RESUMEN
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.
RESUMEN
Objective To retrospectively analyze the main factors of abnormal umbilical blood flow in different stage after 24 weeks' gestation,and to evaluate its treatment outcomes.Methods 256 cases with abnormal umbilical blood flow were selected.The abnormality happened in different stages after 24 weeks' gestation and they were inspected and treated routinely.Latency factors of the different stage were analyzed to discover the primary reason,and the treatment outcomes were compared.Results The significant differences of constructional proportion were observed in different stage(x2 =25.60,P ＜ 0.05).The influence factors of different stages were as following:hypertension relative disease (33.33 ％) between 24 and 27 weeks' gestation,the umbilical cord factor (16.67 ％) ; the incidence rate of abnormal umbilical blood was 42％ between 28 and 36 weeks' gestation,including hypertension disease(28.70％),the umbilical cord factor(15.74％) ;umbilical cord (31.37％) between 37 and 40 weeks' gestation,although gestation period hypertension disease reduced,but still accounted for 22.54％,the placenta factor was 12.74％.After treatment,the cure rate had significant differences (x2 =11.16,P ＜0.01),89.58％ (24-27 week),80.55％ (28-36 week),69.60％ (37-40 week).Conclusion The hypertension relative diseases and abnormal cord are the primary factors which caused abnormal umbilical blood,24-37 gestation week is the key stage for the inspection and treatment,especially for the hypertension relative diseases.