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目的探讨瘢痕子宫再次妊娠的分娩方式。方法选择句容市下蜀中心卫生院2012年1月至2014年12月收治的瘢痕子宫再次妊娠患者48例,对其分娩方式选择、术中出血量及住院时间进行分析,同时按照1∶2比例选择同时期首次剖宫产与再次剖宫产组进行对照研究,按照1∶2比例选择同时期非瘢痕子宫经阴道分娩与瘢痕子宫经阴道分娩组进行对照研究。结果本研究48例患者再次剖宫产33例(68.75%),均选择子宫下段横切口;15例(31.25%)阴道试产,其中11例试产成功,成功率为73.33%,另4例改行剖宫产。阴道试产成功组术中出血量、住院时间均低于瘢痕子宫剖宫产组,差异有统计学意义(P<0.05)。首次选择剖宫产组术中出血量、手术时间及住院时间均低于瘢痕子宫剖宫产组,差异有统计学意义(P<0.05)。瘢痕子宫经阴道分娩组术中出血量、住院时间与非瘢痕子宫经阴道分娩组比较差异未见统计学意义(P>0.05)。结论对瘢痕子宫再次妊娠分娩方式的选择应综合考虑,对符合阴道试产条件的孕妇鼓励经阴道分娩,应严格掌握试产适应证,加强术中监测,在保证安全的情况下降低剖宫产率。
Objective To investigate the mode of delivery of scar pregnancy again. Methods Forty-eight patients with uterine scar pregnancy who were admitted to Jushu Central Hospital from January 2012 to December 2014 were selected and their mode of delivery, blood loss and length of hospital stay were analyzed. At the same time, 1: 2 Select the same period of the first cesarean section with the second cesarean section control study, according to the ratio of 1: 2 during the same period choose non-scarring vaginal delivery and scarring of the uterus by vaginal delivery group control study. Results In this study, 33 patients (68.75%) underwent cesarean section again in the present study. All the patients underwent transverse vaginal incision in the lower uterine segment. Fifteen patients (31.25%) underwent vaginal trial, of which 11 were successfully trial-produced with a success rate of 73.33% Caesarean section to change. The volume of vaginal bleeding and hospital stay in successful vaginal trial group were significantly lower than those in cesarean scar group (P <0.05). The first choice of intraoperative cesarean section bleeding volume, operation time and hospital stay were lower than that of uterine scar cesarean section, the difference was statistically significant (P <0.05). There was no significant difference in bleeding volume, length of hospital stay between the transvaginal cesarean section and vaginal delivery group (P> 0.05). Conclusion The choice of pregnancy mode of uterus scar pregnancy should be considered synthetically. For pregnant women who meet the conditions of vaginal trial production, vaginal delivery should be encouraged. Indications of trial production should be strictly controlled, intraoperative monitoring should be strengthened, cesarean section should be reduced under the condition of ensuring safety rate.