Analysis Of Vaginal Delivery Outcome And Clinical Features In Scarred Uterus Pregnancy

Objectives Through the analysis of the outcome and clinical characteristics of vaginal delivery of scar uterine pregnancy,the feasibility of vaginal delivery of scar uterine pregnancy was discussed to provide scientific basis for improving the probability of successful vaginal delivery of scar uterine pregnancy.Methods The cicatricial pregnant women admitted to qinhuangdao maternal and child health hospital from January 2013 to May 2016 were selected as the case group,and the non-cicatricial pregnant women in the second pregnancy were selected as the control group.Analysis of two groups of maternal pregnancy and childbirth,including the basic characteristics of the maternal,mother labor time limit,intrapartum postpartum blood loss,incidence of postpartum hemorrhage,assisted vaginal surgery rate,perineum full rate,degree of perineal laceration,oxytocin in the labor rate,incidence of puerperal infection,the incidence of uterine rupture,length of hospital stay and cost,labor analgesia,etc.Neonatal situation:including Apgar score,neonatal asphyxia rate,neonatal weight,incidence of neonatal birth injury and other relevant clinical data.SPSS 20.0 statistical software was applied to establish the database and conduct data collation and analysis.Results In this study,a total of 90 cases of pregnant and parturient women with scar were included.Among them,there were 83 cases with a history of cesarean section at the lower uterine segment once,and 7 cases with a history of myomectomy without penetrating uterine cavity.The analgesia rate was 12.22%in 11 cases.The control group included a total of 112 cases of second vaginal delivery of non-scar pregnant women.1Analysis of basic characteristics of research objects:There was no difference between the case group and the control group in age,gestational age,BMI before delivery,increased body mass during pregnancy,birth body mass of previous neonates,time between operation or delivery,and cervical Bishop score before delivery.Previous cesarean section were lower uterine segment crosscutting mouth,double stitching,Ⅰlevel for the lower uterine segment scar^[1].Uterine myomectomy did not penetrate the uterine cavity,and there were no complications.2 Analysis of clinical indicators of research objects:1)In the case group,the first stage of labor（5.82±3.51）h,the second stage of labor（36.90±25.71）min,and the third stage of labor（7.50±3.97）min.Total labor duration（6.56±3.59）h.The control group had the first labor（4.36±2.87）h,the second labor（17.33±13.26）min,and the third labor（7.49±3.19）min.Total labor duration（4.83±2.90）h.The duration of the first,second and total labor duration in the case group was longer than that in the control group（P<0.05）.2)Intrapartum hemorrhage（116.45±54.67）ml in the case group;1h postpartum bleeding（215.78±60.35）ml,2h postpartum bleeding（248.78±47.85）ml,24h postpartum bleeding（279.00±73.59）ml.Hemorrhage at birth（109.82±54.67）ml in the control group;1h postpartum hemorrhage（210.54±56.91）ml,2h postpartum hemorrhage（240.98±61.05）ml,24h postpartum hemorrhage（269.55±62.65）ml,there was no difference between the two groups（P>0.05）.3)There was no difference between the two groups in vaginal midwifery,perineal integrity,perineal laceration,and the use of oxytocin during labor（P>0.05）.4)The hospitalization time of the case group was（3.57±1.29）days,and the hospitalization cost was（6436.24±2985.10）yuan.The length of hospitalization in the control group was（3.29±1.20）days,and the hospitalization cost was（4734.84±925.43）yuan.There was no difference in the length of stay between the two groups（P>0.05）.There was a difference in hospitalization cost between the two groups（P<0.05）.5)No complications such as puerperal infection and uterine rupture were found.6)Neonatal outcome:there was no difference in neonatal asphyxia rate and neonatal weight between the two groups（P>0.05）.Both groups were born with proletarian injury.3 In the case group,labor analgesia was used in 11 cases and labor analgesia was not used in 79 cases.Mother and child outcomes:1)The duration of first labor and total labor in analgesia group was longer than that in non-analgesia group（P<0.05）.2)There was no difference in the amount of bleeding at birth,1 h,2 h and 24 h after delivery between the two groups（P>0.05）.3)There was no difference in neonatal asphyxia rate between the two groups（P>0.05）.4)There was no difference in VAS score between the two groups before labor analgesia（T0）（P>0.05）;VAS scores of complete hysterotomy（T4）and fetal delivery（T5）were different in the two groups 1 hour（T1）,2 hours（T2）and3 hours（T3）after labor analgesia（P<0.05）.Conclusions The duration of the first,second and total labor of the scar uterine pregnancy and vaginal delivery was longer than that of the non-scar uterine group.The incidence of postpartum hemorrhage and the rate of vaginal operation were not increased.No puerperal infection and uterine rupture occurred.Vaginal trialyield of scar uterine pregnancy is low.Neonatal asphyxia rate and birth injury rate did not increase.The selection of labor analgesia can reduce the VAS score,do not increase the amount of postpartum hemorrhage and neonatal asphyxia rate,is conducive to improve maternal compliance.Table 18,Reference117.