剖宫产后阴道试产的产时及产后评估

发布时间：2018-05-04 21:34

本文选题：剖宫产后阴道试产 + 再次剖宫产　；参考：《实用妇产科杂志》2016年08期

【摘要】：目的:探讨剖宫产后阴道试产(TOLAC)患者自然临产时及产后的评估及监测。方法:选择四川大学华西第二医院产科就诊的成功剖宫产后阴道分娩的患者42例(VBAC组),及同期就诊的瘢痕子宫急诊剖宫产患者50例(CS组)和阴道分娩的初产妇50例(正常分娩组)为研究对象,对3组患者的母儿相关情况进行比较。结果:3组患者的年龄、孕周、孕前体质量指数(BMI)及妊娠合并症情况比较,差异无统计学意义(P0.05),VBAC组胎儿双顶径(BPD)小于其他两组(P0.05),宫颈Bishop评分高于其他两组(P0.05)。与正常分娩组比较,VBAC组产后2小时内出血量多(P0.05),但产后2~24小时内出血量和新生儿5分钟Apgar评分差异无统计学意义(P0.05)。与CS组比较,VBAC组患者24小时出血量少且住院天数短(P0.05),而新生儿5分钟Apgar评分差异无统计学意义(P0.05)。结论:自然临产后,胎儿双顶径较小且宫颈成熟度较高的瘢痕子宫患者可以进行阴道试产,与再次剖宫产相比可以减少产后出血量及住院天数。在TOLAC过程中需要动态观察,严密监护,尤其要注意预防产时和产后2小时出血。
[Abstract]:Objective: to investigate the evaluation and monitoring of spontaneous labor and postpartum in patients with vaginal trial delivery after cesarean section. Methods: 42 cases of successful vaginal delivery after cesarean section, 50 cases of CS group of emergency cesarean section of scar uterus and 50 cases of primipara of vaginal delivery were selected from Huaxi second Hospital of Sichuan University. Cases (normal delivery group) were studied. The maternal and infant correlation of three groups of patients were compared. Results there was no significant difference in age, gestational weeks, pregestational mass index (BMI) and pregnancy complications between the two groups. There was no significant difference in BPDs between the two groups. The cervical Bishop score was higher in the VBAC group than in the other two groups. Compared with the normal delivery group, the volume of blood loss in VBAC group was more than that in 2 hours postpartum, but there was no significant difference in the amount of blood loss within 24 hours after delivery and the 5-minute Apgar score of newborn. Compared with CS group, the patients in VBAC group had less blood loss in 24 hours and shorter days in hospital than those in CS group (P 0.05), but there was no significant difference in 5-minute Apgar score of newborns (P 0.05). Conclusion: after spontaneous labor, the patients with scar uterus with smaller biparietal diameter and higher cervix maturity can undergo vaginal trial delivery, which can reduce the amount of postpartum bleeding and hospital stay compared with the second cesarean section. During TOLAC, dynamic observation and close monitoring are needed, especially to prevent bleeding during labor and 2 hours postpartum.
【作者单位】：四川大学华西第二医院;
【基金】：国家自然科学基金青年科学基金(编号:81200452) 四川省科技支撑计划项目(编号:2015SZ0139)
【分类号】：R714.4

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