摘要
瘢痕子宫再次妊娠时风险明显高于非瘢痕子宫。为降低子宫破裂的风险,应结合孕周及子宫瘢痕厚度,选择合理的终止妊娠时机。尽管瘢痕子宫再次妊娠终止时多选择再次剖宫产,但可结合患者意愿和全面评估情况在严密监测下经阴道试产。再次剖宫产手术前,应对手术风险和难度充分评估,重点应关注胎盘异常情况,尤其应筛查出凶险性前置胎盘,妥善制定围手术期方案。麻醉方式采用蛛网膜下腔麻醉联合硬膜外麻醉可确保满意手术效果。再次剖宫产手术时,粘连和出血是最常见的手术难题,应熟悉解剖结构,提高手术技巧,选择合理的手术切口以避免损伤周围脏器和产后出血。为降低瘢痕子宫再次妊娠相关风险,应重视产后避孕宣传教育,避免意外妊娠的发生。
The risk of repeated pregnancy with scar uterus is much higher than that with non -scar uterus. To lower the risk, it is critical to reasonably terminate the pregnancy according to gestations and thickness of scar. Although it is inclined to do caesarean surgery when terminate the repeated pregnancy with scar uterus, the transvaginal trial would be an alternative way under patients＇ willingness and comprehensive assessment. Before surgery, it＇ s crucial to estimate the risk and difficulties, and more attention should be paid to ,abnormal placenta, especially screening the dangerous placenta previa as to plan for the perioperative. Technically, the subarachnoid anesthesia combined with epidnral anesthesia could highly ensure the good result of surgery. During the surgery, adhesion and hemorrhage are the most common headaches. Good knowledge of anatomy, skilled procedures and rational surgical incisions would significantly prevent damages of surrounding organs and post - operative hemorrhage. To reduce the risk of repeated pregnancy with scar uterus, focus should be put on contraception education in order to avoid accidental pregnancy.
出处
《中国计划生育和妇产科》
2012年第4期19-22,共4页
Chinese Journal of Family Planning & Gynecotokology
关键词
瘢痕子宫再次妊娠
术前评估
围手术期处理
产后避孕
repeated pregnancy with scar uterus
preoperative assessment
perioperative management
postpartum contraception
