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目的探讨瘢痕子宫妊娠的分娩方式及结局。方法对2004年1月-2009年12月广汉市人民医院295例剖宫产术后和20例子宫肌瘤剥除术后足月妊娠孕妇的分娩方式、分娩结局及母婴并发症进行分析,并将其再次行剖宫产的285例与随机抽取同期首次剖宫产285例进行对照。将进行阴道分娩的30例与随机抽取同期首次阴道分娩30例进行对照。结果 315例中46例行阴道试产,30例试产成功,成功率65.2%。再行剖宫产285例,手术率90.5%。阴道分娩组无新生儿窒息,产后出血量、先兆子宫破裂发生率与对照组比较差异无统计学意义。再行剖宫产产后出血量比瘢痕子宫经阴道分娩组高,平均住院天数、产后出血、严重粘连发生率均较后者高,差异有统计学意义(P<0.05)。结论瘢痕子宫再次妊娠分娩并非是剖宫产绝对指征,对有试产条件者,在严密监测下阴道试产是安全可行的。
Objective To investigate the delivery mode and outcome of scar pregnancy. Methods From January 2004 to December 2009 in Guanghan People’s Hospital, 295 cases of cesarean section after cesarean section and 20 cases of uterine fibroids, full-term pregnant women after delivery mode of delivery, delivery outcomes and maternal and child complications were analyzed, And 285 cases of cesarean section again and random caesarean section at the same period for the first time 285 cases were compared. 30 cases of vaginal delivery and random vaginal delivery at the same period 30 cases were compared. Results Of the 315 cases, 46 patients underwent vaginal trial production and 30 patients were successfully trial-produced with a success rate of 65.2%. 285 cases of cesarean section and then surgery rate of 90.5%. No vaginal delivery group neonatal asphyxia, postpartum hemorrhage, the incidence of threatened uterine rupture compared with the control group, no significant difference. Recurrence of cesarean section postpartum bleeding than the scarring of the vaginal delivery group, the average length of stay, postpartum hemorrhage, severe adhesions were higher than the latter, the difference was statistically significant (P <0.05). Conclusion Reproductive pregnancy in cesarean uterus is not an absolute indication of cesarean section. It is safe and feasible for vaginal trial to be conducted under closely monitored conditions.