探讨剖宫产术后再次妊娠时的分娩方式选择和拟采取措施及阴道分娩的安全性和可行性。

采用回顾性分析法，分析2004年1月至2009年12月在本院剖宫产术后再次足月妊娠的387例患者的临床病历资料。其中，41例符合阴道试产的适应证，且愿接受阴道试产，将32例接受阴道试产成功者纳入观察组，将另外355例再次接受剖宫产的孕妇纳入对照组(本研究遵循的程序符合本院人体试验委员会指定的伦理学标准，得到该委员会审查、批准。分组征得受试对象同意，并与其签订临床研究知情同意书)。比较两组患者产后24 h内出血量、产褥病率、新生儿Apgar评分、住院时间、住院费用等。总结观察组分娩特点。

剖宫产术后再次妊娠分娩患者中，阴道分娩成功率为78.0%(32/41)，无1例发生子宫破裂。两组患者在产后出血、产褥病率、住院时间、住院费用方面比较，差异有显著意义(P<0.05)，而新生儿窒息发生率比较，差异无显著意义(P>0.05)。

剖宫产术后再次足月妊娠分娩，通过严密观察产程，发现难产及时处理、严格掌握阴道分娩适应证，多数可经阴道安全分娩。剖宫产术后再次妊娠，并非绝对阴道分娩禁忌证。

To explore the delivery mode of patients with prior cesarean section, and the safety and feasibility of vaginal delivery after cesarean section.

From January 2004 to December 2009, 387 cases of pregnancy delivery after cesarean section were recruited into this study. They were divided into two groups according to different method of delivery, observation group (n=32, virginal delivery) and control group (n=355, cesarean section). The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Centre for Capital University of Medical Sciences. Informed consent was obtained from all participants. The following indexes were compared between two groups: 24 h post-partum bleeding volume, neonatal Apgar score, length of stay, hospital charges, etc.

The successful rate of vaginal delivery was 78.0% (32/41) with no uterine rupture. The rest of 355 cases were chosen to accept cesarean section. There had statistically significant differences of postpartum hemorrhage, puerperal morbidity, length of stay, hospital charges between two groups (P<0.05), but had no significant difference of incidence of neonatal asphyxia (P>0.05).

Most of the patients with prior cesarean section could deliver safely through vaginal labor, if the indication and contraindication of vaginal labor were grasped strictly and the labor processes were observed intensively. Pregnancy after cesarean section is not a absolute indicator for cesarean section again.