The mode of delivery includes vaginal delivery (natural, forceps, etc.) or cesarean section. Most low-risk women have a smooth labor and the mother and child are safe. However, the labor process is a complex and dynamic process, and abnormalities may occur at any time for both the mother and the fetus. Depending on the actual situation of the progress of labor, the doctor will communicate with the mother or her family in a timely manner when conditions permit, and adopt various appropriate obstetric techniques to solve obstetric problems. Due to individual differences, each mother may have this or that “situation”. The following complications occur every day in the obstetrics clinic and are always alarming. Successful treatment will bring you relief; “red and purple” patients, i.e., patients with massive bleeding, amniotic fluid embolism, or purple around the mouth in the case of cardiopulmonary disease, may make you feel like an enemy, or like you are in an abyss. If you read the information on Dr. Guo Peifen’s website, have some basic knowledge of the disease pattern, develop a good lifestyle, and take timely delivery or accept your doctor’s advice, most of the risks can be turned into a miracle. Dr. Guo Peifen will introduce the causes, clinical manifestations and management of these complications to you in detail. When you are admitted to the hospital, your doctor will ask you and your family to read and sign the condensed version of these contents; therefore, we recommend pregnant couples to read them in advance. If you are able to standardize your obstetrical examination, do more good deeds and accumulate more virtues, the chances of these bad outcomes will be very low. The following are recommended to be read first by the patient’s husband. I. Some risks of natural delivery. 1. Natural delivery may require episiotomy/suture and perineal anesthesia for pain relief; bone and soft birth canal lacerations may occur during delivery. Lateral perineal incision is a means of facilitating rapid delivery of the fetus to avoid severe perineal laceration, fetal distress, or maternal physical or cardiorespiratory failure. It is a relatively minor procedure with all the complications of “surgery” (bleeding from the wound, infection, poor wound healing, incision dehiscence, hardness and scarring, and in the long term itching and painful sexual intercourse), and too much episiotomy is not good, and too little episiotomy increases the rate of neonatal asphyxia and severe perineal lacerations. Dr. Guo Peifen presided over the relevant topics and research results, won the third prize of the Armed Police Force Medical Achievements. Nowadays, we can still see some old women, in the old society, giving birth to more children, perineal laceration is serious, and there is no suture repair, the vaginal opening protrudes a piece of meat, the vagina is loose, the urine is not good to control, and shy to talk about it, do not dare to seek medical treatment, it is really pitiful. Bone birth canal injury: mostly manifested as pubic symphysis separation sign, serious cases can not get out of bed and walk for half a year after delivery, most people can heal naturally after 1-2 weeks of rest. Soft birth canal injury: trial of labor for too long, easy to occur will soft tissue (such as bladder, urethra, vagina) injury, and then the reproductive tract fistula, hematuria, incontinence and so on. In severe cases, severe perineal lacerations occur, which can injure the anal sphincter and rectal mucosa. Injuries to the fetal scalp are more often characterized by scalp edema (commonly known as natal tumor) and subcutaneous hematoma; the former resolves in 24-48 hours, and scalp hematoma is rare but takes a long time to heal. However, a few present with intracranial fetal injuries such as intracranial hemorrhage. When sewing perineal wounds, anesthesia medication will be given for pain relief, which can relieve your pain to a large extent. 2. If labor progresses abnormally, appropriate treatment (e.g., rupture of membranes manually, use of hysterotonin, etc.) is needed. If there is no improvement after treatment; especially if there is a sudden change in the fetal heart rate (manifested by recurrent decrease or deceleration of fetal heart rate variability, and low or high baseline rate). In cases highly suggestive of fetal distress, labor needs to be terminated as soon as possible. The modalities include (i) continuation of vaginal trial of labor combined with forceps and fetal head attraction, or (ii) cesarean section, to be decided by the hospital and the patient. In case of emergency, the hospital has the right to make the decision directly, and the patient’s understanding is requested; however, adverse outcomes such as neonatal asphyxia or even intrauterine fetal death may still occur. Most of the fetal heart rate first stress fast, maternal fever or fetal infection, the fetal heart is too fast, up to 180, 200 bpm or more, increase the burden on the fetal heart; if you can not correct, and then the fetal heart beat is inhibited, the heart rate slows down, slows down, slows down, or even none. Just like fetal movement, at first the fetus becomes violent because it wants to struggle for death; then the fetal movement decreases, it can’t struggle any more, and finally it really doesn’t move. A considerable number of intrauterine deaths occur at home as a result of the pregnant woman’s failure to pay sufficient attention to the fetal movements, which can be said to occur every month, so I always ask the pregnant woman to pay attention to, and count, the fetal movements when I am in the outpatient clinic. Sometimes to the hospital, but the fetus is already in a state of near death, its brain may have been adversely affected, continued to the birth of the newborn body metabolic abnormalities, and even neonatal death. Amniotic fluid meconium pollution is divided into light, heavy, heavy meconium pollution, amniotic fluid yellow-green, like a flush toilet tap water flushed open stool, and the sewer is still blocked. Normal amniotic fluid is clear, like a few drops of milk dripping into a tub of tap water, milky white. The fetus urinates in late pregnancy, which is the main component of amniotic fluid, which in turn is swallowed by the fetus into the stomach or inhaled into the lungs, creating a cycle. If the amniotic fluid is contaminated by meconium in such a way that it is also sucked into the lungs, large particles of meconium block the capillary airways, and the newborn cannot breathe after birth, and meconium aspiration pneumonia occurs, which is extremely difficult to treat. 3, amniotic fluid embolism, DIC, although the incidence is low, but the mortality rate can be as high as 80%. 2014 Xiangtan, Hunan, amniotic fluid embolism event, the media reported a lot of, you can carry out the relevant knowledge of learning. Xiangtan amniotic fluid embolism incident, the hospital in serious maternal resuscitation, launched the relevant rescue process, and the patient’s family had more communication, but the medical outcome is not ideal, by some media reports are not actual, these media eventually also be punished. Ken asked everyone to do their learning up front, and to work with physicians to diagnose early and intervene early; not to become experts when there is an adverse medical outcome. We also hope that physicians will not be overconfident and overbearing, but will listen to their patients. 4. The occurrence of hemorrhage during labor (postpartum hemorrhage in medical terminology) and late postpartum hemorrhage (24 hours after delivery), which is now the number one cause of maternal death. Psychological factors such as elective surgery, emergency surgery, expecting to have a boy, etc.; prolonged trial of labor, extreme fatigue; oversized fetus, excessive amniotic fluid, twin pregnancies, which hold up the uterus too much, like a balloon blown over, and after the delivery of the fetus, the balloon can’t be shrunk back, so there’s a large amount of intrauterine hemorrhage, which can reach up to 1,000 ml within 1 or 2 minutes. structural abnormalities of the uterus, uterine, vaginal laceration (seen in maternal violence, the head of the fetus umbilical cord is in the Vagina, there is a strong maternal ruthless to umbilical cord out of the fetus at once, but the vagina and perineum is not fully dilated; vaginal inflammation, the tissue will be more brittle and tearing), easy to occur serious soft birth canal laceration and massive bleeding. Placenta previa (if the previous delivery was by cesarean section and the current pregnancy has a placenta previa, it will be extremely dangerous) is a bleeding condition that requires the mother to prepare more money and blood sources, prepare for hysterectomy or uterine artery embolization, etc. Placental implantation, placental adhesions, and placental tissue mass remaining in the uterine cavity can cause heavy bleeding. Late postpartum hemorrhage may manifest as recurrent menstrual-like bleeding or heavy bleeding at one time. If postpartum ultrasound suggests that there are large abnormal echoes in the uterus, prompt evacuation of the uterus may be necessary. Dr. Guo Peifen has designed a three-step procedure for checking for retained placenta during cesarean section: 1. After delivering the placenta, probe the bottom of the uterus with a finger; 2. Clamp both uterine horns with an oval forceps; and 3. Check the integrity of the placenta with the operator on the table. In some cases, the placenta praevia has grown into the cervical canal and must be removed under direct vision, as above. 5. Premature rupture of membranes is a sign of obstructed labor and intrauterine infection. If the infection cannot be controlled, maternal or fetal neonatal sepsis may occur. Once the membranes rupture, the amniotic fluid will only gradually decrease, of course, new amniotic fluid will be generated every day. Usually about 24-48 hours after rupture of membranes, if there is no fever, uterine pressure, amniotic fluid odor, good response to fetal heart rate monitoring, and the examination indicators are not obviously high, it does not matter, and the family should not worry too much with the rush of cesarean delivery. Artificial rupture of membranes is a routine technique in obstetrics, mainly used for ① to understand the nature of amniotic fluid: low fetal movement or abnormal fetal heart rate monitoring: artificial rupture of membranes, amniotic fluid outflow, such as amniotic fluid contaminated with fecal matter (such as light yellow / dark green), can help to understand the degree of fetal distress. ② Induce labor: Primary after secondary uterine contraction weakness, by rupturing the membranes, the fetal head can better press/stimulate the lower uterine segment to strengthen the uterine contraction. Commonly used in gestational diabetes mellitus/delayed pregnancy, etc. (iii) In case of ineffective induction of labor by hysterotonin, rupture the membranes manually at the right time to obtain more effective contractions. However, there are also the following dangers: ① Infection: especially when there is vaginal inflammation or other parts of the body infection source, and part of the source of infection. ② A few patients may not be able to enhance the effect of contractions. ③ Decrease in amniotic fluid: amniotic fluid outflow and decrease in amniotic fluid volume, resulting in pressure/worry on the umbilical cord. ④ Umbilical cord prolapse: the umbilical cord is the only channel for the fetus to obtain nutrients and nourishment; if the head of the fetus is not in the pelvis with excess amniotic fluid, the umbilical cord is prone to prolapse after rupture of membranes, and the fetus can be stillborn in a short period of time, and it is necessary to elevate the breech position, and in case of prolapse, an emergency cesarean section is needed. ⑤ Rupture of anterior vessel: Rarely, the vessel located on the fetal membrane is pinched and ruptured, the vessel is filled with fetal blood, once ruptured, it can lead to fetal anemia and stillbirth. ⑥ Amniotic fluid embolism. 6. Preterm birth. Preterm babies have a low survival rate and a high prevalence of illnesses, such as necrosis of the small intestine, infections, and neurological damage, and there may be long-term sequelae, such as poor hearing (seen in one case) and uncoordinated movement of the limbs (seen in one case); the cost of medical care is high, and there may be a lack of human and financial resources. Many fetuses have specific etiologies of their own, such as congenital malformations. We had a patient with placental abruption at 35 weeks, emergency cesarean section, neonatal resuscitation, cranial CT scan, a large tumor. The pediatrics department of the Armed Forces Hospital has had several cases of very low birth weight babies that have been successfully resuscitated, such as birth weights around 900g. This does not indicate that all newborns of this size, at 29 weeks of gestation, 30 weeks of labor, end well. Preterm labor, early preterm labor is a serious obstetric complication, and with all the medical advances over the years, obstetrics has been stretched to the limit in this area, and it’s a shame! The level of pediatrics in resuscitating low-birth-weight babies has improved a lot. Therefore, the emergence of complications or comorbidities that endanger the life of the mother, are required to terminate the pregnancy as soon as possible, premature newborns to pediatricians. Currently, the survival rate of children born at 30 weeks of gestational age in Guangzhou’s tertiary hospitals is about 60-85%, and in good hospitals it may reach 90%. At 32 weeks, the survival rate can be as high as 95%. For water breaking at 24 weeks, or less than 26 weeks, in the 2014 obstetrics guidelines, it is recommended to abandon the fetus. Unless it is a very uncomplicated pregnancy and the family is financially well off. Both the hospital and the patient are willing to take great medical risks and can be challenged. Once a couple in their early 20’s, first child, had their water break at 22 weeks, estimated to have too much amniotic fluid, started to keep the baby alive, and refused antibiotics; in this case, don’t get emotional. Leave a non-infected uterus in, still afraid of the future birth of a good child? 7. Umbilical cord prolapse or hidden prolapse. The umbilical cord is the only channel for the fetus to obtain nutrients and oxygen and discharge metabolic wastes in the uterus. After the umbilical cord prolapses to the fetal head and pelvic space, the umbilical cord pressure on the bony part of the umbilical cord can completely block the umbilical cord blood flow. In severe cases, the fetus (on the verge of) dying in the uterus, difficult to rescue. Two years ago, I was out playing ball, the department paged me to resuscitate, the umbilical cord came off into the vagina, the physician on the phone said that her hand had been in the vagina of the mother against the fetal head, the umbilical cord between her fingers, not squeezed, elevated the buttocks, also filled the bladder, the fetal heart is okay, sent to the operating room on the way. The situation is tense, I ran all the way, usually 15 minutes of road, 4 minutes to run, legs are cramped, sweaty hands wash on the operating table, 3 minutes to deliver the child, mild asphyxia. One year in Xinjiang, the umbilical cord also prolapsed, I did a C-section directly in the delivery room, but fortunately in time, the newborn did not asphyxiate. However, because of premature rupture of membranes and excessive amniotic fluid, it is not uncommon for the patient to be in the hospital room, and as soon as she gets up, the umbilical cord comes out and the fetus dies in her stomach. Now that balloons are often used in obstetrics, Dr. Guo Peifen reminds everyone to pay special attention to umbilical cord prolapse accidents now. A few days ago (July 2015) there was a breech maternity, the duty physician repeatedly asked her to operate, she insisted on waiting for a good time the next day, the result of the first half of the night fetal membranes rupture, a leg into the vagina, while a large umbilical cord, but also out of the fright of the neighboring bed, the physicians a good meal of resuscitation, local anesthesia, cesarean delivery. This local anesthesia cesarean section, or very painful, damage is quite large. 8, 30min after the delivery of the fetus, the placenta is not delivered, you need to remove the placenta by hand. There may be a lot of bleeding, a cleanup is not complete and tissue residue, need to operate again, etc.; if the placenta implantation, may be hysterectomy or uterine artery embolization, increasing the chance of infection, etc.. Four years ago, the niece of a director of our hospital, first pregnancy, cleft lip and palate, induced labor in the primary hospital, is the placenta can not come out, transferred to the local Maternal and Child Health Hospital, four doctors on the stage to remove the placenta, can not come out; fortunately, the bleeding is not much. We drove more than 3 hours to the Armed Forces Hospital. We used MTX chemotherapy, stayed for more than 20 days, WBC fell badly, mouth grew a lot of mouth sores, vaginal inflammation is also heavy, there is always watery material from the vagina, a Saturday morning, suddenly hemorrhage, sent to the central operating room, the placenta automatically discharged. 2014, this patient surnamed Liu, natural delivery of a baby girl in our hospital, the third stage of labor went smoothly, the placenta was delivered naturally. This case report was later selected for the Proceedings of the National Annual Meeting of Obstetrics and Gynecology.In 2015, a patient after our hospital, also a first-born baby, the fetus came out, the placenta did not come out, bleeding more, sent to the Interventional Department for bilateral uterine arterial embolization + 40mg MTX, postoperative fever for 3 days, reaching 40 degrees, with several days of ibuprofen, the director was worried that ibuprofen would lead to gastrointestinal ulcers. I found that she was weak, anemic, poor appetite, and gave her Chinese medicine, Angelica peony soup + biochemical soup, added smallpox pollen to kill the embryo, two days to expel the placenta, and there was not a lot of bleeding, and she only stayed in the hospital for 9 days. Of course, there are unsuccessful cases, we received a patient from a rented house, the disc was so tightly adhered that the midwife pulled so hard that the uterus turned out; subordinate doctors sometimes also do this kind of thing. Removing the placenta by hand is a surgical procedure, and there is a separate fee for it. Moreover, the process of removing the placenta by hand is very painful for the mother, easy to bleed, requires expensive strong contractions, antibiotics after delivery, and most of the time, postpartum evacuation of the uterus is required (forceps, Dr. Kuo does ultrasound by himself after removing the placenta by hand and ultrasound-guided evacuation of the uterus). These treatments increase the cost of hospitalization considerably. 9. The use of oxytocin to induce labor is also a very common technique in obstetrics. Patients are asked to sign a consent form upon admission. The use of uterotonin, the following situations may occur: ① induction of labor failed, the use of uterotonin did not work, the stomach pain does not get up, the need for the next day to continue to use, or to increase the dose (once a patient, Jiang, director of the use of uterotonin with 0.5%, the child came out); is generally believed that, the use of uterotonin for 2-3 days, can not be delivery, for the failure of induction, it would be appropriate to use other methods; ② contractions are too dense (contractions more than 4 times in 10 minutes), or contractions too long! contractions too dense (4 contractions in 10 minutes or more), or contractions too long (uterine spasms, more than 1 minute of pain at a time), or contractions too strong and uncoordinated contractions, howling in pain; sustained contractions lead to the uterus can not be fully stretched, the placenta does not get the blood supply, the fetus will be hypoxic embarrassment, fetal monitoring of the deceleration of the fetal heart. Stop the contractions in time, 5 minutes can be relieved, do not be too nervous. The key is, the contraction is gone again, the fetal heart is okay, can you continue to use it: Yes, if the contraction is excessive or insufficient again, it is appropriate to cesarean section; ③ drug allergy, oxytocin allergy, I have not seen, antibiotic allergy, I have seen some. Cesarean section, after the delivery of the placenta, a large number of contractions, antibiotics into the body at once, there may be allergic reactions and cardiovascular kinetic abnormalities. Because of the large doses of oxytocin, can lead to a decrease in heart rate and increase in blood pressure; ④ water and sodium retention, oxytocin has the effect of antidiuretic hormone, resulting in an increase in sodium in the body, can appear edema, weight gain, cardiac burden slightly increased. In our hospital, we use contractions to induce labor, with special guards and infusion pumps, which is very safe. If #2 occurs, the mother herself will be fine if she snaps the clamp on the infusion tube. Pain, caused by contractions, needs to be handled with a mindset of “pain and pleasure”. The patient who had her third child insisted on a cesarean section and was ready to be sent to the operating room; I checked in on her and told her to look around at the group of physicians, and I said, “Look at them, who would be willing to operate on you? No one operated on her, and I said, “Come on, put a balloon in, and have the baby tonight.” As a result, at 19:00, she was standing by the armrests, in some pain, and I laughed at her and said, “Don’t you just wish you were in pain sooner.” She went into labor at 22:45. Another diabetic patient, hospitalized for 4 days, I put her balloon, the next day I was off the night shift, to break her membranes, 11:30 has not been regular contractions, I personally went to talk to get her to sign for the use of oxytocin, 4 hours later, it was born. 10. Neonatal birth injuries; such as brachial plexus nerve injury, clavicle fracture (sometimes hidden fracture, which is only discovered after transferring to the pediatrics department), muscle injuries, etc.; especially in the case of shoulder dystocia in a large child. Most of these cases occur in fetuses with a high body weight. It is recommended to control the weight of the fetus up to 3300 g, which is ideal. Above 3500g, labor becomes difficult and the cesarean section rate increases. Although a significant number of people have successfully delivered children over 8 pounds, it does not indicate that it can also be possible. How big a butt (vaginal and perineal body), how big a baby. A fetus that is too large is itself susceptible to the injuries described above, and is in the womb, subjected to prolonged and excessive compression, leading to brachial plexus injury and fracture tendencies, which may be compounded by forceful delivery of the shoulders during labor. However, it is impossible not to labor the shoulder. The fetal head comes out, but the shoulder can’t come out, and the short neck of the fetus is stuck there. Think about it, is there any other way but to pull outward? Although there is a set of professional techniques to deal with shoulder dystocia, we should not give midwives and doctors a hard time, not everyone can pass the exam in front of the problem. The delivery of a huge child, resulting in a large female pelvic floor birth injury, perineal excision is even larger, difficult to recover after delivery, the quality of sexual life may be affected; serious cases of urethra and bladder may be damaged, urinary difficulties, urinary incontinence, to the age of 40 years old, the tissues of the natural loosening of the cough, the urine will flow, which is why the urology department to do the pelvic floor patch so much reason; postpartum and timely pelvic floor rehabilitation, have a good effect. 11, patients with moderate or severe anemia, prone to hemorrhage; if the anemia is not corrected as soon as possible, Schieffer’s sign can occur, etc., blood transfusion is recommended. See related articles on Guo Peifen’s website. 12, Other: heart failure (early may only manifest as cough), pulmonary embolism, lower extremity venous embolism, may even occur after discharge. The incident of sudden maternal death of a doctoral student of the Chinese Academy of Sciences (CAS) that occurred in January 2016 at the Third Hospital of North Medicine, i.e., rupture of the internal aortic dissection, 3 hours before and after the onset of the disease, is another major event that has affected the whole country, involving the highest level of hospitals in our country, the highest level of knowledge and science and technology in the CAS, involving the official red-head documents, the violence of medical malpractice, and the media’s rights and wrongs. This unfortunate woman, 4 years, experienced all the misfortunes that women suffer for the birth of a child, fetal termination, ectopic pregnancy, premature birth, premature death, pregnancy high signs, and finally a rare disease. All we can say is that she had really bad luck. I just hope that my patients and their families can understand the many “helplessness” in medical treatment, and listen to their physicians in our hospitals, or discuss and communicate with their physicians more often, so that they can finally get a good medical result. Second, the main complications of cesarean section: due to the specificity of medical science and individual differences, in the process of surgery and the emergence of: 1, anesthesia accidents: can appear heartbeat, pager arrest, etc. In fact, on the operating table is more common. In fact, on the operating table, more often seen is sudden hypotension, the patient nausea, vomiting, vomiting very hard and poor, but also particularly dangerous, may be mistakenly inhaled into the airway caused by the chemical necessary pneumonia. 2, the operation side injury: such as the bladder, ureter (especially common in the full vaginal trial of labor and fetal position of the bottom of the cesarean section), intestinal tubes (mostly in the scarred uterus and other abdominal secondary surgery) and other neighboring tissues and organs; postoperative hematuria is very common, that is, the vesicoureteral injuries occurred. 3, bleeding; intraoperative and postoperative bleeding due to a variety of reasons, late postpartum hemorrhage, etc., the need for blood transfusion; after a variety of conservative treatment to control bleeding effect is poor, may have to remove the entire uterus (so far, total hysterectomy is the most complete obstetric hemostasis), etc.; 4, amniotic fluid embolism, DIC (occurrence of a low incidence, but the mortality rate is very high), etc.; postoperative embolism may be embolism/lower extremity venous embolism and death. . The amniotic fluid embolism that occurred in Xiangtan Maternal and Child Health Hospital in 2014 was a big event that educated the nation. The family of this woman in labor, if they had agreed to remove the uterus as early as possible, perhaps she would not have lost her life. Amniotic fluid embolism can occur in early, middle, or late pregnancy; during induced or spontaneous labor; before or after delivery of the fetus; but it has a higher chance of occurring during or after a cesarean section. It is a kind of allergic disease, the amniotic fluid in the coarse particles of the components, into the mother’s blood, to the lungs, blocking the mother’s lungs small blood vessels, the mother does not get oxygen, and then waterfall-like allergic reaction, the disease progresses very quickly, extremely difficult to save. 5, heart failure, convulsions (prenatal, delivery, postpartum) coma, etc.; 6, infected umbilical cord prolapse, fetal distress and even fetal death in utero, etc.; 7, may be preterm, preterm or diabetic pregnant women with a high rate of fetal disease, survival rate is low, and more need to be transferred to the neonatology department, increasing costs; this article is mainly a small number of late maturation of the fetal lung development, the occurrence of wet lung after birth of newborn, clinically referred to as the early full-term baby. 8, near-term complications: postoperative incision healing, the need for two-phase suture; bladder paralysis to urinary retention and so on. Long-term complications include postoperative adhesions, intestinal obstruction, chronic abdominal pain, uterine scar pregnancy and uterine rupture and bleeding (if the placenta happens to grow in the uterine scar when you get pregnant again, it will not be a good color), abnormal uterine bleeding, urinary abnormalities and so on; it is advisable to use contraception for two years after the operation. 9. It is very common for the amniotic fluid to become more fecal-contaminated during labor and delivery, and the doctor needs time to observe and detect it dynamically. If the amniotic fluid fecal staining is serious, the newborn may be asphyxiated, if necessary, transfer to pediatrics for further treatment; clear patients know that there is no obvious signs of fetal cardiac arrest, sudden death occurs, at this time the difficulty of rescue is very great, and the prognosis of the fetus, the newborn is poor, and most of them think that this is related to fetal metabolic disorders, therefore, some of our obstetrics department introduces newborn metabolic disorders screening, the cost of nearly 1,000 yuan, is still very valuable. It is still very valuable. 10. Problems of ligation: very few people can still have intrauterine pregnancy and ectopic pregnancy after ligation; and the ovarian function may decrease in advance and abdominal pain may occur; and infertility or ectopic pregnancy may occur when tubal reversal fails. This article requires the couple’s signature and opinion. 11. Conventional choice of transverse abdominal skin incision; or choose the original incision to re-enter the abdomen (the physician will remove the original scar), the patient can also choose the traditional longitudinal incision to enter the abdomen. In special cases (skin infection, rash, etc.), the surgeon will decide on the incision; in some cases of aggressive placenta previa, the abdominal incision is sometimes about 30cm long, crossing the umbilical chakra. 12. Birth defects in newborns: despite rigorous prenatal examinations such as ultrasound, fetal malformations, especially cardiac malformations, may still exist; some malformations, especially functional abnormalities, may gradually manifest themselves even after birth; 13. Increased fecal staining of the amniotic fluid during delivery is very common and requires time for dynamic observation. If the amniotic fluid fecal infection is serious, leading to neonatal asphyxia and transfer to pediatrics; especially no signs of intrauterine infection and other reasons may lead to no obvious signs of fetal cardiac arrest and neonatal accidents, at this time the difficulty of rescue is very great; premature ablation of the membranes, placenta praevia hemorrhage, prolapse of the umbilical cord and so on, the need for emergency rescue and the difficulty of the great; 14, post-operative analgesia: postoperative continuous analgesia, maintenance of two days or so, at your own expense; Postoperative ordinary pain medication, the cost of a few dollars, the use of too many times may be addictive and pain relief effect is slightly worse; 15, in recent years, the incidence of placenta implantation is on the rise, it is difficult to make a clear diagnosis in the prenatal period; such as intraoperative discovery of placenta implantation, it may be necessary to remove the uterus, the loss of fertility, such as the retention of the uterus will require long-term follow-up after the operation, after the operation, it may be open again to stop the hemorrhage or other treatments; 16, other: the complexity of the current disease is difficult to Early diagnosis, unpredictable accidents, especially life-threatening or disabling accidents, etc. 17. Use of expensive medicines: contraction promoters, hemostatic gauze, anti-adhesion agents, special sutures, etc., should be paid for at one’s own expense. Opinion of the patient and her family: After careful consideration, she strongly requests/agrees to have a caesarean section. The patient is aware of and willing to bear the risks of the above possible accidents and complications. The doctor will try to control the above risks and make every effort to save the patient. If the above happens, the patient understands and cooperates with the treatment and pays the medical fees. In the case of some unavoidable situations (as mentioned above), the incidence is low but the mortality rate is very high. We will do our best to notify the family and hope for the best possible outcome. When there is a sudden change in the condition of the mother or child, the hospital reserves the right to make treatment decisions based on the condition. We ask for the understanding and support of the mother and her family, including understanding of the hospital’s handling of the situation and timely payment of treatment fees. Basically, our department refuses cesarean section without medical indication if the patient and her family insist on it, and the pain during labor can be treated by breathing method or analgesic labor. Opinions of the patient or her relatives and organization: The patient or her relatives are aware of the possible adverse prognosis, accidents and complications that may occur during natural delivery and cesarean section, and agree to the hospital’s medical treatment in accordance with the corresponding diagnostic and therapeutic norms, and perform the signing procedures.