The Analysis In The Outcome Of The Third Trimester Of Uterine Scar Pregnancy

Objective: To explore the outcome of the third trimester of uterine scar pregnancy,to provide the evidence of clinical management for the evidenced-based medicine.Methods: A retrospective survey was conducted to the patients who had been admitted to the obestetrics department of Beijing command general hospital of PLA,from January 2010 to December 2014,all of which had been under rules of regular inspection and had given birth to baby in the same hospital. The total sample included704 women in total, 352 women who were diagnosed uterine scar pregnancy was taken as the observation group,and 352 pluripara who were not diagnosed uterine scar pregnancy were taken as the control group.We collected the information of the age,gravidity,parity,the week of termination of pregnancy,and the number of increased BMI during pregnancy period for women from both groups.Besides, we made a survey on the ways of delivery,and the incidence rate of placental praevia,placental conglutination/implant,placental abruption,rupture of uterus,postpartum hemorrhage,puerperal morbidity.In addition,we made a collection of data of weight of the new-born babies and the 1st min,,5th min,10 th min Apgar score of the baby.Comparison was made between the two groups in the ways of delivery,incidence of pregancy related complications and the conditions of the babies.T-test was used to compare the mean of each group,χ2 test was used to compare the incidence rate of each group.Results :1. The comparisons of basic condition of women from both groups:(1)the average age of the observation group and control group,the difference between the two groups did not show statistically significance.( 2) the average week of delivery in the observation group and control group,the difference between the two groups did not show statistically significance.(3)the average mean gravidity of the observation group and control group,the difference between the two groups did not showstatistically significance.(4)the average mean parity of the observation group and control group,the difference between the two groups did not show statistically significance.( 5) the average increased BMI during pregnancy period of the observation group and control group,the difference between the two groups did not show statistically significance.2. The comparisons of ways of delivery between the two groups:314 cases(89.20%)were in the way of uterine- incision in the observation group, and 145 cases( 41.19%)in the control group, there was statistically significance between the two groups. 38cases(10.80%) were in the way of natural labor in the observation group, and 207cases(58.81%) in the control group, there was statistically significance between the two groups.3. The comparisons of incidence of compliacations in gestation period between the two groups:the incidence rates of placenta praevia and placenta conglutination/implant in the observation group were 11.93% and 8.81%, the incidences of thecontrol group were 1.14% and 0.57%, the differences were statistically significant( P < 0.01). The incidence of placental abruption in the observation group was 3.69%, the incidence of the control group was 0.28%,the differences was statistically significant( P<0.01).4. The comparisons of incidence of compliacations in labor state and puerperal state between the two groups:the incidence of hysterorrhexis and postpartum hemorrhage in the observation group was 2.56% and 10.51%, while the incidence of the control group was 0.28% and 2.27% in control group, the differences was statistically significant( P<0.01). The incidence of puerperal fever in the observation group was10.23%, the incidence of the control group was 4.55%,the differences was statistically significant( P<0.01).5. The comparisons of conditions of new-born babies:the average weight of the new-born babies in the observation group and the control group,the difference between the two groups was not statistically significant( P>0.05).The average 1st min Apgar score of the new-born babies in the observation group and the controlgroup,the difference between the two groups was not statistically significant( P>0.05).The average 5th min Apgar score of the new-born babies in the observation group and the control group,the difference between the two groups was not statistically significant( P>0.05).The average 10 th min Apgar score of the new-born babies in the observation group and the control group,the difference between the two groups was not statistically significant( P > 0.05).The incidence of asphyxia neonatorum in the observation group and the control group,the difference between the two groups was not statistically significant( P>0.05).Conclusions:1.Cesarean delivery was still the main way for the uterine scar pregnancy women who got pregnant again to terminate pregnancy.2.The incidence of placenta praevia and placenta abruption and conglutination/implant in scarred uterus pregnancy is higher than in the non-scarred uterus.3.The incidence of hysterorrhexis, postpartum hemorrhage and puerperal fever in scarred uterus pregnancy is higher than in the non-scarred uterus.