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目的观察剖宫产术后再次妊娠阴道试产(TOLAC)的临床结局,为临床对剖宫产术后再次妊娠产妇分娩方式的选择提供参考。方法回顾性分析2014年2月至2016年10月住院分娩的剖宫产术后再次妊娠阴道试产的78例产妇(TOLAC组)和择期重复剖宫产272例产妇(ERCD组)的临床资料,并选择同期非瘢痕子宫成功阴道分娩的足月初产妇120例作为正常对照组,记录三组产妇产后24 h出血量、新生儿出生后5 min Apgar评分、住院时间、住院费用、子宫破裂例数、产褥病率等指标,并对各组上述指标的结果进行分析。结果三组产后24 h出血量、住院时间和费用比较差异有统计学意义(P均<0.01),两两比较显示,产后出血量、住院时间和费用在TOLAC组和正常对照组均低于ERCD组(P均<0.05),TOLAC组与正常对照组相近(P均>0.05);三组新生儿出生后5 min Apgar评分差异均无统计学意义(P>0.05)。TOLAC组78例中,阴道试产成功61例(TOLAC成功亚组),占试产者的78.2%,阴道试产失败转为剖宫产17例(TOLAC失败亚组);对两亚组的比较显示,失败亚组产后出血量、住院时间和费用均高于成功亚组(P均<0.05),新生儿出生后5 min Apgar评分差异无统计学意义(P>0.05)。TOLAC组、ERCD组和正常对照组产褥病分别发生2例(失败亚组、成功亚组各1例)、4例和2例,产褥病率组间差异无统计学意义(P>0.05)。各组均无子宫破裂发生。结论在严格掌握阴道试产指征、加强产时监护的条件下,对剖宫产术后再次妊娠者进行阴道试产是可行的。
Objective To observe the clinical outcome of re-pregnancy vaginal intermission (CTA) after cesarean section and provide a reference for clinical choice of delivery mode after cesarean section. Methods The clinical data of 78 pregnant women (TOLAC group) and 272 pregnant women (ERCD group) undergoing elective vaginal delivery after cesarean section during hospital delivery from February 2014 to October 2016 were analyzed retrospectively. , And select 120 cases of term full-term primipara in the same period of non-scarring uterus as the successful vaginal delivery as the normal control group. The 24 h postpartum hemorrhage, the Apgar score, the hospitalization expense, the number of uterine rupture , Puerperal morbidity and other indicators, and the results of each group of the above indicators were analyzed. Results The blood loss, hospitalization time and cost at 24 h postpartum were significantly different among the three groups (all P <0.01). The comparisons showed that postpartum hemorrhage, hospitalization time and cost were lower in TOLAC group and normal control group than those in ERCD group (All P <0.05). The TOLAC group was similar to the normal control group (all P> 0.05). There was no significant difference in Apgar scores at 5 min after birth between the three groups (P> 0.05). Of the 78 TOLAC patients, 61 (60% of successful TOLAC patients) were successful in the vaginal trial, 78.2% of those in the trial, and 17 failed caesarean section in the vaginal trial (failed TOLAC subgroup) Comparisons showed that postpartum hemorrhage, length of hospital stay and expenses in failed subgroup were higher than those in successful subgroup (P <0.05). There was no significant difference in Apgar score at 5 min after birth (P> 0.05). There were 2 cases of puerpera in TOLAC group, ERCD group and normal control group (failed subgroup, 1 case in success subgroup), 4 cases and 2 cases respectively. There was no significant difference between the two groups (P> 0.05 ). No uterine rupture occurred in all groups. Conclusion Under the condition of strictly grasping the indications of vaginal trial and strengthening the supervision of the time of delivery, it is feasible to carry out the vaginal trial of the second pregnancy after cesarean section.