| Purpose:Through the retrospective collection of the case data of patients with re-pregnancy after cesarean section in Yan’an University Affiliated Hospital from 2016 to2020,the time between re-pregnancy and pregnancy outcome were analyzed.It is hoped that women who are willing to continue pregnancy after cesarean section will be provided with guidance on the interval between pregnancy,so as to obtain a better maternaland child outcome.Method:Through the medical record browser of our hospital,retrospectively analyze the cases of singleton pregnant women who were hospitalized in the three obstetric wards of our hospital for delivery from January 2016 to December 2020 and re-pregnant after cesarean section.The medical history has been written through the medical records.The patient’s different pregnancy intervals and pregnancy outcome were visited back and forth.According to the inclusion and exclusion criteria,the eligible 3474 study subjects were divided into five groups according to the repregnancy interval(N): N≤1 year,1<N≤2 years,2<N≤5 years,5<N≤10 years group,N>10 years.Use the browser to record the age of the pregnant woman(<35 years old,≥35 years old),gestational age,pregnancy times,body mass index,delivery method and other general information in detail,and record hypertensive diseases during pregnancy(excluding chronic hypertension complicated with preeclampsia and preeclampsia).Pregnancy with chronic hypertension),the incidence of gestational diabetes;abnormalities of the placenta(placenta previa,abruption of placenta,adhesions of the placenta,and placental implantation);adverse maternal pregnancy outcomes(premature rupture of membranes,postpartum hemorrhage),Incomplete uterine rupture,complete uterine rupture);Adverse neonatal outcomes(premature infants,giant infants,low birth weight infants,fetal distress,intrauterine death).The data was analyzed with SPSS 25.0 statistical software,and the characteristics of the data and the changes over the years were summarized using descriptive research methods.The main observation indicator is the composition ratio.Results:1.Comparison of the number of pregnant women with different pregnancy intervals: This study finally included 3474 pregnant women with complete medical records.Among them,18 people in the N≤1 year group,accounting for about 0.52%;211 people in the 1<N≤2 year group,accounting for about 6.07%;1540 people in the 2<N≤5 year group,accounting for 44.33%;5<N≤10 years There are 1394 people in the group,accounting for about 40.13%;the group of N>10 years is 311 people,accounting for about 8.95%,as shown in Fig 1.2.Analysis of the general data of the five groups of mothers: In terms of age,the average age of the women in the five groups was(27.98±3.50)years in the group of 1<N≤2 years,and the oldest in the group of N>10 years,which was(35.58±3.43)years.It can be seen that with the extension of the pregnancy interval,the childbearing age is gradually increasing.Among them,2731 people are under 35 years old,accounting for78.61%;There are 743 people ≥35 years old,accounting for about 21.39%.And in the 1<N≤2 years group,the proportion of people<35 years old accounted for the largest(about 94.79%),and the proportion of people>35 years old in the N>10 years group was the largest(about 64.63%).The average pregnancy times of the five groups of women in the 2<N≤5 years group was(2.68±0.85)times,and the average pregnancy times in the N>10 years group was(3.26±1.08)times.The pregnancy times of pregnant women with N<5 years remained basically stable.The average gestational week of the five groups of women in the N>10 years group was(37.81±2.68)weeks;the pregnancy interval was less than 10 years,and the average gestational week of the group of 1<N≤2 years was the smallest,which was(38.12±1.19)weeks.N<10 years of gestational weeks remained basically stable.The five groups had the lowest average BMI of(27.04±3.20)kg/m2 in the group of 1<N≤2 years,and the highest average BMI of(28.14±3.40)kg/m2 in the group of N>10 years.N<5 years pregnant women’s BMI remained stable.With the prolongation of the interval between pregnancy,the age of the parturient is increasing,there are more pregnancies,the gestational week is smaller,and the BMI is higher.See Tab 1.3.Comparison of the incidence rates of pregnancy-induced hypertension and gestational diabetes in the five groups:N > 10 years group had 32 cases of pregnancy-induced hypertension,with the highest incidence rate of 10.29%,including 7cases of pregnancy-induced hypertension.12 cases of preeclampsia and 13 cases of severe preeclampsia;103 cases occurred in the group of 5<N≤10 years,the incidence rate was 7.39%,including 31 cases of hypertension during pregnancy,37 cases of preeclampsia,and 35 cases of severe preeclampsia The incidence rate of 2<N≤5 years group was 5.78%,including 29 cases of hypertension during pregnancy,43 cases of preeclampsia,and 17 cases of severe preeclampsia;the incidence rate of 1<N≤2 years group was 2.37%,including 21 case of hypertension during pregnancy,3 cases of preeclampsia.It can be seen from Figure 2 that the incidence of hypertension in pregnancy is gradually increasing as the interval between pregnancy increases.The incidence of GDM in the five groups was the highest in the 1<N≤2 years group,which was 7.58%.Except for the<1 year group,the incidence of GDM was basically the same in the other groups because the number of cases was very small.See Fig 2 and Tab 2.4.Comparison of the incidence of abnormal placenta previa in five groups: 62 cases of placenta previa occurred in total(including 24 cases of dangerous placenta previa,19 cases of complete placenta previa,6 cases of marginal placenta previa,13 cases of partial placenta previa Among them,there were 5 cases of dangerous placenta previa with placenta accreta,1 case of hysterectomy),and 0 cases of placental abnormality in the less than 1 year group.1<N≤2 years group has 11 cases of placenta previa,with the highest incidence rate of 5.21%,including 3 cases of dangerous placenta previa;5<N≤10 years group has 28 cases with an incidence rate of 2.01%,including 11 cases of dangerous placenta previa;2<N≤5 years group incidence rate was 1.36%,including 10 cases of dangerous placenta previa,including 1 case of dangerous placenta previa with placenta accreta undergoing hysterectomy;N>10 years Group incidence rate was 0.64%;five groups had 38 cases of placental abruption,1<N≤2 years group had 9 cases of placental abruption,the highest incidence rate was 4.27%;5<N≤10 years group incidence rate was 0.44%.The incidence of placental adhesions in the five groups of maternal placental adhesions in the 2<N≤5 years group and 5<N≤10 years group was relatively low,0.45% and 0.50%,respectively;the incidence in the 1<N≤2 year group and the >10 year group The rates are 0.95% and 0.96% respectively.The incidence of placenta accreta in the five groups was the highest in the group of 1<N≤2 years,which was 1.42%,and the incidence of the other groups was lower.And among the five groups,the incidence of placental abnormalities was the highest in the 1<N≤2 years group,which was 11.85%(25/211);it was lower in the 2<N≤5 years group,which was 3.18%(49/1540).See Tab 3.5.Comparison of the incidence of adverse pregnancy outcomes among the five groups: A total of 18 pregnant women in the N≤1 year group were enrolled.Due to the small number of cases,no adverse pregnancy outcomes were found.4 cases of complete uterine rupture.The incidence of premature rupture of membranes,postpartum hemorrhage,incomplete uterine rupture,and complete uterine rupture of pregnant women in 1<N≤2 years group are: 8.53%,1.90%,9.95%,0.00%;2<N≤5 years The above-mentioned incidences of pregnant women in the group are: 6.63%,1.82%,10.84%,0.06%;the above-mentioned incidences of pregnant women in the group of 5<N≤10years are: 9.90%,1.58%,9.40%,0.22%;N>10 years The above-mentioned incidence rates of pregnant women in the group were: 12.54%,2.89%,12.86%,0.00%;among them,the incidence of premature rupture of membranes,postpartum hemorrhage,and incomplete uterine rupture were the highest among pregnant women in the N>10 years group,which were 12.54%,2.89%,12.86%.The incidence of premature rupture of membranes in pregnant women in the group of 2<N≤5 years is the lowest at 6.36%.The incidence of premature rupture of membranes less than 2 years and greater than 5years is gradually increasing;the incidence of postpartum hemorrhage and incomplete uterine rupture There is no significant change in the rate between pregnancy intervals greater than 1 year and less than 10 years.The incidence of complete uterine rupture was the lowest in each group,and it did not occur within 2 years between pregnancy.It may be related to the termination of pregnancy in the first trimester of re-pregnancy within 2years after cesarean section.See Tab 4.6.Comparison of the incidence of adverse neonatal outcomes among the five groups of pregnant women: A total of 18 pregnant women in the N≤1 year group were enrolled,and one giant fetus occurred.Due to the small number of cases,no other adverse outcomes were found.The premature infants,low birth weight infants,giant fetuses,fetal distress,and intrauterine morbidity of pregnant women in the 1<N≤2 years group were11.3%,0.47%,2.37%,2.84%,0.00%,and premature infants The incidence rate is the highest,followed by fetal distress;the above-mentioned incidence rates of pregnant women in the 2<N≤5 years group are: 2.66%,1.23%,4.74%,1.23%,0.26%.The incidence of giant fetuses is the highest,followed by premature infants.The incidence of low birth weight infants and fetal distress is relatively low and consistent;the above incidences of pregnant women in the 5<N≤10 years group are: 4.73%,1.36%,3.80%,2.15%,0.22%,and the incidence of preterm infants The highest incidence is followed by giant fetuses;the above-mentioned incidence rates of pregnant women in the N>10years group are: 8.03%,0.00%,4.50%,0.64%,0.64%,premature infants have the highest incidence,followed by giant fetuses.Among them,the incidence of preterm infants in the group of 2<N≤5 years is the lowest,and the incidence of less than 2 years and greater than 5 years is gradually increasing,which is consistent with the incidence trend of premature rupture of membranes;the incidence trend of giant fetuses is in pregnancy After an interval of more than 5 years,the incidence trend of gestational diabetes is basically the same;the incidence of low birth weight infants and fetal distress has no obvious changes with the year.The intrauterine incidence of unexplained fetal death is increasing year by year.See Tab 5.7.Comparison of delivery methods of five groups of pregnant women: This study included 3474 patients,of which 3364 patients chose to have another cesarean section,accounting for 96.83%;110 patients who chose vaginal delivery,accounting for 3.17%.See Tab 6.Conclusion:1.For pregnant women who are pregnant again after cesarean section,the incidence of adverse pregnancy outcomes is related to the length of the pregnancy interval.This study shows that there are fewer complications between mothers and infants within 2 to 5 years between re-pregnancy after cesarean section.Therefore,it is recommended that women who are willing to continue pregnancy after cesarean section can get better maternal and fetal outcomes if they become pregnant again within 2 to 5years of pregnancy. |
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