异均无统计学意义(P＞0. 05);试验1组的术中出血量大于对照1组,差异有统计学意义(P＜0. 05);试验2组与对照2组比较,产妇年龄、孕周、新生儿体重、第二和第三产程时限、会阴Ⅰ度和Ⅱ度撕伤情况差异均无统计学意义(P＞0. 05);试验2组产后2 h出血量大于对照2组,差异有统计学意义(P＜0. 05);2组新生儿生1、5 min Apgar评分、脐血PH值、第一产程时限差异有统计学意义(P＜0. 05);试验2组会阴切开率和阴道助产率均高于对照2组,差异有统计学意义(P＜0. 05);2组间产后出血率和新生儿窒息率的差异均无统计学意义(P＞0. 05).结论 瘢痕子宫再次妊娠选择阴道分娩利大于弊,并非首选二次剖宫产,若无阴道分娩禁忌,应考虑阴道试产.%Objective To investigate the different delivery modes in the second pregnancy after previous cesarean section as well as maternal and neonatal outcomes and complications. different delivery mode of repeated pregnancy after previous cesarean section and the incidence of complications of mother and infants. Methods The study was performed by means of retrospective case-control analysis. A total of 379 pregnant women with the second pregnancy after previous cesarean section and gestational weeks≥34 weeks were enrolled as subjects, in whom,there were 327 cases of repeated cesarean section (experimental group 1) and 52 cases of vaginal delivery (experimental group 2),moreover,the other 352 cases of non scarred uterus cesarean section were enrolled as control group 1,and 109 cases of non scarred uterus natural delivery were enrolled as control group 2. The delivery outcomes of puerpera were observed and compared among the four groups. Results There were no significant differences in maternal age, gestational weeks, neonatal body weight, 1 min Apgar scores and umbilical cord blood pH between experimental group 1 and control group 1 (P＞0. 05). The intraoperative bleeding volume in experimental group 1 was significantly larger than that in control group 1 (P＜0. 05). There were no significantly differences in maternal age, gestational weeks, neonatal body weight, duration of the second and third stage of labor, perineum tear at degreeⅠand degreeⅡbetween experimental group 2 and control group 2 (P＞0. 05). The postpartum 2h bleeding volume in experimental group 2 was significantly larger than that in control group 2 (P＜0. 05),moreover,there were significant differences in 1 min and 5min Apgar scores, umbilical cord blood pH and duration of the first stage of labor between the two groups (P＜0. 05). In addition the perineum incision rate and vaginal midwifery rate in experimental group 2 were significantly higher than those in control group 2 (P ＜0. 05), however, there were no significant differences in postpartum hemorrhage rate and neonatal asphyxia rate between the two groups (P＞0. 05). Conclusion The vaginal delivery in pregnant women with scarred uterus and the second pregnancy is superior to caesarean section,the latter is not the first choice,therefor,vaginal birth should be tried if pregnant women have no contraindication of vaginal delivery.
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