| In recent years about the scar uterus pregnancy childbirth way more research, there was large variation, and medical mode, there were big differences of scar uterus pregnancy childbirth way choice again there were still a lot of controversy. Study significant uterine scar may produce a variety of effects on the mother and child during pregnancy again, with time, pregnant uterine wall by the pressure increases, the surgical incision to reach the endometrium, the uterine scar become part of the weakest parts of the healing does not affect, may directly affect the lives of mother and child.Scar uterus has a great influence on the pregnancy childbirth, is very important to choose what kind of delivery way, scar uterus will have various effect on maternal, uterine rupture occurred, placenta transplantation, a significantly increased risk of postpartum hemorrhage. Scar uterus pregnancy again choose delivery mode influenced by many factors, in order to reduce medical disputes, clinicians generally by choose cesarean section, and a lot of women have vaginal trial production delivery, lack of confidence. Cesarean section is applied to the midwifery of high-risk pregnancy and abnormal pregnancy operation, high safety, less maternal pain, but may cause complications and sequelae, in recent years, many studies have shown that vaginal trial production is no longer a cesarean section delivery taboo pregnancy childbirth way again.Objective:To analyze the uterine scar pregnancy delivery mode selection and solving, and understand the scar pregnancy pregnancy incidence of different delivery modes, analysis and non scar pregnancy compared with women, postpartum hemorrhage, hysterectomy of different, to scar the uterus of pregnant women vaginal delivery provide clinical reference.Methods:Two hundred puerperas with uterine scar pregnancy again in The First AffiliatedHospital of Soochow University and Maternal and Child Health Hospital of Yancheng from 2012 to 2015 were selected,The gestation period of 11 years from the last 15 months to surgery, patients had a history of cesarean section,puerperas were divided into cesarean section scar pregnancy group(127 cases) and scar pregnancy vaginal delivery group(75cases) according to the actual mode of delivery.One hundred puerperas with no uterine scar pregnancy again in the same time were selected,puerperas were divided into no-cesarean section scar pregnancy group(58 cases) and no-scar pregnancy vaginal delivery group(42cases) according to the actual mode of delivery.All maternal and neonatal clinical data are organized, cesarean section operation time and all the maternal blood loss was recorded,Cause pilot failed pregnancy maternal vaginal uterine scar again was analyzed,different mode of delivery uterine rupture scar pregnancy, newborns,blood loss,intraoperative complicationswere compared,the difference of delivery mode, postpartum complication and so on between scar pregnancy and non scar pregnancy were compared.Results:(1)vaginal delivery trial to testify against maternal resources to 97 cases of vaginal delivery, which 75 cases were successful vaginal delivery, 22 cases of failed to turn for caesarean birth, other indicators of 53 cases were adopting cesarean section, there was no indicator of maternal were taken cesarean section production.(2) The uterine scar vaginal delivery 75 cases(37.1%) and the proportion of natural delivery 97 cases(48.0%) were significantly lower than the non-scarred uterus vaginal delivery group 52 cases(52.0%), and proportion of natural delivery 78 cases(78.0%)(P<0.05).(3)Scar pregnancy group and vaginal delivery failure turn for cesarean section 22 cases because of difficult labour 2 cases(9.0%), fetal distress 3 cases(13.6%) and the aura of uterine rupture 4 cases(18.1%) and Trial production process of subjective will require cesarean section 13 cases(59.0%)。(4)Scar group uterine pregnant women bleeding vaginal delivery group(181.1 ± 20.6)ml was significantly less than cesarean group(253.1 ± 51.8) ml, length of stay(4.6 ± 0.5) dwas significantly shorter than cesarean group(6.7 ± 0.8) d, incidence of neonatal asphyxia(4.0%) and cesarean section group(5.6%) was not significantly different(P> 0.05), uterine scar group vaginal delivery group birth weight(3265.1 ± 87.0) g was significantly smaller than the scar uterine cesarean(3625.0 ± 73.1) g(P <0.05).Cesarean uterine scar group incorporated prevalence(12.8%) higher than the uterine scar vaginal delivery group(10.7)(P> 0.05), but the difference was not significant.(5)Univariate analysis showed that age, prenatal BMI, gestational age, since the last time cesarean section, vaginal delivery history, labor hospitalization, cervical dilation and other factors related to the success of vaginal delivery(P <0.05), Maternal age, prenatal BMI, gestational age, perinatal hospitalization as independent variables included in the Logistic regression model showed that the results showed that maternal age(OR = 1.024),prenatal BMI(OR = 1.064), from the previous cesarean section(OR = 1.052), whether labor hospitalization(OR = 2.158), cervical dilation(OR = 0.749), history of vaginal delivery(OR = 2.315) on the impact of vaginal delivery(P <0.05).(6)Scar uterine cesarean delivery group bleeding(25.31 ± 51.8) ml was significantly higher than that of non scar uterine cesarean section delivery group(23.05 ± 48.7) ml(P<0.05), Scar uterine cesarean sections surgical time(59.1 ± 21.5) min was significantly longer than than in scar uterine cesarean sections(49.1 ± 11.2) min(P < 0.05), the incidence of puerperal fever(12.8%) patients with scar uterine cesarean delivery group was significantly greater than the scar uterine cesarean section group(2.1%)(P < 0.05),two groups of maternal hospitalization time difference was not obvious(P> 0.05).(7)Cesarean section scar pregnancy the infection(0.8%), intervention(0.8%) and amniotic fluid embolism(0.8%), the incidence of neonatal asphyxia incidence(5.6%) and non-pregnant group scar wound infection(0%), intervention(0%) and amniotic fluid embolism(2.1%), the incidence of neonatal asphyxia incidence(4.8%) were no significant difference(P> 0.05),uterine scar cesarean section group incidence of postpartum hemorrhage(13.3%) was significantly greater than non-uterine scar cesarean group(2.1%)(P<0.05).(8)Two pregnant groups women bleeding vaginal delivery, duration of labor, Apgar score, neonatal asphyxia, and other indicators of hospital stay were no significant difference(P> 0.05).Scarred uterus vaginal delivery group stage of labor(10.20 ± 0.28) h and blood loss(170 ± 15) ml were higher than the non-uterine scar group stage of labor(9.30 ± 0.51) h and blood loss(158 ± 12), but no significant difference(P> 0.05).Scarred uterus vaginal delivery ratio of vaginal delivery group(17.3%) was significantly higher than non-scarred uterus vaginal delivery group(1.9%)(P<0.05).Conclusion:(1)Scar pregnancy maternal civil rights mode of delivery in cesarean section mainly,postpartum hemorrhage after caesarean section(2)Hysterectomy higher incidence and clinical need to correctly grasp cesarean section indication, reduce the rate of cesarean section.(3) Scar pregnancy pregnant women with vaginal delivery conditions and the consent of the pregnant women and their families agree and sign a voluntary book, vaginal delivery is the best mode of delivery。(4)Uterine scar pregnancy and delivery, the history of vaginal delivery, labor and other factors of admission is a successful trial of labor protective factors.(5) Vaginal delivery requires accurate knowledge of vaginal trial production conditions, a comprehensive understanding of prenatal cesarean testify, crossing healing,scar thickness, and the lower two time intervals of pregnancy.(6)Vaginal trial production in line with mothers, pregnant women need to fully communicate, and to accompany the implementation of one.Scar pregnancy vaginal delivery in need to closely monitor women to produce, detection of fetal, improve vaginal delivery rate, reduce cesarean section on maternal risk. |
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