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目的比较瘢痕子宫(SU)再次妊娠经阴道分娩与剖宫产的母婴结局。方法选取2014年5月—2015年5月滑县人民医院收治的SU再次妊娠产妇110例,根据产妇体检结果并结合产妇及其家属意愿共同商榷分娩方式。根据分娩方式不同分为剖宫产组43例与经阴道分娩组67例。观察两组母婴结局指标(产妇出血量、新生儿体质量、新生儿Apgar评分、住院时间)、住院费用、新生儿患病情况(包括肺炎、病理性黄疸、脐炎、颅内出血)及新生儿神经心理评定量表(NBNA)评分。结果 110例SU再次妊娠产妇中选择阴道试产48例,成功率为89.58%(43/48),5例试产失败选择剖宫产成功。选择剖宫产的62例产妇均分娩成功。两组新生儿Apgar评分比较,差异无统计学意义(P>0.05);阴道分娩组产妇出血量少于剖宫产组,住院时间短于剖宫产组,新生儿体质量小于剖宫产组,差异有统计学意义(P<0.01)。剖宫产组住院费用为(4536.25±325.98)元,高于阴道分娩组的(2964.23±210.39)元,差异有统计学意义(P<0.01)。两组新生儿肺炎、病理性黄疸、脐炎、颅内出血发生率比较,差异无统计学意义(P>0.05)。两组新生儿行为能力、原始反射、被动肌张力与主动肌张力评分比较,差异无统计学意义(P>0.05)。结论瘢痕子宫再次妊娠经阴道分娩的母婴结局较剖宫产更佳,对新生儿神经行为影响较小,但是应严格掌握其适应证,提高其安全性。
Objective To compare the maternal and infant outcomes of vaginal delivery and cesarean delivery of scarred uterus (SU). Methods A total of 110 pregnant women were enrolled again from May 2014 to May 2015 in Huaxian People’s Hospital. According to the results of the maternal examination and in combination with the wishes of their mothers and their families, the mode of delivery was discussed. According to the mode of delivery is divided into cesarean section group 43 cases and vaginal delivery group 67 cases. Maternal and infant outcomes (maternal bleeding, neonatal weight, neonatal Apgar score, hospital stay), hospitalization costs, neonatal morbidity (including pneumonia, pathological jaundice, omphalitis, intracranial hemorrhage) and neonatal Children’s neurological assessment scale (NBNA) score. Results Among 110 pregnant women who underwent pregnancy, 48 vaginal samples were also obtained, with a success rate of 89.58% (43/48). Five patients failed in the trial to choose cesarean section. 62 cases of cesarean section choose maternal delivery were successful. There was no significant difference in neonatal Apgar score between the two groups (P> 0.05). The vaginal delivery group had less maternal bleeding than the cesarean section group, shorter hospital stay time and shorter cesarean section, , The difference was statistically significant (P <0.01). The cost of hospitalization for cesarean section was (4536.25 ± 325.98) yuan, which was higher than that of vaginal delivery group (2964.23 ± 210.39) yuan, the difference was statistically significant (P <0.01). Neonatal pneumonia, pathological jaundice, omphalitis, the incidence of intracranial hemorrhage between the two groups was no significant difference (P> 0.05). There was no significant difference between the two groups in newborns’ abilities of behavior, initial reflex, passive muscle tension and active muscle tension (P> 0.05). Conclusion Maternal and neonatal outcome of vaginal delivery of scar pregnancy is better than that of cesarean delivery, and has little effect on neonatal neurological behavior. However, indications should be strictly controlled to improve its safety.