Delivery Way Analysis Of Scarred Uterus Re-pregnancy After Cesarean Section

Objective:The number of caesarean sections(CS)is increasing globally in recent years,and repeat CS after a previous CS is a significant contributor to the overall CS rate.An important question many obstetricians have to pay attention to is how to select the delivery way for most women with previous CS.Some domestic academics have recently suggested that vaginal birth after caesarean(VBAC)which has been widely recommended,results in fewer undesired results or complications is the better option for most women.It can be seen as a real and viable measure to reduce the rate of caesarean.But maternal morbidity such as uterine rupture,postpartum and other complications in women with previous cesareans is higher when TOLAC fails.In some places,it has become common practice for a woman who has had a caesarean section to have this procedure again as a matter of routine.For women who are likely to have a successful vaginal delivery,routine ERCD may result in excess morbidity and cost.This manuscript will summarize the evidence on VBAC and ERCD to help clinicians identify candidates,provide evidence-based counseling,and increase the rate of VBAC.The present study analyzed clinical date in February 2014 to October 2015 of some cases in our hospital,to guide clinicians to make appropriate clinical treatment for pregnant women with previous CS.Methods :A total of 204 patients in our hospital from February 2014 to October 2015 were analyzed retrospectively,including 68 patients with vaginal delivery as observation group(group A)and 68 patients with non-scarred uterus vaginal delivery in the corresponding period were selected as the control group(group B),68 cases underwent elective cesarean section were selected as another control group(group C).And the values of postpartum indicators of the three groups were compared to find out the more appropriate delivery mode for pregnant women with previous CS.Results:(1)The differences in the total stage of labor,the amount of postpartum hemorrhage,puerperal infection,the hospital stay,the neonatal asphyxia rate and neonatal weight between group A and group B were not statistically significant(P>0.05).(2)The vaginal birth after caesarean group was significantly higher than the vaginal delivery group in the episiotomy rate,significant difference was note.(P<0.05).(3)The differences in the depth of lower uterine segment,puerperal infection,the neonatal asphyxia rate and neonatal weight between group A and group C were not statistically significant(P>0.05).(4)Significant difference was noted between the VBAC group and the ERCD group on the amount of postpartum hemorrhage,the hospital stay(P<0.05).(5)Ultrasound assessment of the risk of uterine rupture in women with uterine scars is would be of limited value.Conclusion:(1)For the patients with scarred uterus re-pregnancy after cesarean section,the vaginal delivery way should be chosen on the premise of close monitoring of stages of labor and strict mastery of vaginal delivery indications in order to reduce the harm to mother and child.(2)In patients with a previous caesarean delivery,the ERCD women has an increased risk of short and long-term maternal complications and the greater economic burden and more hospital stay than the VBAC women.(3)There is no auxiliary examination which could assess the risk of uterine rupture exactly in women with uterine scars.Ultrasound assessment of the risk of uterine rupture is limited.Closely inspecting the stages of labor rigorous is still the key measure to prevent the rupture of uterines.