The Clinical Research Of Maternal And Fetal Outcomes And The Delivery Modes Of Scarred Uterus

Research Objective:To know the outcomes of maternal and neonatal with scarred uterus.To observe the differences outcomes between vaginal birth after cesarean section and elective repeated cesarean section,which can help to let the mothers with scared uterus to choose a suitable delivery mode.Research Mothods:A retrospective analysis from 2013 to 2015 Yangzhou Subei Hospital and Child Health-Care Center of Yangzhou. From the cases with scarred uterus,there are the 465 cases with scarred uterus which choose repeatd cesarean section versus 351 cases undergo primary cesarean.To compare the differences between the vaginal birth after cesarean section and elective repeated cesarean section,get 2089 cases from Child Health-Care Center of Yangzhou with scarred uterus,and which merger other indications for cesarean section are excluded.At last,there are 2035 cases choose elective repeated cesarean section(ERCS group),9 pregnat women fail to Trial of labor after cesarean,45 cases undergo vaginal birth after cesarean section(VBAC group).Comparing the different outcomes between the two groups.At the same time, there are 45 cases which choose vaginal birth and never undergoing cesarean section(VBNC group),the cases are random-accessed. Then choose the differences between VBAC and VBNC.Research Results:1. From 2013 to 2015,the women who delivery are 9804、8957、10463, cesarean sections are 4855、4506、5168, the scarred uterus are 805、1006、1402。The rate of cesarean and scarred uterus is increasing.From 2013-2015,the rate of scarred uterus pregnant is 8.2%、11.2%、 13.4%.In the women who undergo cesarean sections,the rate of scarred uterus is 16.6%、 22.3%、27.1%.2.There are significant differences with the outcomes,such as the time for operation,the hemorrhage volume,the Hb of the mothers,the blood transfusion,the bad uterus constriction,bad healing,the adhesions of pertineal cavity,the problems with placenta and do the B-Lynch operations (P<0.05).however,the healing,uterus rupture and whether ablate the uterus or not is not significantly different (P>0.05).For the outcomes of neonatals,oremature birth,neonatal asphyxia and do to the neonatal wards are signifiacantly different (P<0.05).The rate of neonatal death is not different (P>0.05)3.To analyse the differences between ERCS and VBAC,the time for delivery, the hemorrhage volume,the days to be in hospital, bad healing,the money, Apgar score of neonatals are significantly different (P<0.05). ERCS have more gangerous in hemorrhage volume,the days to be in hospital, bad healing,the money, Apgar score of neonatals, the time for delivery is shorter. But the weight of neonatals between the two groups are not of significant difference(P>0.05). There are significant differences in thickness of scar,the year of the primary cesarean. VBAC and VBNC are not significant different in hemorrhage volume, the days to be in hospital and Apgar score of neonatals (P>0.05) Research Conclusions: 1.Because of the fertility policy,the rate of cesarean and scarred uterus is increasing. Among the women who undergo cesarean sections,the rate of scarred uterus is also increasing. 2.The maternal and neonatal outcomes with scarred uterus are worse,so we should also control the rate of scarred uterus. 3.Vaginal birth after cesarean section is better than elective repeated cesarean section,so the pregnant women with scarred uterus can also try to TOL if undergo with the guidelines for vaginal birth after cesarean section,which can also help to decrease the cesarean rate.