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02 August 2022, Volume 38 Issue 8 Previous Issue    Next Issue

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Early identification and management of postpartum hemorrhage due to uterine atony during vaginal delivery. LIU Yan-yan, FENG Ling 2022, 38(8): 773-776.  DOI: 10.19538/j.fk2022080102 Abstract ( )   Uterine atony is the most common cause of postpartum hemorrhage. Common high-risk early-warning indicators include：bleeding volume，blood loss rate，vital signs，shock index and fibrinogen level. Based on early-warning indicators，plans should be made in advance. Rescue measures must reflect "initiative"，and early intervention can avoid adverse consequences.

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Retained placenta after vaginal delivery：risk factors and management. SHI Meng-meng, CHEN Jing-si, CHEN Dun-jin 2022, 38(8): 776-779.  DOI: 10.19538/j.fk2022080103 Abstract ( )   Retained placenta is one of the most common complications during vaginal delivery. With the release of "three-child policy" in China and the increase of pregnancy at advanced maternal age，the incidence of retained placenta will predictably increase year by year. Strengthening the identification of risk factors and active management of third stage of labor are of great significance to preventing postpartum hemorrhage and reducing maternal mortality.

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Prevention and management of third and fourth-degree and special lacerations of perineum. ZHANG Qin-jian, YAN Jian-ying 2022, 38(8): 780-783.  DOI: 10.19538/j.fk2022080104 Abstract ( )   The third and fourth-degree perineal lacerations are a serious complication of vaginal delivery，and because the laceration involves the anal sphincter complex and/or anal mucous membrane，they are referred to as obstetric anal sphincter injuries（OASIS），which is the most common cause of postpartum anal incontinence and severely affects the quality of life. Accurate assessment of the extent of perineal laceration and timely repair of the anatomy after vaginal delivery is essential to restoring sphincter function and improve prognosis. However，some occult OASIS is sometimes missed and cannot be identified in clinical practice. Unrecognized，unrepaired，or poorly healed OASIS can develop into perineal-rectal fistula or rectal-vaginal fistula. It is necessary to strengthen the prevention and management of OASIS，appropriately apply quality management tools，analyze the risk factors and key aspects leading to OASIS，and develop and implement improvement measures from several key points，such as pregnancy and labor management，assisted delivery capacity enhancement，risk assessment，prevention and treatment，in order to reduce or avoid the occurrence of OASIS while improving the ability to identify and repair OASIS.

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Early identification and management of occult postpartum hemorrhage caused by genital tract laceration.  CHEN Lu, ZHOU Wei-xiao, HE Jing 2022, 38(8): 784-787.  DOI: 10.19538/j.fk2022080105 Abstract ( )   There are many risk factors for the formation of postpartum hematoma after vaginal delivery.Larger vulvovaginal hematomas or special types of hematomas，such as broad ligament hematoma and/or retroperitoneal hematoma，often have occult onset and are difficult to detect early，which can cause occult postpartum hemorrhage and endanger the life of pregnant women.According to the location and size of hematoma，whether it continues to increase，and the stability of maternal hemodynamics，conservative treatment，pelvic artery embolization or surgical treatment can be selected.

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Common causes and prevention of uterine rupture. JIN Jin, WANG Zhi-jian 2022, 38(8): 787-791.  DOI: 10.19538/j.fk2022080106 Abstract ( )   Uterine rupture is a perinatal complication that seriously threatens the life of the mother and fetus. With the opening of the fertility policy，the incidence of uterine rupture in pregnant women in China is on the rise. The main cause of uterine rupture is scarred uterus. The cause of scarred uterus includes not only cesarean section but also the history of uterine surgery with non-obstetrical factors，which is also the most easily neglected cause. Uterine rupture of scarred uterus often occurs in the process of vaginal delivery，but placental implantation can lead to spontaneous uterine rupture in the middle and third trimester of pregnancy，which is worthy of clinical attention. Abdominal pain，vaginal bleeding，and decreased fetal heart rate are common clinical manifestations of uterine rupture，while occult uterine rupture in the middle and third trimester of pregnancy is often characterized by abdominal pain and shock. Therefore，the early identification and timely surgical treatments of uterine rupture are closely related to the maternal and fetal outcomes. We focus on the common causes and clinical manifestations of uterine rupture，hoping to improve the vigilance of clinicians and improve the maternal and fetal outcomes.

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Prevention of neonatal asphyxia during vaginal delivery.  GONG Yang-yang, CHEN Zhen, QI Hong-bo 2022, 38(8): 791-795.  DOI: 10.19538/j.fk2022080107 Abstract ( )   Neonatal asphyxia is a common acute and severe disease during vaginal delivery and is also a significant cause of adverse outcomes for newborns. We should thoroughly evaluate the maternal and fetal conditions during the perinatal period，clarify the high-risk factors，closely observe the progress of labor，correctly interpret CTG，and give necessary obstetric intervention in time in order to reduce the occurrence of neonatal asphyxia，reduce the neonatal ICU rate，and improve maternal and infant outcomes.

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Early identification，prevention and treatment of shoulder dystocia and brachial plexus injury. FU Jing, LI Xue-lan 2022, 38(8): 795-798.  DOI: 10.19538/j.fk2022080108 Abstract ( )   Shoulder dystocia is the main cause of neonatal brachial plexus injury，which is difficult to predict and often leads to serious maternal and fetal complications.Prevention and correct treatment are very important.It is suggested to make a comprehensive evaluation and preparation and to identify early.Once it occurs，it's necessary to quickly establish a rescue team and deliver as soon as possible by loosening the incarcerated front shoulder，reducing the fetal shoulder diameter and increasing the pelvic diameter，so as to reduce the adverse outcome of mother and child.

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Instrumental delivery and neonatal birth injuries. LI Lu-yao, ZHAO Yang-yu 2022, 38(8): 798-801.  DOI: 10.19538/j.fk2022080109 Abstract ( )   Instrumental delivery，including forceps delivery and vacuum extraction，makes a great contribution to decreasing caesarean delivery rate and increasing vaginal delivery rate，as well as handling dystocia. Experienced care providers with appropriate training are the keys to a successful vaginal delivery. Inappropriate operations could do severe maternal and neonatal harms，and even cause permanent birth injuries to newborns. Obstetrician should make thoughtful judgements by fetal and maternal conditions, along with their experience，to come to a conclusion whether an instrumental delivery is doable. It is with great importance to decrease maternal and neonatal morbidity rate.

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Implementation of emergency cesarean section during vaginal delivery. PENG Shu-min, ZHOU Wei 2022, 38(8): 801-804.  DOI: 10.19538/j.fk2022080110 Abstract ( )   Acute fetal distress during vaginal delivery is the main reason for emergency cesarean section. This article mainly describes the definition，timing，indications and time limit of emergency cesarean section，in order to help medical staff to respond to emergencies in obstetrics correctly，grasp the indications of emergency cesarean section strictly，and take safety and quality as the core to ensure the safety of mother and newborn.

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Twin pregnancy management in vaginal delivery. HUANG Rong, QI Wen-jin 2022, 38(8): 805-808.  DOI: 10.19538/j.fk2022080111 Abstract ( )   Twin pregnancy belongs to the category of high-risk pregnancy，which is often complicated by other pregnancy comorbidities and complications，and has a high incidence of adverse maternal and child outcomes. It remains one of the most challenging events in obstetrics how to choose the appropriate time and mode of delivery in twin pregnancy. Based on the domestic and foreign latest literature and guidelines on vaginal delivery of twin pregnancy at home and abroad，and combined with the experience of vaginal delivery of twin pregnancy in our hospital，this article aims to promote natural delivery and provide help for the effective control of cesarean section.