Risk Factors For The Adverse Outcome Of Maternal And Infant In Repeat Cesarean Section And The Effect Of Anesthesia Method On The Outcome

Objectives:With the change of fertility policy in China,more and more pregnant women are carrying out repeat cesarean section.Due to the scar uterus and the increase of complications,the incidence of postpartum hemorrhage and birth asphyxia is also increased.At present,postpartum hemorrhage and birth asphyxia are the most dangerous factors to the safety of mothers and infants in China.Therefore,the risk factors of postpartum hemorrhage and birth asphyxia in parturient undergoing repeat cesarean section were analyzed through a retrospective study.At the same time,the effects of different anesthesia methods on maternal and infant outcomes of repeat cesarean section were studied.Methods:1.Based on the electronic medical record system of the hospital,the clinical medical date of 2442 women who had repeat caesarean section in our hospital from October 2015 to October 2017 were gathered.Basic maternal information,preoperative data,pregnancy-related complications,anesthesia,intraoperative and postoperative information were recorded.According to the criteria of postpartum hemorrhage,women were divided to postpartum hemorrhage group(group PPH,n=346)and non-postpartum hemorrhage group(group NPPH,n=2096).According to the criteria of birth asphyxia,cases were divided to birth asphyxia group(group BA,n=62)and non-birth asphyxia group(group NBA,n=2380).Risk factors of postpartum hemorrhage and birth asphyxia were screened by logistic regression models.2.In order to determine the influence of anesthesia methods on maternal and infant outcomes,the patients were divided to general anesthesia group(n=140)and intraspinal anesthesia group(n=2302)according to different anesthesia methods.After the preoperative and intraoperative factors matched by propensity score matching(PSM),the general anesthesia group(n=131)and the intraspinal anesthesia group(n=131)were matched.Then the intraoperative blood loss,transfusion rate,uterine atony rate,birth asphyxia rate,hemostasis methods and hospitalization days were compared between the two groups.Results:1.Stepwise regression showed that the risk factors of postpartum hemorrhage after repeat cesarean section were placenta previa [odds ratio(OR)=17.858,95% confidence interval(95%CI)8.359-38.149],prenatal anemia(OR=10.882,95%CI 6.190-19.129),uterine atony(OR=6.608,95%CI 3.604-12.115),operative time >100min(OR=5.202,95%CI 2.196-12.321,reference group: operative time ≤60 min),placental adhesion(OR=3.103,95%CI 1.657-5.810),ASA Ⅲ～Ⅳ(OR=3.821,95%CI 2.062-7.081),reference group: ASA Ⅰ～Ⅱ)],placental implantation(OR=3.054,95%CI 1.122-8.313),gestational week < 35(OR=4.003,95%CI 1.571-10.201,reference group: gestational week ≥39).Risk factors of birth asphyxia for repeat cesarean section were renal dysfunction(OR=9.330,95%CI 1.426-61.040),general anesthesia(OR=2.896,95%CI 1.306-6.422),pregnancy hypertension(OR=3.371,95%CI 1.519-7.479),uterine atony(OR=2.528,95%CI 1.137-5.618),premature infant(OR=3.625,95%CI 1.576-8.335),low birth weight(OR=6.448,95%CI 2.858-14.550).2.After PSM,the incidence of birth asphyxia at 1 minutes after birth in general anesthesia group was higher than intraspinal anesthesia group(10.7% vs 3.8%,P<0.05).However the incidence of birth asphyxia at 5 or 10 minutes after birth had no statistical difference between the two groups.There was no statistical difference in the incidence of postpartum hemorrhage,transfusion rate,uterine atony rate,intraoperative blood loss,hemostasis methods and hospitalization days between the general anesthesia group and the intraspinal anesthesia group(P>0.05).Conclusions:1.Risk factors of postpartum hemorrhage for repeat cesarean section included gestational week < 35,placenta previa,prenatal anemia,placental implantation,placental adhesion,prolongation operation time,uterine atony and ASA classification.2.Risk factors of birth asphyxia for repeat cesarean section were pregnancy hypertension,renal dysfunction,uterine atony,premature infant,low birth weight and general anesthesia.3.Compared with intraspinal anesthesia,general anesthesia did not increase the amount of intraoperative blood loss and the incidence of postpartum hemorrhage.However,general anesthesia can increase the birth asphyxia rate at 1 min after birth,but has no significant effect on the birth asphyxia rate at 5 min and 10 min after birth.