Pregnancy outcome analysis on second pregnancy women with scarred uterus / 上海预防医学

Objective To analyse the pregnant outcome of second pregnancy women with scarred uterus after two-child policy was issued. Methods In this study, 51 308 pregnant women who gave birth in 6 hospitals in Minhang District from Jan 2015 to Dec 2018 were studied to analyze the delivery mode and pregnancy outcome in women with scarred uterus. Results ① From 2015 to 2018, there were 9 762 (19.03%) pregnant women with scarred uterus in Minhang District and 91 (0.93%) of them delivered vaginally.Scarred uterus was the most frequent indication of cesarean section (42.06%).② The incidence of severe postpartum hemorrhage (bleeding volume≥2 000 mL) in scarred uterus group was higher than that in no-scar uterus group(χ2=8.268, P=0.004).③ Adverse pregnancy outcomes were noted:there were 42 cases of pernicious placenta previa (4.30‰), 6 cases of hysterectomy (0.61‰) and 22 cases of critical rescue (2.25‰) in scarred uterus group, with higher risk than those in no-scar uterus group(χ2=178.9, P < 0.001;Fisher exact probability method P=0.000;χ2=4.272, P=0.039).There was no significant difference in perinatal mortality between scarred uterus group and no-scar uterus group (χ2=3.240, P=0.072);The maternal mortality rate among both groups was 0. Conclusion With the adjustment of fertility policy, the number of pregnant women with scarred uterus and the risk of pregnancy increase.It is necessary to strengthen the management of early warning and assessment of risk during pregnancy of scarred uterus.By effectively controlling the first cesarean section, the risk of scarred uterus re-pregnancy should be avoided.

Analysis on the rate and indications of cesarean section in Minhang District of Shanghai in recent five years / 上海预防医学

To analyze the changes in cesarean section rate and its indication in recent 5 years (from 2008 to 2012), then providing evidence for intervention measures . [Methods] Retro-spective analysis of recent 5 years was done for Minhang District maternity and infant quarterly statements and cesarean section clinical data . [ Results ] The rate of cesarean section still showed an upward trend, and vaginal birth rate declined year by year .The cesarean section rate of Shanghai census register was significantly higher than that of non Shanghai registration , but the gap was smaller and smaller .The first 4 indications for cesarean section were fetal distress , cephalopelvic disproportion , scar uterus , and so-cial factors.Scar uterus increased year by year , and in 2012 rose to the first one.Fetal distress, cephalo-pelvic disproportion decreased year by year , and social factors had no obvious change . [ Conclusion] The main reasons for the high rate of cesarean section were social factors , medical factors , economic factors and others.Comprehensive intervention measures should be taken actively for controlling the cesarean sec -tion rate in the reasonable scope .