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Objective:To evalaute the efficacy of butorphanol mixed with different doses of hydromorphone in improving patient-controlled intravenous analgesia (PCIA) after secondary cesarean section.Methods:Two hundred American Society of Anesthesiologists physical status Ⅱsingleton pregnant parturients, aged 18-45 yr, at 37-42 week gestation, with body mass index≤30 kg/m 2, undergoing elective secondary cesarean section under combined spinal-epidural anesthesia, were allocated to one of 4 groups ( n=50 each) using a random number table method: butorphanol (group B) and butorphanol mixed with different doses of hydromorphone groups (group BH 1, group BH 2 and group BH 3). Flurbiprofen 50 mg, butorphanol 1 mg and granisetron 3 mg were intravenously injected after delivery during operation.The analgesic pump was connected and turned on at the end of operation.The PCIA solution contained butorphanol 0.24 mg/kg and granisetron 6 mg in group B, butorphanol 0.24 mg/kg and hydromorphone 0.06 mg/kg and granisetron 6 mg in group BH 1, butorphanol 0.24 mg/kg and hydromorphone 0.09 mg/kg and granisetron 6 mg in group BH 2, butorphanol 0.24 mg/kg and hydromorphone 0.12 mg/kg and granisetron 6 mg in group BH 3.The PCIA solution was diluted with normal saline to 150 ml, and the patient-controlled analgesia (PCA) pump was set up to deliver a 3.0 ml bolus dose with a 15-min lockout interval and background infusion at 2.5 ml/h in all the four groups.The degree of pain was evaluated using the VAS score.When the VAS score>5 points after pressuring analgesia pump at rest, flurbiprofen axetil 50 mg was intravenously injected for rescue analgesia.VAS scores during movement, at rest and during uterine contraction and observer′s assessment of alertness/sedation scale score were recorded at 3, 6, 24 and 48 h after operation.The requirement for rescue analgesia, effective pressing times of PCA, overall satisfaction score, OAA/S score<5, adverse reactions and time to the first flatus were recorded within 48 h after operation. Results:Compared with group B, VAS scores in different states were significantly decreased after operation, the effective pressing times of PCA were decreased within 48 h after surgery, and the overall satisfaction score was increased in BH 1, BH 2 and BH 3 groups ( P<0.05). Compared with group BH 1, no significant change was found in VAS score in different states after operation in group BH 2 ( P>0.05), and VAS score was significantly decreased at rest after operation in group BH 3 ( P<0.05). There was no significant difference in VAS scores between group BH 2 and group BH 3 ( P>0.05). There were no significant differences in the requirement for rescue analgesia, effective pressing times of PCA and overall satisfaction of the puerperae among BH 1, BH 2 and BH 3 groups ( P>0.05). There was no significant difference in the time to the first flatus after operation, requirement for rescue analgesia and incidence of observe′s assessment of alterness/sedation scale score<5 and adverse reactions among the four groups ( P>0.05). Conclusions:Compared with butorphanol alone, butorphanol mixed with hydromorphone is helpful in reducing maternal pain and improving the overall satisfaction, with fewer adverse reactions.Butorphanol 0.24 mg/kg mixed with hydromorphone 0.09 mg/kg is recommended.
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ABSTRACT Objective To investigate the distribution of parturients at Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho according to the Robson classification, identify the cesarean rate in each Robson Group, and understand which group contributes more to the prevalence of Cesarean sections. Methods This is a retrospective observational cross-sectional study conducted through the analysis of medical records of parturients admitted to Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho from October 2016 to August 2019. Results A total of 9,794 births were recorded, and 31% were by Cesarean section. The most prevalent Robson Groups were Group 3 (25.7%-2,519), 1 (22.8%-2,234), and 5 (20.5%-2,006). The relative contribution of Cesarean sections was greatest in Groups 5 (39%), 2 (18%), and 1 (12.5%). Conclusion This study demonstrated the Robson classification is useful to lead to a more critical view, identifying the groups that deserve more attention, since they are the major contributors to cesarean rates; hence, the management protocols could be modified aim to reduce cesarean rates.
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Objective: To investigate the clinical curative effect of the abdominal aortic balloon occlusion in caesarean section for pernicious placenta previa and previa accreta. Methods: Data of 18 puerperants with pernicious placenta previa and previa accreta who underwent the abdominal aortic balloon occlusion in caesarean section were retrospectively analyzed. The amount of intraoperation blood loss and transfusion, the effective rate of balloon occlusion, the occlusion time, hysterectomy and complications were recorded. Results: All the 18 puerperants underwent the abdominal aortic balloon occlusion in caesarean section successly, with the technical success rate was 100% (18/18). The mean amount of blood loss was (1 276.11±761.59)ml during the caesarean section. And the mean amount of leukoreduced red blood cells transfusion was (2.86±1.51)U. No puerperant was dead of bleeding. The effectiveness of the abdominal aortic balloon occlusion was 100% (18/18), with the occlusion time was (24.06±26.19)min. Four (4/18, 22.2%) puerperants were underwent the hysterectomy due to serious placenta implantation, which even extensively invaded the cervix, bladder and intestine. No serious complications related to the abdominal aortic balloon occlusion and the interventional embolization were occured during the caesarean section. Conclusion: For the puerperants with pernicious placenta previa and previa accreta, the abdominal aortic balloon can effectively block blood flow, reduce the amount of blood loss and transfusion during caesarean section, and reduce the rate of hysterectomy and the risk of the operation.
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Objective To explore the influencing factors of the vaginal birth after cesarean section (VBAC), and establish a model for predicting the risk of trial of the trial of labor after cesarean section (TOLAC). Methods From January 2016 to December 2018, total 694 pregnant women who underwent TOLAC in Northwest Women's and Children's Hospital were retrospectively analyzed. Those cases were divided into two groups according to the mode of delivery: the VBAC group and the failed TOLAC group. At the same time, 700 cases in the elective repeat cesarean section (ERCS) group were randomly selected as control group. The influencing factors of VBAC were analyzed by univariate and multivariate logistic regression, and the pregnancy outcomes between the three groups were compared. Results (1) The VBAC rate was 76.1% (528/694) and 166 women underwent the failed TOLAC (23.9%, 166/694). (2) Univariate analysis found that, the pre-pregnancy body mass index (BMI) [(22.0±3.0),(23.3±2.7) kg/m2], the previous vaginal delivery history [10.4%(55/528),3.6%(6/166)], the cervical score (5.2±1.9,4.3±1.6) and the neonatal birth weight [(3 315 ± 468), (3 484 ± 274) g] of the VBAC group were significantly different from the failed TOLAC group (P<0.05). (3) The comparison of pregnancy outcomes: the neonatal birth weight was (3 315± 468) g, and the intrapartum hemorrhage volume was (255 ± 121) ml in the VBAC group, which were significantly lower than those in the failed TOLAC group [intrapartum hemorrhage (325 ± 173) ml] and the ERCS group [(3 572±344) g, (281±125) ml], there were statistically significant differences in the comparison among the three groups (all P<0.05). Two cases of bladder injury occurred during cesarean section in the TOLAC failure group (1.2%,2/166). The rates of the blood transfusion, puerperal infection, 5-minute Apgar score and neonatal ICU admission among the three groups were no statistically significantly different (all P>0.05). There was no maternal or perinatal death. (4) Multivariate logistic regression analysis showed that the delivery age of pregnant women ( OR=0.92, 95% CI : 0.87-0.98), pre-pregnancy BMI ( OR=0.92, 95% CI :0.86-0.98), vaginal delivery history ( OR=3.31, 95% CI : 1.35-8.01), cervical score ( OR=1.29, 95% CI :1.13-1.42) and the birth weight of the neonates <3 300 g ( OR=3.15, 95% CI : 2.02-4.90) were independent influencing factors for VBAC. The area under curve of the receiver operating characteristic curve was 0.74. Conclusions The influencing factors of VBAC are delivery age, pre-pregnancy BMI, vaginal delivery history, cervical score and neonatal birth weight <3 300 g. The adequate individualized management and assessment of the TOLAC may be helpful to improve the VBAC rate.
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Objective@#To investigate the effect of the transverse incision of the lower segment of the upper uterus in the treatment of scar uterine redelivery, and to analyze the safety of the surgical method.@*Methods@#88 patients with scar uterus who received cesarean section were randomly selected as research subjects, aged 24-37 years old, weight 53.3-76.9kg.According to the method of random numbers, they were divided into observation group and the control group, 44 cases in each group.The observation group received transverse incision of the lower segment of the uterus.The control group received conventional cesarean section.The operation time, intraoperative conditions, surgical incision healing, overall hospitalization time and neonatal Apgar score were statistically observed.@*Results@#The intraoperative blood loss of the observation group[(50.1± 3.2) mL]was significantly higher than (48.9±1.7)mL of the control group, and the difference between the two groups was statistically significant(t=2.099, P<0.05). The fetal delivery time, postoperative ventilation time in the observation group were (9.5±3.3)min, (331±97)min, respectively which were significantly shorter than those in the control group, and the differences between the two groups were statistically significant(t=3.018, 4.733, all P<0.05). The neonatal Apgar score of the observation group (9.3±1.2) was significantly higher than (8.8±2.4) of the control group(t=4.800, P<0.05). In the observation group, newborn hypoxia 0 cases, 1 case of aspiration pneumonia, maternal postpartum hemorrhage in 2 cases.There was no statistically significant difference in incidence of complications between the two groups (χ2=1.03, P>0.05). In the observation group, maternal incision healing class A in 40 cases, scar clearly generated in 7 cases, which in the control group were 37 cases, 11 cases, respectively, the difference between the two groups was statistically significant(t=4.200, P<0.05).@*Conclusion@#Transverse incision of the lower segment of the uterus complied with the tension of skin line, is beneficial to maternal postpartum incision healing, and to some extent can relieve pain, promote parturient recovery, further promote the puerpera restoration, significantly improve the clinical outcome of neonatal birth, postoperative complications and reduce cesarean section, it is worthy of clinical promotion.
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Objective@#To explore the choice of the best mode of delivery after cesarean section.@*Methods@#From January 2015 to December 2016, the clinical data of 2 526 pregnant women admitted in the Eighth People's Hospital of Taiyuan were retrospectively analyzed.A total of 971 cases were cesarean section, among them, the second cesarean section in 367 cases(control group B), cesarean section vaginal delivery in 604 cases(observation group). At the same period, another 186 cases with non-scar uterine pregnancy by vaginal delivery were selected as control group A. The maternal and child outcomes were compared among the three groups.@*Results@#The time of labor, postpartum hemorrhage, hospital stay, the incidence of neonatal asphyxia in the control group A were (6.30±3.03)h, (288.67±220.67)mL, (1.37±0.72)d, 3.76%, respectively, which in the control group B were (6.30±3.03)h, (415.87±356.20)mL, (4.32±0.83)d, 3.54%, respectively, which in the observation group were (5.98±2.87)h, (276.44±211.84)mL, (1.42±0.65)d, 3.48%, respectively.The postpartum hemorrhage of the control group B was significantly higher than that of the observation group[(415.87±356.20)mL vs.(276.44±211.84)mL], the difference was statistically significant(t=11.271, P<0.05). The length of hospital stay of the control group B was also longer than that of the observation group[(4.32±0.83)d vs.(1.42±0.65)d], the difference was statistically significant(t=18.034, P<0.05).@*Conclusion@#In the condition of emergency intercourse with cesarean section, it is safe and feasible to give the vagina trial to the pregnancy of cesarean section which meets the conditions of vaginal delivery.
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Objective To investigate the significance of previous uterine scar excision during the second cesarean section on prevention of previous cesarean scar diverticulum (PCSD). Methods One hundred and seventy-eight cases of multipara women who underwent the second cesarean section were included from January 2012 to January 2017. And they were divided into the control group and the observation group by random digital table, with 89 cases in each group. In the control group, the uterine incision was directly closed by double-layer continuous suture without any treatment to the previous scar, and in the observation group, the previous uterine cesarean scar of the patients were removed, and then the uterine incision was closed by double-layer continuous suture. The surgical related indexes of the two groups were recorded and statistically analyzed. All patients were followed up for 1 year, and the abnormal vaginal bleeding, PCSD, the residual musculocutaneous thickness of diverticulum and the volume of diverticulum were statistically analyzed in those two groups. Results There were no statistical difference between observation group and control group in operation time, intraoperative blood loss, evacuation time, the duration of postoperation bloody lochia and hospitalization time (P>0.05). However, the abnormal vaginal bleeding [5.6% (5/89) vs. 14.6% (13/89)], the incidence of PCSD: 3.4%(3/89) vs. 12.4%(11/89), and the residual musculocutaneous thickness of diverticulum: (7.36 ± 1.66) mm vs. (4.86 ± 1.38) mm, and the volume of diverticulum: (0.37 ± 0.16) ml vs. (0.54 ± 0.15) ml in the observation group were decreased respectively, the differences were statistically significant (P<0.05). Conclusions Excision of previous uterine scar during the second cesarean section is more beneficial for uterine section healing. It will reduce the frequency of PCSD formation, and alleviate the severity of PCSD.
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Objective To investigate the safety of trial of labor after cesarean (TOLAC) and clinical factors associated with successful TOLAC and to compare TOLAC with elective repeat caesarean section (ERCS) in terms of obstetric and neonatal outcomes.Methods A prospective cohort study was conducted among gravidas who had a history of lower segment cesarean section and were hospitalized in the Department of Obstetrics and Gynecology,the Affiliated Drum Tower Hospital of Medical School of Nanjing University from January to December 2014.Exclusion criteria included indications for caesarean section (such as placenta previa,placenta accreta,twin pregnancy,breech presentation and severe preeclampsia),serious maternal complications after cesarean section,lower uterine segment thinner than 3 mm and poor healing of uterine incision.Totally,287 gravidas were enrolled.Among them,142 chose TOLAC and the other 145 requested ERCS.Clinical data of those gravidas were collected and statistically analyzed by t-test,Log-rank test,Chi-square or Fisher's exact test.Results (1) The success rate of TOLAC was 90.8％ (129/142).There was no significant difference in maternal age,gestational age,thickness of lower uterine segment,interval between the two deliveries and neonatal birth weight and asphyxia rate between the successful (n=129) and unsuccessful (n=13) groups (all P＞0.05).Although the two groups had no significant difference in postpartum hemorrhage (PPH) rate,the gravidas who failed in TOLAC lost more blood than those who succeeded [425 (195-675) vs 200 (50-1 400) ml,P＜0.05].Moreover,higher amniotic fluid contamination rate was observed in the unsuccessful group [6/13 vs 17.1％ (22/129),P＜0.05].In the TOLAC group,99.3％ (141/142) were under continuous fetal heart rate monitoring.Incomplete uterine rupture occurred in one women without serious maternal or neonatal outcomes.The reasons for 13 failed TOLAC cases were unbearable pain during labor,abnormal labor,fetal distress and threatened rupture of uterus.(2) Compared with the ERCS group,the TOLAC group showed shorter interval from last cesarean section to the indexed delivery[5 (2-18) vs 6 (2-19) years],younger maternal age [(31±4) vs (33 ±4) years old] and less blood loss [200 (50-1 400) vs 300 (100-1 500) ml] (all P＜0.05).Conclusion Our study shows that,those who preferred TOLAC were younger,or had shorter pregnancy interval from last cesarean section.The success rate of TOLAC is high for women undergoing systematic prenatal assessment and close management during labor with less blood loss and non-serious maternal and neonatal complications compared with ERCS.
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Objective To observe the effect of modified Fu Qingzhu's Shenghua decoction on uterine involution after repeat cesarean section.Methods Randomized and parallel design was adopted in the study.A total of 112 cases were recruited into an observation group and a control group.56 cases in the observation group were treated with oral Fu Qingzhu's Shenghua decoction for 5 days,while 56 cases in control group were treated without any herbs.The follow-up was 42 days.Duration of lochia,hemoglobin concentration,and abnormalities of uterine ultrasound were observed.Results Duration of lochia rubra (5.1 ± 1.2 d vs.5.8 ± 1.3 d;t=-2.734,P=0.007) and the duration of lochia rubra and lochia serosa in the observation group 25.0 (21.0,29.8) d vs.29.0 (26.0,33.8) d;Z=3.873,P＜0.001) were all lower than the control group.The lochia complete ration in 42 days (94.9％ vs.82.1％,x2=4.264),the average hemoglobin concentration (115.43 ± 10.68 g/L vs.104.29 ± 9.90 g/L,F=4.159) and sum of the three uterine diameters (14.2 ± 1.0 cm vs.14.8 ± 1.3 cm,t=-2.686,P=0.008) in the observation group were all higher than the control group.The incidence of uterine cavity hydrops (3.57％ vs.17.85％,P=0.015) in the observation group was lower than the control group.Conclusion Fu Qingzhu's Shenghua decoction has promotive effects on uterine involution after repeat cesarean section.
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Objective To explore the application value of uterine incision suture in multiple segment shrinkage in cesarean section.Methods 85 pregnants with uterine scar who taken cesarean section were selected.In the single month,the pregnants were included in the observation group(43 cases):after pruning scars,uterine lower segment weak muscle tissue by wrinkling suture to reinforce the thickness of the lower segment again from both sides of the suture,intermediate knotted suture the uterine incision.In the bimonth,the pregnants were included in the control group(42 cases):after pruning scars by conventional suture incision of lower uterine segment.The duration of vaginal bleeding time after operation ,postoperative 42 days ,3 months ultrasonography of uterine incision healing were observed.Results The postoperative vaginal bleeding volume of the observation group was less than that of the control group[(480.55 ±53.75)mL vs.(550.14 ±50.45)mL],the bleeding time was less than that of the control group[(21.31 ±6.78)d vs.(30.45 ±5.16)d],the differences were statistically significant(t =3.65,2.28,all P <0.05).March B -ultrasonography uterine incision after surgery,the good healing rate of the observation group was 95.35%,which of the control group was 78.57%,the difference was statistically significant(χ2 =4.35,P <0.05). Conclusion Incision under section shrinkage joint is conducive to the incision structure and muscle layer mechanical recovery and can reduce the amount of vaginal bleeding and time and defect healing of incision morphology.
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Objective To investigate the postoperative complications of pregnant women with two cesarean section.Methods Clinical data of 543 cases of pregnant women with two cesarean section (group A) were retrospective analyzed,and at the same period two spontaneous vaginal delivery in 963 cases(group B),225 cases of pregnant women with the first cesarean delivery add second vaginal delivery(group C) were analyed in contrast.The postoperative close,long-term complications of three different delivery way were censused.Results (1) Postoperative complications:141 cases(26％) in group A,29 cases(3％) ingroup B,27 cases (12％)in group C,and three complications occurrence rate had significant difference (x2 =182.711,29.712,43.040,all P ＜ 0.05).(2) The complications of postpartum bleeding,pelvic adhesions in group A were significantly higher than those of C group(all P ＜0.05) ;And the close complications of postpartum hemorrhage,infection of incision,postpartum fever and the long-term complications of chronic pelvic inflammation,pelvic adhesion in group A,C were significantly higher than those in group B (all P ＜ 0.05).Conclusion The cesarean section is traumatic,which can significantly increase maternal intraoperative,postoperative complications.Clinicians should avoid no indications of cesarean section,reduce the cesarean section rate;For secondary pregnancy after cesarean section,vaginal delivery can be given under the strict observation.
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Objective To observe the clinical application of extraperitoneal cesarean section(ECS) plus forceps vs transperitoneal cesarean sections(TCS) in repeated cesarean section.Methods 98 multiparous women with scar uterus for elective repeated cesarean sections were recruited retrospectively,47 cases for ECS plus forceps(group A),and 51 cases for TCS(group B).The multiparous women with hyperglycemia not controlled,severe preeclampsia,heart disease,placenta previa,premature rupture of membrane,a history of ＞ 1 cesarean section,myoma and/or ovarian neoplasm were excluded.Results Skin incision to baby delivery time and total operation time of group A were (7.7 ± 2.8) min and (42.8 ± 9.7) min,respectively,which were significantly shorter than (9.3 ± 3.2) min and (47.6 ± 9.4) min of group B,(t =2.700,2.497,P =0.008,0.014).There was significant difference in blood loss volume during the operation and postoperative 2 hours,which was (310.4 ± 106.3) mL,(365.3 ± 142.8) mL respectively(t =2.142,P =0.035).The Visual Analog Scale for pain (VAS pain) was (2.8 ± 1.8) in group A and (4.1 ± 1.9) in group B,respectively (t =3.252,P =0.002).The gastrointestinal function recovery mean time of group A was significantly shorter than that of group B (12.5 h versus 16.0h,t =2.771,P =0.007).And the postoperative febrile morbidity was significantly lower in group A than in group B(8.5％ versus 25.5％ ;x2 =4.918,P =0.033).The patients with chronic pelvic pain followed up after operation was 3 versus 12,and the difference was significant (x2 =5.143,P =0.026).There were no differences in neonatal Apgar score at 1 minute,birth asphyxia and wound healing rates.Conclusion ECS plus forceps can be safely used for repeated cesarean section,with the advantages of less operation time,less bleeding volume,lower postoperative morbidity,and fewer complications than TCS.
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Objective To explore the appropriate approach of delivery after cesarean section of Uyghur women in primary hospitals in Xinjiang Uyghur Autonomous Region.Methods A total of 5 154 women delivered in Luopu County People Hospital,Hetian Prefecture,Xinjiang Uyghur Autonomous Region from January 2011 to December 2012.Among them,178 Uyghur women had cesarean section history.The interval between the previous cesarean section and this delivery varied from 1 year to 17 years.The number of cases attempting vaginal labor and the indications of the previous cesarean section were recorded.The indications for the second cesarean section were analyzed.The gestational weeks at delivery,blood loss in 2 hours after delivery,neonatal birth weight,newborn asphyxia,the rate of postpartum fever (≥38 ℃) and hospitalization days were compared between the two approaches of delivery.Results (1) Among the 178 cases,119 cases attempted vaginal labor,the rate of attempting vaginal labor was 66.9％ (119/178).A total of 113 cases succeeded in vaginal delivery (the vaginal delivery group),with the successful rate of attempting vaginal delivery of 95.0％ (113/1 19),and the successful rate of vaginal delivery was 63.5％ (113/178).For those 119 women succeeded in vaginal delivery,the indications of the previous cesarean sections were as following:pregnancy complications (68.1％,81/119),macrosomia(5.0％,6/119),dystocia (14.3％,17/119),pregnancies complicated with other diseases(5.0％,6/119) and cesarean section on maternal request(7.6％,9/119).(2) 15 cases in the cesarean section group had postpartum hemorrhage,with the incidence of 13.3％(15/113).The mean total labor time was (507± 182) minutes.6 cases attempting vaginal delivery failed and turned to cesarean section.(3) 59 cases received the second cesarean section (the cesarean section group).The rate of second cesarean section was 33.1％ (59/178).The indications of the second cesarean section were as following:contracted pelvis (5％,3/59),pregnancy complications (42％,25/59),macrosomia (20％,12/59),short interval between the two cesarean sections(≤2 years); (12％,7/59) and cesarean section on maternal request (20％,12/59).(4) Gestational weeks at delivery,rates of newborn asphyxia in the vaginal delivery and cesarean section groups showed no significant statistical difference (P＞0.05).In the vaginal delivery group,the average blood loss in 2 hours after delivery was (259±213) ml,the rate of postpartum fever was 10.6％,the mean fetal birth weight was (3 272±477)g and the mean hospitalization was (1.8±1.6) d.In the cesarean section group,they were (400±320)ml,54.2％,(3 539±500)g and (8.7±2.2)d,respectively.There was significant statistical difference (P＜0.01) between the two groups.Conclusions Vaginal delivery after cesarean section could be attemped in Uyghur pregnant women in Xinjiang primary hospitals,if doctors could choose the indications strictly and monitor closely.These could increase the success rate and safety of vaginal delivery and therefor reduce the cesarean section rate.
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Objective To analyze the complications of pregnant secondary cesarean in scar uterus,to provide theoretical guidance for cesarean section.Methods 160 pregnant women of secondary cesarean uterine scar were chosen as the study group.80 pregnant women of non-scar uterine were chosen as the control group.Results The bleeding volume during operation,operation time,operation fee,postoperative bleeding,uterine resection rate,neonatal asphyxia in study group were (432 ± 331) mL,(64 ± 21) min,(0.91 ± 0.11) million,(262 ± 187) mL,4.4％,11.9％,which in the control group were (361 ± 209) mL,(44 ± 16) min,(0.63 ± 0) million,(184 ± 132) mL,1.3％,6.3％ respectively,the differences were significant (t =2.52,8.19,26.10,4,4.76,x2 =3.98,all P ＜ 0.05).The two groups had no statistically significant difference in organ damage situation (P ＞ 0.05).Conclusion Secondary cesarean uterine scar easily lead to maternal blood loss and increased postoperative bleeding,prolonged surgery,increased hysterectomy rate,increased incidence of neonatal asphyxia and other complications.Pregnant uterine scar pregnancy is a high-risk pregnancy,pregnancy for maternal uterine scar secondary surgical indications should be strictly controlled.
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Objective To explore the optimal timing of termination of pregnancy,we analyzed the different gestational age in repeat cesarean delivery and maternal and neonatal outcomes.Methods This was a retrospective study.The information of cesarean sections was collected from maternal obstetric records in the electronic medical recording system of the First Affiliated Hospital of Chongqing Medical University from June 1,2011 to June 30,2013,and women with intrauterine viable singleton pregnancies delivered after 37 weeks of gestation without prenatal complications were selected.They were divided into five groups with different gestational weeks.Maternal general information,perioperative outcome and rate of neonatal adverse event were analyzed with one way ANOVA analysis and Chi-square test.Results A total of 579 cases of elective repeat cesarean at term were performed.The ratios of cesarean section prior to 39 and 39-39+6 weeks of gestation were 64.6％ (374/579) and 29.0％ (168/579),respectively.No fetal,neonatal or maternal death occurred.There were no statistically significant differences in the termination of pregnancy at 37-37+6 weeks,38 38+6 weeks,39-39+6 weeks,40 weeks and ≥ 41 weeks between the two time intervals for cesarean section (P＞0.05).There were statistically significant differences in the length of hospitalization [(4.9±3.0),(4.3 ± 1.3),(4.3 ± 1.0),(4.5± 1.2) and (4.0±0.7) d,respectively; F=2.849,P＜0.05].No significant difference was observed in the maternal BMI,placental membrane residue,maternal perioperative bleeding,premature rupture of membrane (PROM),intensive care unit (ICU) admission and uterine resection (P＞0.05).There were statistically significant differences among the five groups in neonatal weight [(3 082.9±479.2),(3 318.1 ±390.8),(3 415.7±431.1),(3 630.5±475.2) and (3 334.0±242.5) g,F=13.798] and length [(48.8± 1.5),(49.3± 1.5),(49.6± 1.5),(50.0± 1.5) and (47.8±3.9) cm,F=7.460; both P＜0.05].One min and 5 min Apgar scores also showed statistically significant differences [1 min:(9.7±0.7),(9.8±0.6),(9.8±0.4),(9.7±0.5) and (8.8±2.7) ; F=4.432; 5 min:(9.9±0.3),(10.0±0.3),(10.0±0.2),(10.0±0.2) and (9.2± 1.8),F=9.625; all P＜0.05].The overall rates of neonatal adverse events,including the admission to neonatal intensive care units (NICU),the rates of cardiopulmonary resuscitation or ventilator therapy,asphyxiation,as well as the length of stay in NICU ≥ 5 d among the five groups also showed statistically significant differences [overall:5.4％ (5/93),1.8％ (5/281),0.6％ (1/168),0.0％ (0/32) and 2/5,x2=16.812;NICU:3.2％ (3/93),1.1％ (3/281),0.0％ (0/168),0.0％ (0/32) and 1/5; x2=1 1.294; cardiopulmonary resuscitation or ventilator therapy:2.2％ (2/93),0.7％ (2/281),0.0％ (0/168),0.0％(0/32) and 1/5,x2=10.584; asphyxiation:1.1％ (1/93),0.7％ (2/281),0.0％ (0/168),0.0％ (0/32) and 1/5,x2=9.637; NICU ≥ 5 d:3.2％ (3/93),1.1％ (3/281),0.0％ (0/168),0.0％ (0/32) and 1/5,x2=1 1.294; P＜0.05].The risks of neonatal adverse outcomes in delivery at 37-38+6 weeks were:OR=1.1(95％CI:1.0-2.1) at 37 37+6 weeks,OR=1.3 (95％CI:0.9-1.9) at 38-38+6 weeks,compared with delivery at 39-39+6 weeks.Conclnsions The percentage of repeat cesarean delivery prior to 39 weeks of gestation is high in our hospital,early termination of pregnancy would not reduce the maternal perioperative adverse outcome,but may increase the risk of neonatal adverse events.Taking into account the maternal benefit,we suggest 39 39+6 weeks of gestation as the best time of elective repeat cesarean in order to reduce the risk of neonatal adverse events.
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PURPOSE: To examine delivery type of mother who have had a previous cesarean and identify maternal factors related to type of delivery. METHODS: The study sample included 60,504 mothers who had delivered through cesarean section. Related variables were categorized as sociodemographic factors (age, residence, health insurance type, income level) and clinical characteristics (14 maternal factor, 4 fetal factor and pre-term). For data analysis, chi2 and multivariate logistic regression were conducted. RESULTS: Among the 60,504mothers, 3,075 were delivered through Vaginal Birth After C-Section (VBAC) and the VBAC rate was 5.1%. Underage 34, the VBAC rate increased according to age increases up to 3%. Mothers residing in urban areas had VBAC more frequently than mothers in rural area. Mothers in the high and middle income levels had a greater possibility of having VBAC than mothers in lower income levels. A greater likelihood of increase in repeated cesarean section were found in mothers with maternal and fetal factors. CONCLUSION: Evidence based nursing practice guidelines and education programs for previous cesarean section mothers and health policy are needed to increase VBAC.
Subject(s)
Female , Humans , Pregnancy , Cesarean Section , Evidence-Based Nursing , Health Policy , Insurance, Health , Logistic Models , Maternal Health Services , Mothers , Parturition , Statistics as Topic , Vaginal Birth after CesareanABSTRACT
ObjectiveDiscussion early period diagnosis uterine scar pregnancy effective method.Methods According to clinical medical history,HCG test,Type-B ultrasonic ( MR if Necessary) diagnosis.Under type-B ultrasonic monitoring clear uterine after interventional embolization of uterine artery drug infusion.Results41 cases (89.13％ ) according to clinical mdical history,HCG test,Type-B ultrasonic diagnosis.5 cases( 10.87％ ) diagnosed with nuclear magnetic resonance(MR),diagnosis rate 100％.46 cases disposable thorough clear uterine after interventional? embolization of uterine artery drug infusion,cure rate 100％.ConclusionAccording of clinical medical history,HCG test,Type-B ultrasonic was the best method of diagnosis uterine scar pregnancy in early period.Using interventional embolization of uterine artery drug infusion and then clear it,it was Safe reliable method.
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Objective To explore the complications and influence of repeat cesarean section after previous cesarean delivery. Methods The styles of the total 67 cases of repeat cesarean section were reviewed, and the mater-nal ages, gestarional weeks, time intervals between the two times of delivery, and the styles of the previous cesarean section were analyzed. Results Of the total 67 case of repeat cesarean section ,there were 8 cases with relatively se-vere adhesion, 1 case with hysterectomy. There were 9 cases with intraoperative blood loss over 500ml(13.4%). The rate of adhesion induced by abdominal transverse incision of cesarean section was significantly higher than that of ab-dominal longitudinal incision of low cesarean section. Conclusions When we determining a style of cesarean section, we should comprehensively consider the obstetrical conditions of the pregnant women to select abdominal incision style and uterine incision style. The quality of previous cesarean delivery determines the complications of repeat cesarean section.