A Logistic Analysis Related To Influencing Factors On Postpartum Hemorrhage And Asphyxia Neonatorum Among Second Pregnancy With Caesarean Section And The Management Of Anesthesia

Objective To retrospectively review the clinical features of the second pregnancy among pregnant women with caesarean section,respectively.Investigate the effects of different mode of anesthesia for CS on maternal and neonatal outcomes among the second pregnancy with the diagnosis of placental previa-accrete and severe preeclampsia.Methods Total 1983 second pregnancy were enrolled in the study.The maternal basic information,pregnancy complications and comorbidities,maternal and neonatal outcomes were compared.Analysis the risk factors of postpartum hemorrhage and neonatal asphyxia in second pregnancy among pregnant women with cesarean section.Compare the haemodynamics and the maternal and neonatal short-term outcomes in different mode of caesarean anesthesia among the second pregnancy combine with placenta previa-accrete and severe preeclampsia,respectively.Compare the maternal hemodynamics and outcome of autologous blood versus intraoperative blood transfusion for cesarean section with postpartum hemorrhage.Results Compared with the primiparae,the second pregnancy with CS were at increased risk of placenta previa,placenta accrete,postpartum hemorrhage(PPH),transfusion and anoxia neonatorum(p<0.01),and the rate in Caesarean section after virginal birth(CAVB)group was the most significant.The risk factors of postpartum hemorrhage in CS among second pregnant women were as follows: premature delivery(OR=2.795,CI:1.44-5.425),prenatal anemia(OR=2.410,CI:1.10-5.26),placenta previa(OR=28.00,CI:13.86-56.60),placenta accreta,(OR=4.434,CI :1.847-10.642)The risk factors of neonatal asphyxia in CS among second pregnant women were as follows: preterm birth(OR=3.331,,CI:1.857-5.974),low birth weight(OR=9.510,CI:4.998-18.097),severe preeclampsia(OR=3.545,CI:1.171-10.729),placental abruption.(OR=6.589,CI:1.232-35.237);Among second pregnant mothers combine with placenta accreta and / or accrete was implemented CS,in the ERCS,general anesthesia group resulted in higher perioperative blood pressure,and the rate of admission to ICU、length of stay than intervertebral anesthesia group(p <0.05),other maternal and neonatal outcomes were not significant difference.In CAVB,the incidence of adverse outcomes in neonates was higher in the general anesthesia group,the difference was statistically significant(p <0.05).Conclusion The second pregnancy with CS were at increased risk of maternal adverse events,and the CAVB is especially prominent;Premature delivery,prenatal anemia,placenta previa,placenta accrete were the risk factors of PPH in CS among second pregnant women;Preterm birth,low birth weight,severe preeclampsia and placental abruption were the risk factors of neonatal asphyxia in CS among second pregnant women;Intervertebral anesthesia is superior to general anesthesia in CS among second pregnancy with placenta previa-accrete or severe preeclampsia,and general anesthesia is relatively safe to ERCS.