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目的探讨剖宫产术后子宫下段菲薄的瘢痕子宫孕妇阴道分娩的安全性及母婴结局。方法回顾性分析2006年1月-2015年12月天津市第一中心医院妇产科收治的剖宫产术后再次妊娠的128例孕妇的完整资料,分为观察组即院外自发临产的下段菲薄组41例和对照组即院内待产组87例。两组孕妇均在严密监测下阴道试产,分别对两组孕妇的临床指标进行比较。结果两组孕妇年龄、孕周、孕次、足月产次、中孕期引产次、与前次剖宫产时间间隔等比较无统计学差异(P>0.05);观察组入院时宫口开大2~5 cm,宫缩间歇期子宫下段最薄处肌层厚度(1.3±0.6)mm,明显薄于对照组临产前的子宫下段肌层厚度(3.8±1.4)mm(t=2.915,P=0.004),对照组临产进入活跃期后,在宫口开大3~5 cm时,宫缩间歇期子宫下段肌层厚度(1.5±0.7)mm,与观察组比较差异无统计学意义(t=1.139,P=0.262);观察组孕妇自入院至宫口开全平均仅(1.8±1.2)h,总产程(6.2±1.9)h,短于对照组总产程(7.9±2.7)h(t=2.011,P=0.039);两组孕妇阴道分娩率无差别,但观察组手术助娩率(52.8%)高于对照组(25.6%)(χ~2=8.059,P=0.005);两组孕妇产道裂伤、产时及产后24 h出血量及新生儿的相关指标与对照组比较均无统计学差异(P>0.05)。结论临产后的瘢痕子宫下段会被拉伸变薄,院外临产的瘢痕子宫孕妇下段虽薄,若无其他阴道分娩的绝对禁忌证,经短时间观察产程进展顺利,可在征得家属同意、严密监护下阴道试产,安全可行,母婴结局好。
Objective To investigate the safety and maternal and infant outcomes of vaginal delivery of scarred uterus in the lower uterine segment after cesarean section. Methods The data of 128 pregnant women who were re-pregnant after cesarean section were retrospectively analyzed from January 2006 to December 2015 in the obstetrics and gynecology department of Tianjin First Central Hospital. The data were divided into two groups: observation group Group 41 cases and control group that the hospital to be produced group 87 cases. Two groups of pregnant women were closely monitored vaginal trial production, respectively, the clinical indicators of two groups of pregnant women were compared. Results There were no significant differences in the age, gestational age, gestational age, full-term birth time, and the number of induced labor in the second trimester between the two groups (P> 0.05) The thickness of myometrium in the lower uterine segment was (1.3 ± 0.6) mm, significantly shorter than that in the control group (3.8 ± 1.4) mm (t = 2.915, P = 0.004). In the control group, the labor rate of uterine segment at the interval of uterine contractions during the period of 3 ~ 5 cm of uterine opening was 1.5 ± 0.7 mm after labor entering the active period, there was no significant difference compared with the observation group (t = 1.139, P = 0.262). The average pregnant women in the observation group were only 1.8 ± 1.2 h from hospital admission to the cervix, and the average length of labor was 6.2 ± 1.9 h, shorter than that of the control group (7.9 ± 2.7 h) (t = 2.011, P = 0.039). There was no difference in vaginal delivery between the two groups, but the rate of labor assistance delivery in the observation group was higher than that in the control group (52.6% vs 25.6%, χ ~ 2 = 8.059, P = 0.005) The birth canal laceration, 24 h postpartum hemorrhage and neonatal related indicators compared with the control group showed no significant difference (P> 0.05). Conclusions After labor, the lower uterine segment of the scar will be stretched and thinned. Although the lower segment of pregnant women with extra-hospital scar is utterly thin, if there is no absolute contraindication for other vaginal delivery, the progress of labor can be observed smoothly after a short period of time. Under custody vaginal trial production, safe and feasible, good maternal and child outcomes.