| In recent years,many studies have paid more attention to the study of the mode of delivery of the second pregnancy of scar uterus after cesarean section.Different women have different differences in the choice of delivery methods,and the medical configuration of different regions is different,so about the scar uterus.The controversy over the choice of delivery methods for the second pregnancy is still relatively large.In recent years,the concept of tria of labor after previous cesarean delivery(TOLAC)has gradually been accepted by the majority of obstetricians.In order to help the maternal postpartum recovery,avoid the risk of cesarean section surgery,after the full evaluation of the obstetrician,in the case of maternal and fetal indicators are consistent,the clinical recommendation is to choose vaginal trial production.And although there is an expert consensus that the second stage of labor should be appropriately shortened in TOLAC,the need for routine implementation of perineal incision is still lacking in evidence.In the vaginal delivery of pregnant women,the midwife must pay attention to the rate of perineal incision.It should not be routinely cut open to avoid adverse effects on maternal health.ObjectivesThe retrospective analysis of maternal and infant outcomes of vaginal delivery of scar uterine pregnant women after cesarean section and the main influencing factors of perineotomy,in order to reduce the perineal incision rate of such pregnant women and how to choose perineotomy Provide evidence.MethodsIn this study,461 cases of scar uterine women who had successful vaginal delivery in a top three hospital in Suzhou from January 2018 to December 2018 were selected.Among them,there were 117 cases in the perineotomy group(group A)and 344 cases in the non-perineotomy group(group B).The self-made perineotomy influencing factors and maternal and infant outcome questionnaire were used to collect relevant clinical data of each group,and their clinical data.Perform retrospective analysis.Perform t-test and ?2 test on the collected data.For the influencing factors,single-factor analysis and multi-factor logistic regression analysis were used.ResultsA total of 461 cases of transvaginal pregnant women who were pregnant again after cesarean section were investigated in this study,including 117 cases in the perineotomy group and 344 cases in the non-perineotomy group.There was no statistically significant difference in baseline data of the two groups of pregnant women's weight,height,age,neonatal weight,and occurrence of megalopus(P>0.05),which are comparable.In 19 single factor analysis,after calculating the statistical value and screening,the history of vaginal delivery,gestational age,hypertensive disorder of pregnancy,type of fetal heart monitoring,natural labor,forceps and fetal suction,second stage of labor were obtained.Time was the main influencing factors,and its P value was<0.05.Multivariate Logistic regression analysis showed that forceps and fetal aspiration,spontaneous labor,type of fetal heart monitoring,time of second stage of labor,gestational week,and hypertension during pregnancy were independent influencing factors.The Apgar score of the newborns in the observation group was(9.31 ±0.36)points,and that of the control group was(9.42±0.53)points,T=1.03,P=0.87,P>0.05,the difference.Not significant;after comparison,the probability of occurren ce of contrasting large children after delivery was very close,?2=2.36,P=0.12,P>0.05,the difference was not obvious;the observed group neonatal weight was not significantly different from the control group,calculation The T=1.90,P=0.06,P>0.05.The incidence of urinary retention was significantly higher in the observation group than in the control group.?2=26.33 and the P<0.001.The difference was obvious.At the same time,the amount of postpartum hemorrhage in the observation group was significantly higher than that in the control group,two hours after birth.Perineum wound pain was significantly greater than that of the control group,T=7.24,P<0.001,the difference was significant.ConclusionsForceps and fetal aspiration,natural labor,type of fetal heart monitoring,second stage of labor,gestational week,and hypertension during pregnancy are the main influencing factors for perineal incision during vaginal delivery after cesarean section.Opening does not improve the maternal and infant outcomes of transvaginal delivery of scar uterus,but may increase some of the near-term and long-term complications of the mother,increase the discomfort of the mother,and cause harm to the mother and her body Comprehensively assess whether there are high-risk factors for perineal incision in women undergoing scar and uterine vaginal trials,In order to achieve targeted perineal incision and minimize the perineal incision rate of scar uterine vaginal delivery,this method is worthwhile. |
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