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Abstract The purpose of this work was to analyze the high-risk factors of complications in the trial of vaginal delivery of a subsequent pregnancy for scar uterus after a previous cesarean. 136 pregnant women with scar uterus with a history of cesarean who were admitted to our obstetrics department from February 2016 to March 2019 were selected and were divided into a successful group and a failed group according to the results of pregnancy and trial of labor vaginal delivery. General data of before, during, and after delivery were collected and the high-risk factors for failed vaginal delivery of scar uterine were analyzed by the logistic regression analysis. Among the 136 patients, 108 cases (79.41%) of vaginal trials were successful, and 28 cases (20.59%) of vaginal trials faired. The univariate analysis showed that the differences in gravidity, parity and the previous cesarean interval, vaginal birth history, prenatal BMI, uterine contraction, gestational age, infant weight, dilatation of the cervix, cervical Bishop score, the height of the fetal head, the thickness of the lower uterus, and whether the membranes were prematurely ruptured were statistically significant (P<0.05). Logistic regression analysis showed vaginal birth history, prenatal BMI ≥ 30 kg/m2, parity ≥ 2 times, cesarean interval <2 times, dilatation of cervix ≥ 1 cm, the height of the fetal head ≥ -3, premature rupture of the membrane and the thickness of the lower uterus of 3.0 to 3.9 cm were the high-risk factors of complications in the vaginal trial delivery of pregnancy again for scar uterus (P<0.05). It is feasible for pregnant women with scar uterus to undergo vaginal delivery, but many related factors can affect the failure of trial of labor. It is necessary to pay attention to all aspects of clinical examination and choose applications strictly according to the indications.
Resumen El propósito del presente trabajo fue analizar los factores de alto riesgo de complicaciones por cicatriz uterina en la prueba de parto vaginal del siguiente embarazo después de una cesárea previa. 136 gestantes con cicatriz uterina fueron seleccionadas con antecedente de cesárea anterior que ingresaron a nuestro servicio de obstetricia de febrero 2016 a marzo 2019, y se dividieron en un grupo exitoso y un grupo fallido según los resultados de las pruebas de embarazo y parto vaginal. Los datos generales anteriores fueron recolectados, durante y después del parto y se analizaron los factores de alto riesgo para el parto vaginal fallido de la cicatriz uterina mediante el análisis de regresión logística. Entre las 136 pacientes, 108 casos (79,41%) de las pruebas vaginales fueron exitosas y 28 casos (20,59%) de las pruebas vaginales fracasaron. El análisis univariado mostró que las diferencias en la gravidez, la paridad y el intervalo de cesárea previa, la historia de parto vaginal, el IMC prenatal, la contracción uterina, la edad gestacional, el peso del lactante, la dilatación del cuello uterino, la puntuación cervical de Bishop, la altura de la cabeza fetal, el grosor del segmento uterino inferior, y si las membranas se habían roto prematuramente fueron estadísticamente significativas (P<0,05). El análisis de regresión logística mostró antecedente del parto vaginal, el IMC prenatal ≥ 30 kg/m2, la paridad ≥ 2 veces, el intervalo entre cesáreas < 2 veces, la dilatación del cuello uterino ≥ 1 cm, la altura de la cabeza fetal ≥ -3, la ruptura prematura de la membrana y el grosor del segmento uterino inferior de 3,0 a 3,9 cm fueron los factores de alto riesgo de complicaciones por cicatriz uterina en la prueba de parto vaginal de un siguiente embarazo (P<0,05). Sería posible que las gestantes con cicatriz uterina vuelvan a someterse a parto vaginal, pero existen muchos factores relacionados que inciden en el fracaso del trabajo de parto. Es necesario prestar atención a todos los aspectos de la exploración física y elegir las aplicaciones estrictamente de acuerdo con las indicaciones.
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Objective:To investigate the effect of improved epidural catheter labor analgesia on the maternal and infant outcome of re-pregnant parturients with scar uterus.Method:A total of 100 cases of re-pregnant women with scarred uterus admitted to Shexian Hospital from January 2019 to January 2020 were selected. According to the random number table, they were divided into the observation group (50 cases) and the control group (50 cases). Parturients in the observation group received a modified epidural catheter for labor analgesia, and parturients in the control group received conventional epidural analgesia. The complications of epidural vascular injury, difficulty in catheterization, multiple catheterization, loss of catheter resistance, urinary retention, intrauterine distress, neonatal asphyxia, postpartum hemorrhage, Apgar score, maternal and neonatal outcomes were compared between the two groups.Results:The rate of epidural vascular injury, difficulty in catheter placement, multiple catheter placement and disappearance of catheter resistancein the observation group were lower than those in the control group: 2.0%(1/50) vs. 14.0%(7/50), 2.0%(1/50) vs. 16.0%(8/50), 0 vs. 8.0% (4/50), 8.0% (4/50) vs. 24.0% (12/50), χ2 = 4.89, 5.98, 4.17, 4.76, P<0.05. The rate of urinary retention, intrauterine distress and neonatal asphyxia in the observation group were lower than those in the control group: 4.0%(2/50) vs. 16.0%(8/50), 2.0%(1/50) vs. 14.0%(7/50), 0 vs. 8.0%(4/50), χ2 = 4.00, 4.89, 4.17, P<0.05. Conclusions:Improved epidural catheter delivery analgesia for patients with scarred uterus can achieve significant results, effectively reduce the incidence of vascular injury, and improve the maternal and infant outcome.
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Background: Placenta previa is an obstetric life-threatening condition with several maternal and fetal complications. The objective of this study is to compare the maternal and fetal outcome of placenta previa in scarred and unscarred uterus.Methods: A retrospective case control study was carried out on 85 cases of placenta previa in the department of obstetrics and gynecology, Paropakar Maternity and Womens Hospital (PMWH) Kathmandu from April 2019 to May 2020 of which 46 had scarred uterus and 39 cases had unscarred uterus.Results: Sixty-one of patients were less than 30 years of age, 62% presented with gestational age 28 to 37 weeks and 67% had parity between 1 to 5. Frequency of placenta previa in scarred uterus was 54% and that in unscarred uterus was 46%. Eighty percent cases with scarred uterus had anterior placenta compared to 33% of cases of unscarred uterus with p value of 0.009. 42% had grade 4 placenta previa on ultrasonography. 45 percent of patient with scarred uterus had PPH compared to 23% in unscarred group with p value of 0.03. Malpresentation was found in 7 cases in scarred group and in one case in unscarred. Cesarean hysterectomy was performed in 6 cases in scarred category compared to 2 in unscarred. Low birth weight was present in 28 cases in scarred category compared to 15 cases in unscarred category with p value 0.03.Conclusions: This study concluded that fetal and maternal outcome is adverse for cases of placenta previa with scarred uterus compared to unscarred uterus.
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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.
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Introduction: Placenta previa complicates 0.3–0.5% of all pregnancies and is a major cause of third-trimester hemorrhage. Itaffects both mother and fetus; therefore, it is important to study this condition and its complications.Aims and Objectives: The aims and objectives of this study were to compare the incidence of placenta previa, associated factors,complications, placental position, mode of delivery, and fetal and maternal outcome in non-scarred uterus and scarred uterus.Materials and Methods: A total of 100 patients identified with the diagnosis of placenta previa beyond 28 weeks of gestationwere taken. The cases were divided into two groups: Scarred and unscarred. Both the groups were compared for parameterssuch as maternal age, parity, frequency of placenta previa, fetal outcome, operative procedures, and maternal morbidity andmortality.Results: Of 100 patients, 23% were in the age group between 18 and 25, 49% between 26 and 30, and 28% between 31 and40 years. 6% of patients in scarred uterus had 2 or more previous dilatation and curettage. In all patients of scarred uterus, 80%of the patients had previous 1 cesarean section, while 15% had two previous sections and 4.5% had previous three cesareansections. Chances of placenta previa increase both with dilatation and curettage and previous cesarean sections. However, itwas found in this study that fetal outcome did not differ much with the presence of scarred uterus.Conclusion: It can be concluded that, in our study, the cesarean section had a significant relationship with placenta previa andthis risk becomes very high with escalation in number of cesarean sections.
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With the implementation of the two-child policy and the wide application of hysteroscopy and laparoscopy,pregnancy of scarred uterus women is increasing year by year,and most patients still choose cesarean section.Complications of cesarean section has also increased.It is an important task for obstetricians to master the timing and mode of termination of pregnancy and reduce complications.The authors make a comprehensive analysis of the timing and complications of cesarean section for the second pregnancy of scarred uterus.
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Objective To investigate the risk factors and etiology of puerperal infection in pregnant women with scar uterus.Methods 276 cases of uterine scar pregnant women were prospectively collected in the hos-pital,according to the development of postpartum puerperal infection or not,all pregnant women were divided into an infection group(n=25)or a non infection group(control group)(n=251).The main clinical features between the two groups were compared and the risk factors of puerperal infection in pregnant women with u-terine scar were analyzed.Results Compared with the control group,the incidence of gestational <37 weeks, perilous placenta previa,postpartum hemorrhage,premature rupture of membranes,placental abruption,preg-nancy induced hypertension and the past history of vaginitis was significantly higher in the infection group,and the difference was statistically significant(P< 0.05).Multivariate logistics regression analysis showed that the risk factors of puerperal infection in pregnant women with scarred uterus included dangerous placenta pre-via,postpartum hemorrhage and placental abruption.Gram negative bacteria were more common,accounting for 72.00%,the most common gram negative bacteria were Escherichia coli(32.00%),the most common gram positive bacteria were Staphylococcus aureus(12.00%).Conclusion Dangerous placenta previa,post-partum hemorrhage and placental abruption are the risk factors of puerperal infection in pregnant women with uterine scar,and Gram negative bacteria are common pathogens.
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Objective:To evaluate the seven existing vaginal birth after cesarean (VBAC)screening tools and to identify additional factors that may predict VBAC or failed trial of labor in China.Methods:In the study,53 patients with 1 previous cesarean delivery who then delivered between January 1,2007 and Novenber 31,2014 were recruited.The average age of the patients was (32.1 ±3.5 )years,the average gestational age was (38.0 ±2.3)weeks.There was no significant difference of the successful group and the failed group in the maternal /neonatal mortality and morbidity,also in the incidence of the postpartum hemorrhage and the postpartum infection.The probability of VBAC was calculated for each participant using 7 prediction models created by Weinstein,Flamm,Grobman,Gonen,Troyer,Smith and Torri.The data were analyzed using t test,rank-sum test,and receiver operating curve analysis. Results:44 trial of labor patients had a vaginal birth after cesarean delivery,and the successful rate was 83%.The scores between the successful group and the failed group had significant difference when eva-luated by Weinstein and Grobman scoring models only.After recalculating the successful rate of VBAC in different score levels according to the references,there was significant difference between the rates of dif-ferent score levels when evaluated by the Weinstein model.The successful rates of different score levels were higher compared to the references (<50%)when evaluated by the Troyer (70%),Gonen (60%),Torri (85.7%)models.The area under the receiver operating characteristic curve of Weinstein prediction model (0.746)and Flamm prediction model (0.723)were more than 0.7,and there was no significant difference between the seven models.Conclusion:Among the seven scoring models,the Weinstein model is more applicable to the population of our country,but a new model more applying to Chinese women still needs to be created.
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Objective To study the different selections of delivery mode of pregnant women, and compare their outcomes. Methods Data of 7 509 pregnant women hospitalized in the General Hospital of Tianjin Medical University between January 2013 and December 2014 were retrospectively analyzed. Of them, there were 6 229 cases of primipara and 1 280 cases of multipara. The numbers of vaginal delivery and cesarean delivery were statistical analyzed between primipara and multipara. The cesarean delivery indications of multipara was also studied. The vaginal delivery rates and cesarean delivery rates, and their outcomes were compared between primipara and scar uterus maternal pregnancy. Results The cesarean delivery rate was higher in multipara than that of primipara (69.06%vs. 57.54%,χ2=59.19, P<0.05). Among them, 631 cases were uterine scar pregnancy, 39 cases (6.18%) were vaginal delivery and 592 cases (93.82%) were cesarean delivery. The uterine scar was the main indicator for cesarean delivery in multipara. Compared the outcomes of cesarean delivery, the weight of neonatal body mass was relatively light, the hospital stay was shorter, the amount of 24 h postpartum bleeding and postpartum fever were less in vaginal delivery in primipara and pregnant women with uterine scar ( P<0.05). There were no significant differences in scores of newborn. There were no significant differences in outcomes of vaginal delivery between primipara and pregnant women with uterine scar. Compared outcomes of cesarean delivery between multipara with scar uterus and primipara, there were increased maternal blood loss and postpartum fever in multipara with scar uterus (P<0.05). Conclusion The cesarean delivery is still the mainly mode for multipara. The vaginal delivery is the best mode for pregnant women with scar uterus compared with that of primipara. The vaginal delivery is the safer way of delivery for pregnant women.
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Objective To explore the significance of ultrasound in choosing the delivery modality in 200 cases scarred uterus gravida′s second deliveries .Methods The study selected 200 cases late pregnancy gravidas who had once uterine incision delivery history and analyzed clinical data retrospectively ,all of them were chosen from September 2010 to September 2013 in our hospital . All cases were taken by transabdominal ultrasound or transvaginal ultrasound firstly ,then taken by transabdomina transvaginal ul‐trasound ,finally contrast obsenved the transabdomina transvaginal ultrasound detections with their caesarean section observations , meanwhile observe how the uterus scar ranking affect the delivery consequence .Results (1)A total of 200 cases had higher uterus scars visualization ratio(100 .0% ) than ransabdominal ultrasound (92 .0% )and transvaginal ultrasound(96 .5% )(P0 .05) .The grading diagnosis coincidence of transabdomina‐transvaginal ultrasound was 89 .74% .(2)The UD rate ,the bleeding vol‐ume during operation and the 24 hours postoperative bleeding volume of scarred uterus gravida grade Ⅱ and grade Ⅲ were signifi‐cantly higher than grade Ⅰ (P<0 .05) .Conclusion Transabdomina transvaginal ultrasound can effectively improve the diagnosis coincidence rate of uterine scar detection and can help to chose the better delivery mode according to the scars healing .
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Objective:To observe the clinical effects and safety of mifepristone combined with ethaeridine in inducing labor at sec-ond trimester of pregnant women with scarred uterus. Methods:Totally 84 cases were randomly divided into the control group and the study group with 42 ones in each. The control group received intrauterine injection of ethaeridine for inducing labor, and the study group received mifepristone additionally for inducing labor. The time intervals from administration to uterine contraction and from induc-tion to delivery, auxiliary medication rate, fetal weight, volume of postpartum hemorrhage, successful rate of induction, adverse events of induction and adverse drug reactions were compared. Results:Compared with those in the control group, the time intervals from ad-ministration to uterine contraction and from induction to delivery were shorter in the study group, and the clear uterine rate and total ad-verse event rate of induction were lower in the study group(P<0. 05). Conclusion: Mifepristone combined with ethaeridine is safer and more effective than ethaeridine alone, which is an appropriate alternative for inducing labor at second trimester of pregnant women with scarred uterus.
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Spontaneous uterine rupture in pregnancy is a rare phenomenon especially in the second trimester. When it occurs one has to suspect placenta percreta. Here we had such a case in a 32-year-old lady who had previous caesarean section for fetal distress 7 years ago. Now she got admitted with a history of 4 months of amenorrhea with severe pallor and hypotension. She did not have any uterine contraction before admission, and there is no history suggestive of any interference with the present pregnancy. On opening the abdomen, there was hemoperitoneum and an intact gestational sac was found protruding through the rent at right side of the fundus. Total abdominal hysterectomy was done, and the placenta was found to be placenta percreta, that was confi rmed by histopathological examination.
Subject(s)
Adult , Cesarean Section/adverse effects , Female , Humans , Hysterectomy/methods , Laparotomy/methods , Pregnancy , Uterine Rupture/diagnosis , Uterine Rupture/etiology , Uterine Rupture/surgeryABSTRACT
Objective To use high frequency ultrasound for scanning the lower uterine segment during the third trimester of scar uterus pregnancy cases were selected. Transabdominal ultrasound scan was done for the fetus between 36th and 40th week of pregnancy, and then the transducer was switched to a high frequency of 7.5-12 MHz to observe the lower uterine segment. The scan results were compared with the obserbations of in complete rupture of lower uterine segment and defective scars in the repeated caesarean section. Results Three types of high frequency ultrasound images were found for the lower uterine segment during the third trimester of scar uterus pregnancy: efficacies of truncation sign (608%,8/118), rat tail sign (44.1%,52/118), and homogeneous echoes (49.1%.58/118). The diagnosis efficacies of truncation sign for incomplete rupture of uterus, rat tail sign for defective scars, and homogeneous echoes for intact cadsarean scars were significantly higher than those of the other two types (X2 valued 20.42, 19.03, and 33.08, respectively, P<0.001). The diagnostic sensitivity, positive predictive value and negative predictive value of the truncation sign were 80.0%, 96.5%, 50.0%, and 99.0%; those of the rat tail sign were 70.0%, 73.8%, 67.3%, and 76.2%; and those of homogeneous echoes were 72.9%, 74.1%, 74.1%, and 73.3%, respectively. Conclusion High frequency ultrasound scan can display the changes of the scars on the lower uterine segment, and may serve as an effective method to diagnose incomplete rupture of uterus, defective and intact scars in the third trimester pregnancy of a caesarean-scarred uterus. To avoid uterine rupture, vaginal trail of labor should be carefully chosen for patients shoeing truncation sign or rat tail sign.
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Objective To explore the clinic value of blood loss during and after cesarean section in women with scarred uterus. Methods From July 2007 to December 2008, thirty-six women with scarred uterus received weighing methods to evaluate the actual blood loss during and after cesarean section in Yuhuangding hospital, while 98 cases without pregnant complications were chosen as control. Results In women with scarred uterus, the blood loss during operation Was (372.4 ± 180.0) ml, and the total amount after 2 hours and 24 hours were (444.7± 228.2) ml and (527.4 ±251.6) ml respectively, which were higher than corresponding values in control group (P < 0. 05). The incidence of postpartum hemorrhage in scarred uterus was 47.2%, higher than that in control group (P < 0. 05). There were no significant differences between two groups in the tests of hemoglobin and coagulation functions (P > 0. 05). Conclusions Scarred uterus may be one of the important reasons which lead to postpartum hemorrhage. The clinical treatment of pregnant women with scarred uterus should focus on the prevention of blood loss during the cesarean section.