Laparoscopic repair of uterine rupture following successful second vaginal birth after caesarean delivery: A case report

BACKGROUND With the increasing trend of vaginal birth after caesarean delivery(VBAC),evaluation of the feasibility and safety of a second VBAC with grand multiparity is worth considering.Intrapartum uterine rupture is diagnosed in approximately one-fifth of all VBAC cases following successful vaginal delivery.To our knowledge,no report is available on the application of laparoscopy to repair postpartum uterine rupture after a successful second VBAC in China.CASE SUMMARY A 31-year-old woman(gravida 5,para 2)at 39 wk and 5 d of gestation was admitted to the hospital in labour.After a successful VBAC and observation for approximately 13 h,the patient complained of progressive abdominal pain.Given the symptoms,signs,and auxiliary examination results,intraperitoneal bleeding was considered.Because the patient was stable and ultrasound imaging was the only method available to assess the possibility of rupture,we recommended laparoscopy to clarify the diagnosis and for prompt laparoscopic uterine repair or exploratory laparotomy if necessary.Operative findings included transverse uterine scar rupture at the lower uterine segment of approximately 5.0 cm in length and 800 mL of intraoperative pelvic haemoperitoneum.Finally,she successfully underwent laparoscopic repair of uterine rupture and recovered very well according to three-dimensional magnetic resonance imaging at 42 d postpartum.CONCLUSION Routine postpartum intrauterine exploration is not beneficial to the mother and may even increase the risk of rupture.This case highlights a laparoscopic approach for repairing uterine rupture in the immediate postpartum period.

Vaginal Birth after One Caesarean Section—Ten Years Experience in a South Eastern Nigerian Hospital

Background: The rising caesarean section rate worldwide is an increasing source of concern to all. A significant contributor to this is a previous caesarean delivery. One strategy in the armamentarium of obstetricians for reducing this is vaginal birth after one caesarean section (VBAC). The safety, outcome and complications of this procedure in our Center which is in a developing country had never been studied hence the need for this work. Aim: To find out the outcome and complications of vaginal births after one caesarean delivery in our Center. Method: A retrospective study involving a ten-year review of all cases of trials of labour after one caesarean delivery in our Center was done. Result: Of the 305 trials of labour after one caesarean delivery, 221 women had vaginal birth giving a vaginal birth after one caesarean section rate of 72.5%. Majority of the babies 303 (99.2%) were alive and had good Apgar scores while 2 (0.7%) died giving a perinatal mortality rate of 7 per 1000 babies. There were complications in 21 (6.7%) of the women with retained placenta, in 7 (2.3%) of the women as the commonest, followed by postpartum haemorrhage in 6 (1.96%). Five (1.62%) women had scar dehiscence while 3 (0.98%) had uterine rupture. Conclusion: Vaginal birth after one caesarean section is safe in well selected cases even in our resource poor settings. It offers our women a culturally-acceptable option of fulfilling long-held dreams of vaginal delivery even after one caesarean section and should be offered to our women whenever possible.

Double balloon device compared to oxytocin for induction of labour after previous caesarean section

Objective: To assess cervical changes, duration of oxytocin infusion, mode of delivery and complications after cervical ripening using a double balloon device in women with a previous caesarean section. Methods: Longitudinal study including 80 women with a previous caesarean section, no previous vaginal delivery and an unfavourable cervix (Bishop

Trial of Labour after Caesarean Section: A 5-Year Review

Background: Trial of labour after Caesarean section (TOLAC) refers to an attempt at vaginal delivery after a previous caesarean section. Outcome is influenced by a number of factors which are important in patient’s selection. Objectives: The aim of this study was to find out the incidence and feto-maternal outcome of the practice of Trial of labour after Caesarean section. Methodology: This is a retrospective study of cases of vaginal birth after Caesarean section Data were retrieved from the case notes of patients who attempted vaginal birth after Caesarean section from January 1, 2013 to December 31, 2017, a period of five years. Result: There were 10,669 deliveries, 3179 of which were through Caesarean section. This gave a Caesarean section rate of 29.8%. A total of 217 patients attempted vaginal birth after Caesarean section and 83 ended up as repeat Caesarean section (38.2%) while 138 (61.8%) had successful vaginal birth after Caesarean section. Patients with previous vaginal delivery, age range 25 - 29 years and interdelivery interval of greater than or equal to 2 years were more successful at achieving vaginal birth after Caesarean section. The leading indications for the repeat Caesarean section include cephalopelvic disproportion (45.8%), poor progress of labour (19.3%) and hypertensive disorders of pregnancy (8.4%). Conclusion: Vaginal birth after Caesarean section was successful in most of the parturients that attempted it in this study especially in patients within the age range of 25 - 29 years, those that have had previous vaginal delivery and with interdelivery interval of greater than or equal to 2 years.

Statistical Analysis of Variables Influencing Type of Birth in Sri Lanka: A Logistic Regression Approach

Caesarean is a major surgical procedure undertaken in obstetrics and its rate is increasing in Sri Lanka as well as in the world. In Sri Lanka, health statistics show an increase in caesarean rates from 13.3% in 1998 to 30.6% by 2007. Due to its potential serious risks and the burden on the health system, many authorities have recommended reducing the caesarean rate for many years. This motivated us to study the most influential variables on the type of birth in Sri Lanka. In this study, based on the Anuradhapura Teaching Hospital records, entire 805 new born babies’ birth information was considered during the month of May, 2015. The variable “Type of Birth” (Normal/Caesarean) was considered as a binary response variable and age, height, weight of mother and sex, weight, length, shoulder length, head circumference of the baby were treated as explanatory variables. Logistic regression was used to model the data and using stepwise regression;mother’s age, height and weight were identified as the most influential variables on the type of birth. Further, it was observed that the odds of having normal birth is 80% higher for woman who belongs to the age group less than or equal to 30 years compared to woman who belongs to the age group greater than 30 years. Moreover, the Hosmer-Lemeshow goodness of fit test was used to check the adequacy of the fitted model. Results from this study revealed that in future, the type of birth may be predicted by considering these identified influential variables.

多角度护理对降低产妇剖宫产率、提高产妇分娩自我效能感的作用

目的探讨多角度护理对降低产妇剖宫产率、提高产妇分娩自我效能感的作用。方法回顾性选择医院2021年1月至2021年11月期间收治的125例产妇作为观察对象,按不同的护理方式将其分为常规组和研究组,其中施行常规护理干预的63例产妇列入常规组,采用多角度护理的62例产妇列入研究组。分析比较两组的焦虑情绪(SAS)、抑郁情绪(SDS)、自我效能量表(CBSEI-C32)、结果期望量表(OE-16)、自我效能期望量表(EE-16)、分娩方式和护理满意度。结果干预后,研究组的SAS、SDS评分低于常规组(P<0.05);研究组的CBSEI-C32、OE-16、EE-16评分均高于常规组(P<0.05);研究组的剖宫产率低于常规组(P<0.05);研究组护理满意度高于常规组(P<0.05)。结论采用多角度护理干预产妇分娩可以改善产妇的心理状态,提高产妇分娩自我效能感,降低剖宫产率,最终提升护理满意度。

Profile of Pregnant Women and Success of the Uterine Test on a Uni or Bi-Scar Uterus at the Maternity Ward of Panzi Hospital, in the Democratic Republic of the Congo

Introduction: Trial of labor after a previous cesarean section (TOLAC) is a method that requires strict monitoring to decrease the cesarean section (CS) rate and improve the maternal and neonatal prognosis. The objective is to determine the profile and outcome of patients with one and two previous CSs who performed TOLAC at Panzi General Referral Hospital. Methodology: This is a cross-sectional study with a prospective collection of data of 111 patients with one and two previous CSs at Panzi Hospital from January 2021 to August 2022. Statistical Package for the Social Sciences SPSS version 23 software was used to analyze the collected data. The percentages of categorical variables were summarized in a frequency table. The mean or median with standard deviation was used to summarize quantitative variables. Results: The overall success rate of the TOLAC was 64%, with 63.8% following one previous CS and 64.3% following two CSs. The mean age of the patients was 27.09 years, with an age range of 25 - 34 years. They were mostly pauciparous (52.2%), married (88.3%), with a high school education (60.4%). The inter-delivery interval > 18 months was noted (64.1%) and overweight in 63.9%. More than three antenatal consultations were performed (58.6%). We found a mean gestational age of 38 (34 - 41) weeks. The perinatal mortality rate was 0.9%. However, we did not record any cases of maternal mortality during the study period. Conclusion: TOLAC after one and two previous CS is implemented in the maternity Unit of Panzi Hospital for well-selected patients. In addition, the success rate is similar after TOLAC with an acceptable maternal-neonatal prognosis.

剖宫产与新生儿高胆红素血症关系的研究

[目的]探讨剖宫产分娩与新生儿高胆红素血症(简称新生儿高胆)的关系,为临床防治新生儿高胆提供依据.[方法]对广西医科大学第九附属医院产科在2003年1月～2004年12月期间出生的新生儿进行研究,通过监测经皮胆红素、血清胆红素,比较剖宫产娩出与非剖宫产新生儿发生高胆的情况.[结果]剖宫产组与非剖宫产组新生儿高胆发生率分别为36.9%和21.8%,差异具有非常显著性(P＜0.01).剖宫产组中母亲有妊娠合并症者新生儿高胆发生率为37.5%,略高于母亲无妊娠合并症者(36.7%),两者间差异无显著性(P＞0.05);两组婴儿合并窒息缺氧、新生儿缺氧缺血性脑病、吸入综合症、感染等疾病与新生儿高胆发生率之间差异无显著性(P＞0.05).[结论]剖宫产可能是引起新生儿高胆的原因之一.

初乳中主要组分的动态变化及产妇年龄和剖宫产的影响

测定了来自20位健康母亲(其中8位为剖宫产)的118份初乳(泌乳第1～7d)中乳糖和蛋白质浓度。通过线性模型,分析产妇年龄和剖宫产对乳糖和蛋白质含量的影响。结果表明,乳糖在泌乳第1d最低,在泌乳1w内增加,其中泌乳第1d的乳糖浓度极显著低于第7d(P<0.01)。乳蛋白的浓度在泌乳第1d最高,泌乳1w内下降,其中前3d水平显著或极显著高于第7d(P<0 05或P<0 01)。初乳中乳糖和乳蛋白含量呈极显著负相关(r=-0.523,P<0.01)。剖宫产母亲初乳中乳糖含量显著低于顺产(P<0 05),剖宫产与顺产母亲初乳中蛋白质含量差异不显著(P>0 05)。产妇年龄的大小与初乳中蛋白质和乳糖含量均无显著关系(P>0 05)。

母乳喂养影响因素分析

目的:了解母乳喂养的状况及其影响因素。方法:将接受产后访视的产妇为调查对象,统一设计问卷,收集资料。结果:151例产妇中,平均母乳喂养率为86.09%。剖宫产或阴道难产、孕产期有合并症或并发症等因素的产妇其母乳喂养率低。结论:母乳喂养受分娩方式、孕期经过等因素的影响,应有针对性减少其不利因素,提高母乳喂养率。

剖宫产术后留置尿管护理方法的探讨

目的探讨剖宫产术后留置尿管病人导尿管放置及拔除的最佳方法。方法将病人随机分为实验组80例,常规组80例,通过改变尿管的放置方法乃拔管方法,观察病人舒适度和拔管后的首次排尿时间及尿路刺激症的发生情况。结果实验组病人留置尿管的不适感明显降低,拔管后1 h内排尿成功率实验组为25%,而常规拔管方法仅为3.8%,实验组尿路刺激症发生率明显低于常规组。结论减轻了剖宫产术后留置尿管病人的不适。

剖宫产时心理干预对镇痛效果的影响

目的:研究剖宫产时心理干预对镇痛效果的影响。方法:将2004年1月～2005年7月选择剖宫产的产妇200例随机分为实验组和对照组各100例;实验组除常规处理外,还根据产妇最关心、最担心的问题应用指导性语言进行阶段性心理咨询和辅导,同时对照组采用常规处理,两组分别于术前、术后进行产妇焦虑自评量表(SAS)测定。结果:两组产妇均存在不同程度的焦虑,并且术前SAS明显高于术后(P<0.01);实验组产妇达T4麻醉平面所需时间明显低于对照组(P<0.01),镇痛效果评分明显高于对照组,(P<0.01);麻醉药物总量明显低于对照组(P<0.01);术后镇痛时间明显高于对照组,有显著性差异(P<0.01)。结论:剖宫产时心理干预有利于加强手术时麻醉镇痛效果。

阴式子宫疤痕妊娠病灶清除术治疗剖宫产术后疤痕妊娠的效果分析研究

目的:本研究对阴式子宫疤痕妊娠病灶清除术治疗剖宫产术后疤痕妊娠的疗效观察,为临床诊断提供参考。方法:选择我院2010年1月至2015年3月期间诊治的剖宫产术后疤痕妊娠患者151例进行分析。所有患者随机分为两组;常规治疗组(n=79)和阴式手术组(n=71)。常规治疗组行B超引导下负压吸宫术,阴式手术组患者行经阴道子宫疤痕病灶清除术+疤痕修补术。分析两组患者术后β-HCG的转阴时间及子宫前壁下段剖宫产疤痕部位包块消失时间、术后6个月B超切口肌层厚度、术中出血量、手术时间、住院天数及治疗后阴道流血时间及月经恢复之间变化。结果:与常规治疗组相比,阴式手术组患者β-HCG转阴时间短(P<0.01)、术后子宫前壁下段剖宫产疤痕部位包块消失快(P<0.01),术后切口肌层厚度厚(P<0.01),治愈率高、手术出血量少(P<0.01),但手术时间长(P<0.01);常规治疗组阴道流血时间及正常月经恢复时间明显长于阴式手术组,且术后需追加甲氨蝶呤的比例明显高于阴式手术组(P<0.01)。结论:阴式子宫疤痕妊娠病灶清除术治疗剖宫产术后疤痕妊娠的效果良好,值得临床推广。

剖宫产与新生儿高胆红素血症的关系探讨

目的 探讨剖宫产分娩与新生儿高胆红素血症的关系。方法 对我院 2 0 0 0年 1月至 2 0 0 1年 9月期间在产科病房出生的新生儿进行微量血清胆红素测定 ,比较剖宫产娩出的新生儿与非剖宫产娩出的新生儿发生高胆红素血症的情况。结果 剖宫产组新生儿高胆红素血症的发生率为 39 6 % (4 70 / 1188) ,非剖宫产组新生儿高胆红素血症的发生率为 2 2 8%(2 4 5 / 10 74 ) ,两者差异有统计学意义 ,χ2 =73 2 ,P <0 0 5。剖宫产组中母亲有妊娠合并症者新生儿高胆发生率为 4 0 1%(10 0 / 2 4 9) ,母亲无妊娠合并症者新生儿高胆发生率为 39 4 % (370 / 939) ,两者差异无统计学意义 ,χ2 =0 0 4 7,P >0 0 5。结论 剖宫产可能是引起新生儿高胆红素血症的原因之一。

影响剖宫产后再孕妇女选择分娩方式的因素

目的探讨影响剖宫产后瘢痕子宫再次妊娠后孕妇选择分娩方式的因素。方法问卷式调查表对2014年7月1日至2015年12月31日在苏州大学附属第一医院建卡和分娩的瘢痕子宫孕妇1 500人,及在院医务工作者1 500人,进行调研,并招募有意愿了解瘢痕子宫阴道试产(TOLAC)且能够坚持参加孕妇课堂的瘢痕子宫夫妇23对进行系列性不同分娩方式的科普宣传,并随访观察最终选择的分娩方式以及结局分析。结果 (1)学历、是否接受过TOLAC宣教、对TOLAC的认知程度和周边是否有瘢痕子宫阴道试产成功(VBAC)病例是瘢痕子宫孕妇尝试TOLAC的独立影响因素(P<0.05)。(2)与专科医生相比,非妇产科专业的医护人员对TOLAC的认知度(63.45%vs.100%)和赞同度(58.36%vs.81.82%)均较低(P<0.05);相较于临床医生,行政医技人员对TOLAC的了解度明显不足(47.37%vs.66.16%)、赞同率也明显降低(33.55%vs.60.10%)(P<0.05)。影响医护人员对于患者可否选择TOLAC的主要考虑包括:对怀疑子宫破裂者成功实施紧急剖宫产把握不大、不愿意承担一旦发生不良结局的后果(68.03%),产房是否有急诊手术室(52.98%),产房是否有专用麻醉师(24.58%),是否配备新生儿特护室(22.44%)以及孕妇及家属配合理解程度(19.77%)。(3)通过宣教,23名瘢痕子宫妊娠妇女阴道试产意愿显著增加(54.55%vs.8.69%,P<0.05)。结论对瘢痕子宫妊娠阴道试产相关知识的了解程度,以及医护人员对阴道试产的认知度和赞同度是影响瘢痕子宫孕妇再次分娩方式选择的重要因素;通过增加宣教可以增加无禁忌证的瘢痕子宫再次妊娠患者的阴道试产率。

利用Smiths公式预测有剖宫产史孕妇再次妊娠分娩方式的初步探索

目的:探讨Smiths公式用于有剖宫产(CS)史的孕妇再次妊娠时预测CS风险的意义。方法:对我院63例有CS史并再次妊娠的经产妇利用Smiths公式对不同分娩方式预测其风险系数并探讨Smiths公式的预测值。结果:63例患者中,按公式计算出CS风险预测值<40%的患者阴道试产成功率达100%,CS风险预测值>40%者有37.5%阴道试产失败。结论:利用Smith公式,取40%为临界点,对CS风险预测值>40%的既往有CS史的孕妇行阴道分娩时需慎重。

剖宫产术后精油配合乳房按摩对泌乳的影响

目的探讨自制按摩液配合穴位进行乳房按摩对剖宫产初产妇术后的泌乳效果。方法将215例剖宫产初产妇，随机分为按摩组和对照组，对照组按常规方法进行护理，按摩组于术后12h后进入按摩室，采用自制按摩液配合穴位进行乳房按摩，观察各组泌乳始动时间和泌乳量等。结果与对照组比较，按摩组泌乳始动时间提前（P〈0．05），泌乳量增加（P〈0．00）。结论自制按摩液配合穴位进行乳房按摩，具有使剖宫产初产妇术后泌乳始动时间提前、泌乳量显著增加的作用。

导乐陪伴分娩在产时保健中的作用

目的探讨导乐陪伴分娩对提高产时保健质量的作用。方法188例产妇(观察组)采用导乐陪伴式分娩与同期239(对照组)无导乐陪伴分娩的产妇比较。结果观察组产妇剖宫产率10.1%,产后出血量(205±6.88)ml,对照组剖宫产率19.25%,产后出血量(236.84±10.04)ml。两组比较差异有非常显著性意义(P<0.01),而产程时间,催产素使用率,阴道助产率和新生儿窒息率两组比较差异无显著性意义(P>0.05)。结论导乐陪伴分娩,降低了剖宫产率和产后出血量。阴道助产率,催产素使用率以及新生儿窒息率不增加。导乐陪伴分娩在产时保健中起着重要作用。

剖宫产术手术室护理成本核算

目的探讨剖宫产手术配合的护理成本核算方法,找出与目前医疗服务价格的差距。方法根据项目综合评估和核算方法,核算剖宫产手术配合的护理成本。结果剖宫产手术配合的护理成本为307.79元。结论全面客观的核算了剖宫产手术的护理成本,为制定相应合理的护理服务价格,为护理服务的价值提供了准确的依据,为今后单病种服务收费提供依据。

合理掌握剖宫产指征降低围生儿死亡率

目的 :探讨降低围生儿死亡率的途径 ,遏制不合理剖宫产上升趋势。方法 :回顾分析 1986年 1月至 1998年 12月 13年间 17784例产妇分娩方式变化及 2 82例围生儿死亡的临床资料。结果 :早产新生儿死亡是围生儿死亡主要原因。早产新生儿及畸形儿死亡与剖宫产率无关。与分娩方式有关的围生儿死亡率与剖宫产率负相关。绝对指征行剖宫产比例从1986年的 38 1%降至 1998年 33 0 % (P <0 .0 5 ) ,社会因素行剖宫产比例从 1986年的 2 2 %上升至 1998年的 5 4% (P <0 .0 5 )。结论 :只有提高对早产儿的诊疗水平及宫内诊疗水平 ,才能有效降低围生儿死亡率。只有通过加强医患沟通 ,合理掌握剖宫产指征 ,才能降低日趋升高的剖宫产率。