摘要
目的研究剖宫产后阴道分娩孕产妇的产程特点及干预措施,规范剖宫产术后阴道试产孕产妇的产程管理。方法选取笔者医院2016年1月~2017年12月剖宫产术后阴道分娩产妇的病例资料114例为观察组,以同期阴道分娩初产妇病例资料355例和无剖宫产史阴道分娩经产妇244例作为对照组,回顾性分析比较各组产程时间、产时的干预措施及围生结局。结果观察组各产程及总产程时间均短于初产妇对照组(P<0.05),但第二产程及总产程较经产妇对照组时间延长(P<0.05)。观察组产程中干预措施(如人工破膜、缩宫素使用、分娩镇痛、间苯三酚使用)的发生率显著低于初产妇对照组(P<0.05),观察组中人工破膜及会阴侧切发生率高于经产妇对照组(P<0.05)。3组新生儿Apgar 1min及5min评分比较,差异无统计学意义(P>0.05);观察组产时出血量较两对照组增多,产后出血量较初产妇对照组明显增多(P<0.05),观察组产时发热发生率高于经产妇对照组,但低于初产妇对照组,且初产妇对照组会阴裂伤情况与观察组之间比较,差异有统计学意义(P<0.05)。结论剖宫产后阴道分娩第一产程时长与经产妇对照组相似,在出现宫口停止扩张后应首先考虑人工破膜促进子宫收缩。第二产程中可以适当放宽会阴侧切指征,进而缩短第二产程。但剖宫产后阴道分娩产时出血及产后出血风险有所增加,应被密切关注。
Objective To study the labor characteristics and intrapartum interventions in vaginal birth after cesarean section and establish standard labor management for vaginal birth after cesarean delivery.Methods A total of 713 cases in this hospital were enrolled from January 2016 to December 2017,of which 114 vaginal delivery pregnant women after cesarean delivery as an observation group,355 primiparas with vaginal delivery and 244 multiparas with vaginal delivery as the primipara control group and multipara control group,respectively.The length of the labor time,the management of labor and the perinatal outcome were compared to determine whether there were different.Results Women in observation group had significantly shorter labors compared to primipara,both the total labor and each stage of the labor,while they had longer second stages of labor and total labor than the multipara.The interventions during labor,such as artificial rupture,use of oxytocin,labor analgesia,use of phloroglucin,were less use in observation group than the primipara control group,but the rate of artificial rupture and episiotomy were higher than the multipara control group.There was no significant difference in Apgar score of 1min and 5min among three groups.The intrapartum and postpartum hemorrhage was higher in the observation group,while postpartum hemorrhage was higher than the compared than other two groups,while the difference in postpartum hemorrhage had no significance between observation group and multipara control group.Moreover,the rate of intrapartum fever of the observation group was higher than the multipara control group,but lower than the primipara control group,and the perineal laceration was significantly different between observation group and primipara control group.Conclusion The first stage of labor of vaginal birth after cesarean was similarly with primipara,artificial rupture should be considered as the first choice when the palace stops expanding.Episiotomy could be widely used in the second stages of labor to shorten
作者
麻艳艳
钱益宇
黄文乐
应辛欣
华莹
Ma Yanyan;Qian Yiyu;Huang Wenle(Department of Obstetrics and Gynecology,The Second Affiliated Hospital of Wenzhou Medical University,Zhejiang 325027,China)
出处
《医学研究杂志》
2020年第5期64-68,共5页
Journal of Medical Research
基金
国家自然科学基金青年科学基金资助项目(81601319)。
关键词
剖宫产术后阴道试产
产程特点
产时干预
Trial of labor after cesarean section
Labor characteristics
Intrapartum interventions
