With the imminent implementation of China’s comprehensive “two-child” policy, many patients with scarred uterus and advanced pregnancy have significantly increased the risk of re-pregnancy, and the risk of serious complications such as scarred pregnancy, uterine rupture and placental implantation has increased, which seriously endangers the safety of mother and child and poses a great challenge to medical workers. It is worthwhile for medical workers to further consider and take corresponding measures on how to deal with the problems brought about by the second pregnancy, reduce the incidence of maternal and perinatal complications and mortality, and ensure the safety of mother and child. In recent years, the rate of cesarean delivery in China is extremely high, and the risk of re-pregnancy in patients with scarred uterus depends mainly on the healing of the uterine incision, the interval between pregnancies and the location of the gestational sac. If the fertilized egg is implanted in the uterine scar after cesarean section, it is necessary to fully explain to the patient and her family that continuing the pregnancy increases the risk of uterine rupture, hemorrhage and hysterectomy, and it is recommended to terminate the pregnancy as soon as it is clearly diagnosed. Note that there are many ways to terminate a scarred pregnancy, but all carry the risk of failure and hemorrhage and must be done on the basis of active preparation. If some patients insist on choosing to continue the pregnancy due to various self or social and family factors, it may develop into an aggressive placenta praevia, which is often combined with placental implantation, increasing the risk of hemorrhage during labor, disseminated intravascular coagulation (DIC), hysterectomy, infection and peripheral organ damage, which seriously endangers the safety of mother and child. Hypertensive disorders in pregnancy are very common, especially in older women, and are a major cause of maternal and perinatal death because they are often combined with obstetric hemorrhage, infection, and convulsions. Currently, according to the international classification, hypertensive disorders in pregnancy are collectively referred to as gestational hypertensive syndrome. Hypertension often appears after 20 weeks of gestation, while late pregnancy is prone to placental abruption, cerebrovascular accident, hypertensive heart failure in pregnancy, acute renal failure, HELLP syndrome, disseminated intravascular coagulation, and eclampsia. If the condition worsens, the pregnancy should be terminated as soon as possible to avoid the deterioration of the condition and the safety of the mother and fetus, and pay attention to the timing and mode of termination of pregnancy. 3. The risk of fetal chromosomal abnormalities increases in older pregnant women In view of the special national situation in China, after the liberalization of the separate two-child policy, some pregnant women who are pregnant again are older, most of them are over 35 years old, or even over 40 years old. The risk of chromosomal abnormalities in fetuses is significantly higher in older pregnant women, and the risk of fetal developmental abnormalities is even higher in older pregnant women because they have a low chance of conception and need to use assisted reproductive technology. As a high-risk group for fetal chromosomal aneuploidy screening, elderly pregnant women need to understand the importance of prenatal screening and prenatal diagnosis, and standardize prenatal examination. 4. Issues related to thyroid disease in pregnancy The incidence of thyroid disease has been increasing in recent years. Abnormal thyroid function can cause endocrine and immune disorders in women of childbearing age, resulting in irregular menstruation, excessive menstrual bleeding or amenorrhea, disruption of the programmed cycle of ovulation, and a drastically reduced chance of conception. If the thyroid gland is hypothyroid, the next generation is prone to mental retardation and short stature and must be supplemented with thyroid hormones to normal levels before pregnancy can occur. For hyperthyroidism, if the hyperthyroidism is not under normal control before pregnancy, pregnancy is also dangerous for the fetus, which may cause miscarriage or low weight; if the hyperthyroidism is under normal control, it is relatively safe to get pregnant with minimal or no dosage. Although it is not recommended to take anti-hyperthyroidism drugs during pregnancy, pregnancy can be attempted. 5, about gestational diabetes mellitus Pregnant women who are overweight or even obese due to poor weight recovery after the first pregnancy, those who have a history of abnormal glucose tolerance and polycystic ovary syndrome, those who have a family history of diabetes mellitus, those who have a history of unexplained stillbirth, stillbirth, miscarriage, huge baby delivery, fetal malformation and excessive amniotic fluid are more likely to suffer from gestational diabetes mellitus. -Once you have gestational diabetes, it has a particularly strong impact on the pregnant woman and the fetus. Not only are you prone to huge babies, underdeveloped fetuses, poor brain development, delayed lung development and delayed heart development, but you are also prone to stillbirth and clinical neonatal hypoglycemia. Not only that. Once a pregnant woman suffers from gestational diabetes, if she is not treated in time and does not do a good job of lifestyle intervention and control, it is easy to evolve into type 2 diabetes, and it is difficult to recover. 6, polycystic ovary syndrome Many women do not necessarily have polycystic ovary syndrome when they have their first child, but as they age, the pressure of work and life and other fast-paced life, coupled with the impact of diet, often lead to a long-term body in an acute or chronic stress state, which can lead to ovarian dysfunction, which is one of the reasons for polycystic ovary syndrome. The causes of infertility in polycystic ovary syndrome are insulin resistance and the inability of the ovaries to ovulate, which affects the normal menstrual cycle. Therefore, if you take measures to prepare for pregnancy but are unable to conceive, you can visit the endocrinology department to find out if polycystic ovary syndrome is the cause. 1. Pre-conception evaluation and standardized prenatal examination: Patients with high-risk factors need to fully evaluate the risk of re-pregnancy before pregnancy, and for those who are suitable for re-pregnancy, the following points should be noted: (1) Targeted examination of blood pressure, blood sugar, thyroid function, gynecological diseases and other high-risk factors. (2) To guide the pregnant women to have a reasonable diet and exercise during pregnancy, to control the weight gain, to prevent the occurrence of huge babies and GDM, and to recommend a reasonable range of weight gain during pregnancy according to BMI. (3) For patients with scarred uterus, the first ultrasound examination in early pregnancy should pay special attention to the healing of the uterine scar and the relationship between the position of the gestational sac and the uterine scar; in mid- and late-pregnancy, the ultrasound follow-up should pay attention to the position of the placenta and the presence of abnormalities such as placenta praevia and placental implantation, so as to make early diagnosis and prevent the occurrence of hemorrhage during labor. (4) To screen for fetal chromosomal abnormalities, pregnant women can undergo ultrasound examination in early pregnancy (11-13+6 weeks) to measure fetal nuchal translucency thickness (NT), and in high-risk cases, chorionic villus biopsy or amniocentesis is feasible, or ultrasound examination in mid-pregnancy to check whether there is any variation of normal fetal anatomical structure. (5) For screening of fetal structural malformations, fetal systemic ultrasound screening (3D ultrasound) is recommended from 18 to 24 weeks of gestation to screen for serious fetal malformations. 2.Strengthen monitoring of high-risk pregnant women: Establish a complete preconception consultation, dietary guidance, pregnancy monitoring and multidisciplinary cooperative diagnosis and treatment system for GDM, and improve the preconception and pregnancy diagnosis and referral system for patients with high-risk pregnancy such as hypertensive disorders in pregnancy, aggressive placenta praevia and preterm delivery, in order to promote the improvement of perinatal outcome of high-risk menstrual mothers. Electronic fetal heart monitoring and ultrasound are important tools for late pregnancy detection in high-risk pregnant women, and umbilical artery Doppler waveform reflects the placental blood supply status, which can be used to monitor the presence of intrauterine hypoxia and other abnormalities in the fetus of high-risk pregnant women during pregnancy. (1) For pregnant women with a history of diabetes mellitus and GDM, a multidisciplinary cooperation platform of obstetrics, endocrinology and nutrition is established to guide pregnant women to have a reasonable diet and self-glucose testing. Strict control of blood glucose before and during pregnancy can reduce the incidence of giant babies, obstructed labor, stillbirths and fetal malformations. (2) When re-pregnant high-risk patients with a history of hypertensive disease in pregnancy, chronic hypertension and chronic kidney disease, pay attention to pre-pregnancy assessment of the patient’s general condition and the presence of other complications, guide reasonable rest and diet, limit excessive weight gain, strive for early prevention, early detection and early treatment, and improve perinatal outcomes. (3) If the scar uterus is combined with placenta praevia, the antenatal ultrasound examination should clarify whether the placenta implantation is combined with placenta implantation. For such high-risk pregnant women, individualized management should be determined and implemented according to the condition of the patient and the fetus, with adequate preoperative preparation, multidisciplinary consultation, large amount of blood preparation, detailed communication with the patient and family, full explanation of the risks of hemorrhage and hysterectomy, and timely cesarean section Terminate the pregnancy to ensure the safety of mother and child. 3. Choice of delivery method: For pregnant women with non-scarred uterus, no contraindications to vaginal delivery, and no signs of labor at >41 weeks of gestation, labor can be induced by appropriate methods based on verification of gestational age and enhanced monitoring. In cases with obstetric indications, delivery by cesarean section is performed. Many women who have undergone cesarean section because of tubal ligation have increased complications. The advantages of vaginal delivery and the complications of cesarean section should be fully explained to patients to avoid cesarean section for women who do not have indications for cesarean section because of the need for one-time tubal ligation. Although women are more responsible for the birth of their children, childbirth cannot be achieved without a “male-female match”. As society develops and industrialization accelerates, factors such as work stress, environmental pollution and sexually transmitted diseases have led to a yearly decline in human fertility. Therefore, for fathers-to-be who wish to have two children, in addition to a balanced diet, exercise, smoking and alcohol cessation and other pre-conception preparations, it is also recommended to conduct a fertility assessment. 1, semen routine examination This is the most basic and important clinical indicator to determine male fertility, the parameters about semen is the first thing physicians need to know, male friends should pay attention to: 3-7 days after intercourse examination, it is best to use the masturbation method to take specimens, to be able to ensure that all the semen is obtained, if necessary, can be rechecked 1-2 times in 2 weeks. 2.Blood test Blood test such as routine blood, liver and kidney function, blood sugar, blood lipid and thyroid hormone can help to detect certain systemic diseases that may have an impact on fertility. 3.Seminal plasma biochemical examination Analysis of the chemical composition of seminal plasma can help to understand the function of epididymis, prostate and seminal vesicle glands. If the patient has low semen volume, azoospermia, oligospermia, unexplained decrease in sperm motility, congenital defects of the accessory gonads and diseases of the accessory gonads, the seminal plasma biochemical examination can be performed, commonly including fructose, carnosine, acid phosphatase, etc. 4, microbiological examination male urinary and reproductive system infections often lead to male infertility, and male urinary and reproductive system infections related to pathogenic microorganisms are bacteria, viruses, spirochetes, mycoplasma, chlamydia, etc., commonly gonococcus, papillomavirus, adenovirus, Chlamydia trachomatis, etc. 5, endocrine examination related to male Reproductive endocrine dysfunction affects male sexual and reproductive function, and is an important cause of male infertility. Genetic tests related to male infertility The normal chromosomes and genes of men are the basis for maintaining normal reproductive function, and abnormal chromosomes and genes can lead to abnormal sexual differentiation and/or sperm production disorders, thus seriously affecting reproductive function. Therefore, it is very important to do chromosome and gene examination for existing sex differentiation abnormalities or other genetic defects, azoospermia and severe oligospermia, family history of genetic diseases, and habitual abortion couples. 7, prostate fluid examination Prostatitis can lead to male infertility. The prostate fluid examination can provide the diagnosis of prostatitis according to 8, the reproductive system ultrasound According to the physical examination and semen analysis, considering the combination of varicocele, cryptorchidism, tumor, syringomyelia, vas deferens obstruction, etc., ultrasound testing can be performed, including scrotal ultrasound and transrectal ultrasound. In the psychological aspect, it is also a part that should not be neglected. A family that needs to add a new family member should be prepared psychologically accordingly. A few points need to be noted. If the patient has psychosomatic problems, it is best to consider pregnancy after 2 years of stabilization. This is because endocrine changes can cause a relapse of the disease. Secondly, for patients with previous psychosomatic problems, it is best to see a psychiatrist for evaluation before deciding. If there are amenorrhea problems, treatment with bromocriptine is not recommended and can lead to relapse. Men who have difficulty quitting smoking and drinking on their own, women who have insomnia and anxiety, and older children who are unacceptable to their parents for having another child can go to the psychology department for consultation. As mentioned above, the implementation of the “two-child policy” will pose a great challenge to medical professionals. In view of the high-risk factors in the process of re-pregnancy for pregnant women of advanced age and scarred uterus, medical workers should increase publicity, correctly assess the risk of re-pregnancy, take appropriate precautions, cooperate in inter-departmental teams, improve the ability to treat critical obstetric cases, reduce the incidence of maternal and perinatal complications and mortality, reduce the occurrence of neonatal defects, and improve the quality of neonatal births.