关键词: 剖宫产, 再次妊娠, 阴道试产

Abstract: Objective To investigate the appropriate obstetric managment of secondary pregnancy after cesarean section. Methods A total of 237 cases with secondary pregnancy after cesarean section from 2005 to 2008 were retrospectively studied. The relevant circumstances of two forms that made up two categories in each form selective re-cesarean section and emergency re-cesarean section; re-cesarean section and vaginal labor had been cautiously compared. Results In 237 labors of secondary pregnancy after cesarean section, there were 158 cases of attempted vaginal labor and 121 cases of vaginal delivery. Hence, the successful rate of attempted vaginal labor was 76.6%(121/158). There were 79 cases with selective re-cesarean section. In emergency re-cesarean section, 31 cases had unrestrictive indication, while was 39.2%(31/79). Consequently it can be said that selective re-cesarean section is strongly related to the psychological elements of the patients and their families. Comparing with volume of delivery blood loss, operation time, dehiscence of uterus incision during operation, postpartum infection, rate of puerperalism and neonatal apnea, there was no significant difference between selective re-cesarean section and emergency re-cesarean section. However, volume of delivery blood loss, postpartum hemorrhage, postpartum infection, rate of puerperalism and days of hospitalization between re-cesarean section and vaginal labor showed significant differences(P<0.05). Conversely, there was no significant difference of neonatal apnea in these two categories(P>0.05). Conclusion It is very important to choose an appropriate labor managment of secondary pregnancy after cesarean section, including meticulous prenatal checkups, good doctor-patient communications, strict handing of restrictive re-cesarean section indications scientifically choosing labor managment and proficient obstetric skills. Attempted vaginal labor in secondary pregnancy after cesarean section is more profitable. Labor trials would not add difficulties and risks in re-cesarean section. The operative skills of primary cesarean section directly affect healing of uterus incision and directly relate to the safety of re-cesarean section. It is not essential to have more than two years apart from the previous cesarean section.

Key words: cesarean section, secondary pregnancy, vaginal labor