| Objective1.To retrospectively analyze the vaginal trial of 889 cases of cesarean section after cesarean section in the First Affiliated Hospital of Xiamen University from January 1,2012 to December 31,2017,and the Xiamen Maternal and Child Health Hospital.Cases,to explore the factors affecting the success rate of vaginal trial production,analyze the maternal and child outcomes of successful vaginal trials,and evaluate the safety and feasibility of vaginal delivery of scar uterus.2.Retrospectively validate the predictive power of the Grobman predictive model and establish a new predictive model。retrospectively analyze the cases of uterine rupture in 121 cases diagnosed by Xiamen Maternal and Child Health Hospital and the First Affiliated Hospital of Xiamen University from January 2012 to December 2017.Explore the high risk factors of uterine rupture。 Method1.Subjects:(1)A total of 889 pregnant women with vaginal trials from January 1,2012 to December 31,2017 were enrolled in the study.Among them,731 cases of successful vaginal trials failed.There were 158 cases.(2)From January 1,2012 to December 31,2017,the cases of cesarean section termination pregnancy in the uterus of the Japanese uterus were re-pregnancy.A total of 300 cases were selected as the control group according to the case number.(3)From January 1,2012 to December 31,2017,30 cases of non-scarred uterus in the Japanese hospital were sampled by stratified sampling according to the case number.(4)From January 1,2012 to December 31,2017,a total of 121 cases of uterine rupture were diagnosed in the Japanese hospital.One case was diagnosed as “aura of uterus rupture”,1 case of uterine rupture of uterine horn,and 1 case of hysteroscopic exploration.See cases of old uterine rupture,a case of abdominal pain after 19 days of VBAC,considering the possibility of incomplete uterine rupture,a total of 117 cases were included in the study.2.methods:(1)self-made unified data collection form,collected through the hospital medical record system included in the study pregnancy Clinical data of women and newborns,including maternal age(years),prenatal BMI(kg/m2),increased weight during pregnancy(Kg),previous cesarean section,history of vaginal delivery,and history of induction of labor greater than 12 weeks,the gestational age of delivery,the thickness of the scar in the lower uterus,the degree of dilation of the entrance to the uterus,neonatal weight,neonatal complications,etc.(2)The SPSS 20.0 statistical software was used to establish a database of maternal and neonatal case data and statistical analysis.(3)Grobman predictive model linear graph can be expressed by formula,vaginal trial production success rate P(success)= Exp(w)/(1 + Exp(w)),where w = 3.766-0.039(age)-0.060(first check BMI)-0.671(African American)-0.680(Hispanic)+0.888(history of vaginal delivery before cesarean section)+1.003(history of vaginal delivery after cesarean section)-0.632(recurrence of cesarean section indication)By plotting the receiver operating characteristic(ROC)curve and calculating the area under curve(AUC)to evaluate the diagnostic performance of the model.(4)First,the single factor logistic regression model was used to screen potential predictors.Variables with a P value of <0.05 in the univariate analysis were further included in the multivariate logistic regression model.Variables with a P value of 0.05 significance in the model were finally used for the construction of Nomogram.The ROC curve was drawn to calculate the diagnostic performance of the AUC evaluation model,the calibration curve was drawn to evaluate the calibration degree of the Nomogram,and the Decision Curve Analysis(DCA)was used to evaluate the clinical utility of the Nomogram.All statistical probabilities are two-sided probability tests.Results(1)The primary cesarean section of obstetrics was scar uterus(41.3%).The first cesarean section of pregnant women with scar uterus was fetal position error(22.1%);(2)the incidence of puerperal infection in vaginal delivery cases of scar uterus Hospitalization days,hospitalization expenses were lower than the cesarean section of the scar uterus(P>0.05),and the number of hospitalization days,hospitalization expenses,incidence of puerperal infection,incidence of postpartum hemorrhage,and newborns in non-scarred vaginal delivery cases There was no significant difference in the incidence of asphyxia(P<0.05).(3)The predictive efficacy of the Grobman model was verified by plotting the receiver’s working curve.The area under the curve was 62%(95% CI: 0.599,0.700)and the specificity was 57.7%.The sensitivity is 0.658.Age,pre-pregnancy BMI,pregnancy weight gain,cervical score,Gonggao’s success in vaginal trials and vaginal trial failures were statistically significant(P<0.05),a new predictive model was established,and the receiver’s working curve was drawn.The lower area is 94%(95% CI: 0.91-0.97),the sensitivity of the new prediction model is 0.904,and the specificity is 0.864.(4)The scar uterus after cesarean section is the most important factor for uterine rupture.In addition,the uterine muscle Tumor excision,uterine mediastinal resection,cervical cerclage,etc.,drug-induced delivery,uterine malformation,VBAC,etc.are risk factors associated with uterine rupture;(5)61.87% of patients with uterine rupture have no obvious complaint symptoms,mainly manifested again Incomplete uterine rupture(96.63%)found during cesarean section,the most common symptom in patients with complete uterine rupture is persistent abdominal pain(26.67%),followed by abdominal pain,abnormal fetal heart monitoring and abnormal fetal movement.Conclusion:(1)Scar uterus is the most important cesarean section in obstetrics.Strictly grasp the first indication of cesarean section in pregnant women,which can effectively reduce cesarean section in obstetrics;(2)vaginal delivery of scar uterus does not increase postpartum hemorrhage The risk of maternal and child infections such as sputum infection and neonatal asphyxia is shorter,less cost,and lower incidence of puerperal infection than re-elected cesarean section;(3)differences in race,geography,medical level,and medical service providers The Grobman predictive model is not fully applicable.Although the new predictive model has higher predictive power and clinical applicability,the predictive factor is simple,the clinical case is more complicated,and the balance between predictive efficacy and actual application value needs to be included,and more factors are included.Evaluation;(4)scar uterus after cesarean section is the most important factor of uterine rupture,in addition,uterine fibroids excavation,uterine mediastinal resection,cervical cerclage,etc.,drug-induced delivery,uterine malformation,VBAC,etc.Risk factors related to uterine rupture;(5)Clinical symptoms of uterine rupture may be paroxysmal or persistent abdominal pain,abnormal fetal heart monitoring,abnormal fetal movement,etc.It should be noted in conjunction with the patient’s history,the history of uterine surgery,be vigilant,to improve the diagnosis rate of uterine rupture... |
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