天津医药

天津医药 ›› 2016, Vol. 44 ›› Issue (10): 1280-1282.doi: 10.11958/20160033

• 临床研究 • 上一篇    下一篇

孕产妇不同分娩方式的选择及结局探讨

庞运夺，马艳，董胜雯，孙忠   

  1. 1 天津医科大学护理学院（邮编 300070）；2 天津医科大学总医院妇产科；3 天津医科大学公共卫生学院
  • 收稿日期:2016-01-25 修回日期:2016-07-07 出版日期:2016-10-15 发布日期:2016-10-21
  • 通讯作者: 孙忠 E-mail:duoduo_amy@163.com
  • 作者简介:庞运夺（1987）， 女， 助理实验师， 硕士在读， 主要从事临床实验教学研究

Study of different modes of delivery and outcome of pregnant women

PANG Yunduo, MA Yan, DONG Shengwen, SUN Zhong   

  1. 1 Nursing School of Tianjin Medical University, Tianjin 300070, China; 2 The Department of Obstetrics and Gynecology, General Hospital of Tianjin Medical University; 3 Public Health School of Tianjin Medical University
  • Received:2016-01-25 Revised:2016-07-07 Published:2016-10-15 Online:2016-10-21
  • Contact: SUN Zhong E-mail:duoduo_amy@163.com

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摘要： 目的 调查初产妇及经产妇不同情况下分娩方式的选择， 并对其分娩结局进行交叉比较。 方法 回顾性分析天津医科大学总医院妇产科 2013 年 1 月 1 日—2014 年 12 月 31 日入院分娩产妇 7 509 例的临床资料， 其中初产妇 6 229 例， 经产妇 1 280 例。 统计初产妇和经产妇阴道分娩和剖宫产例数及经产妇中剖宫产者的剖宫产指征构成比， 比较初产妇及瘢痕子宫孕产妇再次妊娠选择阴道分娩与剖宫产的比例及结局。 结果 经产妇剖宫产率高于初产妇（69.06% vs. 57.54%， χ2=59.19， P＜ 0.05）。 其中瘢痕子宫妇女再次妊娠 631 例， 经阴道分娩 39 例（6.18%）， 再次剖宫产 592 例（93.82%）。 经产妇选择剖宫产的手术指征以瘢痕子宫为主。 初产妇及瘢痕子宫孕产妇选择阴道分娩结局与剖宫产相比新生儿体质量较轻， 孕产妇住院时间较短， 产后 24 h 出血量和产后发热例数均较少（均 P＜ 0.05）， 在新儿评分方面差异无统计学意义。 初产妇与瘢痕子宫孕产妇选择阴道分娩结局差异无统计学意义。 瘢痕子宫经产妇再次剖宫产与初产妇首次剖宫产相比， 会增加孕产妇产后 24 h 出血量和产后发热例数（P＜ 0.05）。 结论 经产妇再次分娩仍以剖宫产为主； 瘢痕子宫经产妇再次妊娠经阴道分娩的结局明显优于首次和再次剖宫产者，经阴道分娩是孕产妇较为安全的分娩方式。

关键词: 分娩, 剖宫产术, 阴道分娩, 剖宫产后阴道分娩, 瘢痕子宫

Abstract: Objective To study the different selections of delivery mode of pregnant women, and compare their outcomes. Methods Data of 7 509 pregnant women hospitalized in the General Hospital of Tianjin Medical University between January 2013 and December 2014 were retrospectively analyzed. Of them, there were 6 229 cases of primipara and 1 280 cases of multipara. The numbers of vaginal delivery and cesarean delivery were statistical analyzed between primipara and multipara. The cesarean delivery indications of multipara was also studied. The vaginal delivery rates and cesarean delivery rates, and their outcomes were compared between primipara and scar uterus maternal pregnancy. Results The cesarean delivery rate was higher in multipara than that of primipara (69.06% vs. 57.54%, χ2=59.19, P＜ 0.05). Among them, 631 cases were uterine scar pregnancy, 39 cases (6.18%) were vaginal delivery and 592 cases (93.82%) were cesarean delivery. The uterine scar was the main indicator for cesarean delivery in multipara. Compared the outcomes of cesarean delivery, the weight of neonatal body mass was relatively light, the hospital stay was shorter, the amount of 24 h postpartum bleeding and postpartum fever were less in vaginal delivery in primipara and pregnant women with uterine scar (P＜ 0.05). There were no significant differences in scores of newborn. There were no significant differences in outcomes of vaginal delivery between primipara and pregnant women with uterine scar. Compared outcomes of cesarean delivery between multipara with scar uterus and primipara, there were increased maternal blood loss and postpartum fever in multipara with scar uterus (P<0.05). Conclusion The cesarean delivery is still the mainly mode for multipara. The vaginal delivery is the best mode for pregnant women with scar uterus compared with that of primipara. The vaginal delivery is the safer way of delivery for pregnant women.

Key words: parturition, cesarean section, vaginal delivery, vaginal birth after cesarean, scarred uterus