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目的探讨剖宫产术后再次妊娠的合理分娩方式。方法回顾性分析医院妇产科收治的剖宫产术后再次妊娠产妇640例临床资料,其中再次剖宫产(RCS)500例,阴道试产(VBAC)140例。比较2种不同分娩方式的构成特点、出血量、住院时长、住院费用、并发症和分娩结局。结果 RCS组出血量多于VBAC组,住院时间长于VBAC组,住院费用高于VBAC组,差异均有统计学意义(P<0.05)。RCS组术后发热、子宫下段切口愈合不良及盆腔粘连等并发症发生率高于VBAC组(P<0.05);2组在子宫破裂率方面比较差异无统计学意义(P>0.05)。RCA组500例,占78.1%;VBAC组140例,占21.9%,其中129例试产成功,成功率92.1%。结论剖宫产术后再次妊娠并非是剖宫产的绝对指征和唯一指征,临床需严格掌握阴道试产及剖宫产适应证,对于符合阴道试产产妇,可在严密监护下行阴道试产,以此来降低剖宫产率及剖宫产给产妇带来的再次伤害。
Objective To investigate the reasonable mode of delivery for the second pregnancy after cesarean section. Methods A retrospective analysis of hospital obstetrics and gynecology admitted cesarean section after re-delivery of pregnant women, 640 cases of clinical data, of which again cesarean section (RCS) 500 cases, vaginal trial (VBAC) in 140 cases. Comparisons of the compositional characteristics of 2 different modes of delivery, the amount of bleeding, length of hospital stay, hospitalization costs, complications and delivery outcomes were performed. Results The bleeding volume of RCS group was more than that of VBAC group, the length of hospitalization was longer than that of VBAC group, and the cost of hospitalization was higher than that of VBAC group (P <0.05). The incidence of postoperative fever, poor healing of lower uterine incision and pelvic adhesions were higher in RCS group than those in VBAC group (P <0.05). There was no significant difference in rupture rate between the two groups (P> 0.05). RCA group 500 cases, accounting for 78.1%; VBAC group 140 cases, accounting for 21.9%, of which 129 cases trial success, the success rate of 92.1%. Conclusion Re-pregnancy after cesarean section is not an absolute indication of cesarean section and the only indication of clinical indications, vaginal and cesarean section should be strictly controlled clinical indications, for vaginal preterm labor, vaginal examination can be closely monitored In order to reduce cesarean section rate and cesarean section to the maternal again hurt.