| Objective:This topic through the pregnancy delivery of scar uterus in female choice,and the pregnancy outcome and neonatal status were analyzed,in order to provide feasible suggestions and prognostic judgement for the pregnant women group,so as to effectively guarantee and promote the health level of scarred uterus female and neonate in china.Methods:From January 2016 to December 2018 in our hospital medical record room hospital register were reviewed and inspected.The data of obstetric delivery cases in our hospital during the past 3 years were collected,including the annual delivery number,number of vaginal delivery,cesarean uterine scar number,other factors of cesarean section number.In addition,422 cases of cesarean section with scarred uterus were selected as observation group and 314 cases of cesarean section for the first time in the same period as control group.A total of 1028 pregnant women with scarred uterus were selected as the research object from January 2016 to December 2018.According to the mode of delivery,they were divided into two groups:ERCS group and VBAC group.Among them,there were 925 cases in ERCS group,24 cases of induced labor failure and 103 cases in VBAC group.Another 120 cases multiparae of vaginal delivery without cesarean section in the same period were selected as non-scar vaginal delivery group(VBNC group).The trend of scarred uterus pregnancy in our hospital in recent 3 years,the methods of cesarean section for the first cesarean section and scarred uterus cesarean section,the conditions and contraindications of vaginal delivery for scarred uterus pregnancy were discovered.Based on that,the clinical data of maternal and newborn in all sample data,including maternity general data,clinical pregnancy outcome and perinatal birth status were collected and compared.Results:①From January 2016 to December 2018,the delivery rate of hospitalized pregnant women in our hospital increased year by year.The vaginal delivery rate increased year by year,the cesarean section rate decreased year by year,and the cesarean section rate of scarred uterus increased year by year.②The bleeding volume and operation time of scarred uterus cesarean section group were significantly higher than those of the first cesarean section group,and the hemoglobin after operation was significantly lower than that of the first cesarean section group.The proportion of uterine atony,abdominal cavity adhesion and placental adhesion after operation increased significantly compared with the first cesarean section group.The difference between the two groups was statistically significant(P<0.05).In addition,the proportion of women in the scarred uterus cesarean section group with blood transfusion,uterine rupture,hysterectomy,uterine knapsack suture and poor wound healing after operation increased slightly compared with the first cesarean section group,but the difference between the two groups was not statistically significant(P>0.05).The rate of perinatal premature delivery,asphyxia rate and neonatal conversion rate in scarred uterus cesarean section group were significantly higher than those in the first cesarean section group(P<0.05),and the rate of fetal death rate was slightly higher than that of the first cesarean section,but the difference was not statistically significant(P>0.05).③The average amount of bleeding during delivery,hospitalization time and hospitalization costs of the ERCS group were significantly increased than the VBAC group,the differences were statistically significant(P<0.05).The proportion of patients with poor wound healing in ERCS group was higher than that in VBAC group,but the difference was not statistically significant(P>0.05).There was no statistically significant difference between the two groups in terms of Apgar score at 1 minute of birth,neonatal asphyxia rate and neonatal weight(P>0.05).④There were significant differences in scar thickness and time from the previous pregnancy between the successful scar uterine vaginal delivery group and the failed vaginal delivery group(P<0.05),but there was no significant difference in neonatal weight(P>0.05).⑤There were no significant differences in maternal and infant outcomes between vaginal delivery group of scarred uterus and vaginal delivery group of non-scarred uterus(P>0.05),such as maternal bleeding volume during delivery,hospital stay,neonatal asphyxia and neonatal weight.Conclusion:Re-cesarean section for scarred uterus pregnant women after previous cesarean section not only increases the difficulty of operation and prolongs the operation time,but also significantly increases the complications and bleeding volume during operation,meanwhile,postoperative recovery is poor.Therefore,based on the full assessment,we should provide a perfect and comprehensive medical rescue equipment and measures,and encourage the scarred uterus pregnant women without contraindication of vaginal trial delivery to carry out vaginal trial delivery first.In addition,the choice of vaginal delivery for scarred uterus pregnant women does not have significant adverse effects on the neonatal birth condition. |
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