Question
After a full-term cesarean section for a child with a completely septate uterus, the patient was diagnosed with cerebral palsy after perineal closure. How should it be treated?
Answer
Management during Pregnancy and Delivery:
- During pregnancy, due to the high rates of miscarriage and preterm delivery in cases of complete uterine septum pregnancy, enhanced monitoring is necessary. Strictly observe for any signs of cervical incompetence, such as painless cervical dilation or expansion, and perform cervical cerclage if needed. During prenatal checks, identify the placental attachment site early to detect placenta previa.
- During delivery, a child with a completely septate uterus can undergo vaginal delivery. If there is secondary uterine atony and prolonged second stage of labor, perform a vaginal examination to check for vaginal septum and whether the uterine septum reaches the external os, which may obstruct labor progress. In cases of abnormal presentation or position, decide on the mode of delivery based on the mother’s age, number of deliveries, pelvis size, and fetal size. However, for elderly primigravidas with poor pregnancy history and abnormal fetal position, consider relaxing the indications for cesarean section. After laparotomy, if a longitudinal depression in the uterine body is found, it is best to make a longitudinal incision in the lower segment of the uterus to remove the septum along with it. Based on the above conditions, there should be no sterilization. Ensure proper reproductive system care and maintenance while waiting for the arrival of the little one.