Clinical Analysis Of Delivery Way In 204 Cases With Ccar Uterine

Obsjective: Through the system analysised of clinical cases of pregnancy with scar uterine(including Cesarean section and Uterine fibroids invisible postoperatively), to research different delivery way with scar uterus impact on maternal and perinatal son,to discuss how to choice the delivery ways with scar uterine and the factors affecting the vaginal trial production,to provide the reference for reducing delivery risk of maternal and perinatal,to provide the reference for reducing complications and mortality.Methods:1. Retrospectively analyzed the clinical data of 204 cases with uterine scar pregnancy again, Included antepartum/intrapartum/ postpartum data. According to the different way of delivery, Divided into elective repeat cesarean delivery(ERCD) group 102 cases and trial of labor after cesarean(TOLAC) group 102 cases, there were 59 cases of vaginal trial produced successfully,referred to as vaginal birth after cesarean(VBAC)group, 43 cases of vaginal trial producted failing,diverted into emergency cesarean section. Compared the general conditions of Maternal and newborn healthy with different delivery ways.2. Combined with domestic and foreign scholars researching and clinical practice, by using the multi-factor Logistic regression analysis, analyzed age, culture level, occupation, gestational age, BMI before delivery, the thickness of the lower uterine segment before delivery, the time apart from the previous cesarean delivery, the history of vaginal delivery, position of foetus, neonatal weight of the pregnant women 。 Screened out meaningful factors,which could impact the ending of TOLAC. Statistical processed: Numerical variables were shown as(`x ± s). All variables were used SPSS17.0 statistical software to analyze. The measurement data was compared with t test and single factor analysis of variance. Calculation data were compared by using χ2 test. Nonparametric data were compared with the Wilcoxon rank sum test. Multivariate regressionanalysis. p < 0.05 refers to the difference was statistically significant, p < 0.01 refers to the difference is highly significant or significant difference.Results:1.TOLAC group(n=102), VBAC group(n=59), 43 cases of vaginal trial producted failing diverted into emergency cesarean section,the reasons of the vaginal trial producted failing included: There were 30 pregnant women afraided of contractions pain and uterine rupture, maternal gave up vaginal delivering to request emergency cesarean section, 3 cases with fetal intrauterine distress, 8 cases with persistent occipital transverse(back),2 cases with stagnation of fetal head descending. 2. Relatived to ERCD group, TOLAC group tend to be older; Less body mass index and smaller gestational age;the number of women with history of vaginal delivery is bigger. These differences are statistically significant(p < 0.05). 3.Blood loss and hospital costs in the TOLAC group were significantly less than the ERCD group, the differences were statistically significant(p < 0.05).4.Neonatal complications of TOLAC group and ERCD group: the Apgar score(1 minute after birth) showed no significant difference( p > 0.05), and there was no perinatal deaths; Neonatal weight in the VBAC group was significantly less than the ERCD group, the differences were statistically significant(p < 0.01).5.The comparison of maternal with complications: No maternal uterine rupture occurred in TOLAC group, 5 cases occurred Incomplete uterine rupture in ERCD group.6.Through the multi-factor Logistic regression analysis, Availabled for the corresponding Logistic regression expression:㏑﹙p/1-p)=17.854+0.282X1-3.940X2+2.889X3-0.719X4+1.367X10,from the expression we can find that pregnant women’s age,occupation, cultural level, delivery gestational age and the history of vaginal delivery are the meaningful factors for impacting the ending of TOLAC. 7. The predictive sensitivity and specificity were 86.4% and 79.1% respectively while the cutpff point was 0.5.Conclusions:1. According with standard of TOLAC, Vaginal trial production rate is higher with older/Less body mass index / smaller gestational age and the more number of women with history of vaginal delivery. Engaged in manual Labour workers compared with mental labor workers are more likely to trial-produce success. Therefore, the influence of non-medical factors on TOLAC ending is of greatsignificance.2. In which hospital that has a rescue equipment and can implement emergency cesarean section, the doctor should control TOLAC indicatio and contraindication strictly to ensure safety of vaginal trial production with uterine scar pregnancy again. 3. For pregnant women with a history of cesarean section,strengthen the prenatal education, guiding the right think about VBAC failure, rational choice childbirth way.