Clinical Analysis Study Of Full-Term Pregnancy In Scarred Uterus Delivered Vaginally

Purposes: A retrospective analysis was conducted to compare the differences between vaginal trial of delivery for full-term pregnancy in scarred uterus,vaginal trial of delivery for full-term pregnancy in primigravida,factors affecting successful delivery in vaginal trial of delivery in scarred uterus and the reasons for conversion to cesarean delivery in failed vaginal trial of delivery,to provide a clinical basis for the safety and feasibility of vaginal delivery for full-term pregnancy in scarred uterus and to reduce the cesarean delivery rate.Methods:The cases of patients with full-term pregnancy undergoing vaginal trial of labor from June 2018 to June 2019 in XX hospital were collected,and a total of520 cases were screened according to the inclusion and exclusion criteria,of which120 cases were in the scarred uterus undergoing vaginal trial of labor group(Group A)and 400 cases were in the primigravida undergoing vaginal trial of labor group(Group B).The scarred uterus vaginal trial of labor group(Group A)included 100 cases of successful vaginal trial of labor(Group A1)and 20 cases of failed trial of labor with cesarean delivery(Group A2);the primigravida vaginal trial of labor group(Group B)included 343 cases of successful vaginal trial of labor(Group B1)and 57 cases of failed trial of labor with cesarean delivery(Group B2).We compared the differences between patients with full-term pregnancies in scarred uterus delivered by vaginal trial of labor and those with full-term pregnancies in primigravida delivered by vaginal trial of labor(indicators included: general conditions before delivery such as age,gestational week,BMI before delivery,and the rates of successful trial of labor and failed trial of labor referred to cesarean delivery;delivery outcomes such as time of first,second,and third stage of labor,postpartum hemorrhage,neonatal weight,second stage of labor,number of cases of perineal scoliosis(rate),number of cases of postpartum hemorrhage((rate),number of puerperal infections(rate),number of neonatal complications(rate));comparison of factors influencing the successful delivery of scarred uterus by vaginal trial of labor(indicators included age,BMI,time since last cesarean delivery,history of vaginal trial of labor,weight of the newborn,thickness of the lower transverse uterine incision before delivery in scarred uterus)and comparison of reasons for conversion to cesarean delivery in the event of failed vaginal trial of labor.Results:There was no statistically significant difference between vaginal trial of labor in full-term pregnancy with scarred uterus and vaginal trial of labor in full-term pregnancy with primigravida(P > 0.05),where the differences in general condition before delivery,success rate of delivery,first stage of labor,third stage of labor,neonatal weight,postpartum hemorrhage,postpartum hemorrhage rate,puerperal disease rate,and neonatal complication rate were not statistically significant(all P >0.05),while the differences in second stage of labor,second The differences in the rates of perineal scoliosis were statistically significant(all P < 0.05).The differences in age,gestational week,BMI,interval between last cesarean section,and neonatal weight were not statistically significant in the single-factor analysis affecting successful delivery by vaginal trial of labor in scarred uterus(all P > 0.05);the differences in thickness of lower uterine transverse incision scar before delivery and history of vaginal trial of labor in scarred uterus were statistically significant(all P < 0.05),and the differences in thickness of lower uterine transverse incision scar before delivery and history of vaginal trial of labor in multifactor analysis were statistically significant(all P < 0.05).There was a statistically significant difference in the thickness of the lower uterine incision scar before delivery(P < 0.05),and the ROC curve analysis of the thickness of the lower uterine incision scar before delivery was statistically significant(P < 0.05),with an area under the curve AUC of 0.664 and a diagnostic threshold of 1.25 mm(clinically,1.3 mm is preferred),and the validation data set was formed by random sampling,and validation analysis was performed according to the thickness of the scar The validation analysis was performed by random sampling,and the difference was not statistically significant by paired chi-square test(P > 0.05),and the Kappa value = 0.512(P < 0.01)by Kappa concordance test,with a sensitivity of 89.36% and specificity of 63.63%.The reasons for conversion to cesarean section in failed vaginal trial of labor were: abnormal labor,cephalopelvic disproportion,fetal distress,and abandonment of vaginal trial of labor in the middle of the trial of labor,among which the difference in abandonment of vaginal trial of labor in the middle of the trial of labor was statistically significant(P < 0.05).Conclusions:First,it is feasible and safe to deliver full-term pregnancies with scarred uterus vaginally;second,The thicker the thickness of the lower transverse uterine incision scar,the higher the success rate of vaginal delivery during spontaneous labor in pregnant women with scarred uterus who have a history of vaginal trial of labor,and the thickness of the lower transverse uterine incision scar is greater than 1.25 mm(clinically,1.3 mm is preferred)as a reference value for whether a pregnant woman with scarred uterus can have a vaginal trial of labor and the success rate of vaginal trial of labor.The continuity and uniformity of the scar is also an important factor.Third,the main reason for conversion to cesarean section in the failed vaginal trial of labor in scarred uterus is that the vaginal trial of labor is abandoned in the middle of the trial of labor,and this reason is related to their own will power,obstetrician’s attitude,midwife’s care,labor analgesia and other factors.