A Clinical Analysis And The Discussion On High Risk Factors Of Conversion To Cesarean Section During Vaginal Trial Production

Objective To analyze the causes of cesarean section in vaginal trial production,and to compare the effects of cesarean section on mother and child in different labor stages.The patients who were converted to cesarean section during vaginal trial production were compared with those who had successful vaginal trials in the same period to find out the high risk factors of cesarean section in vaginal trial production.Methods A total of 247 cases,as a research group,was collect in obstetrics department in Anhui Maternal and Child Health Hospital from June 2018 to December 2018.These cases with term-pregnant,single-birth,and cephalic presentation have a willingness to vaginal trial production and can be tested for vaginal trials in the third trimester or at the time of labor,after a high-year asset doctor’s assessment,but the final trial yield is transferring cesarean section.Collect the complete case information of cases and analyze the general information,labor process,indications of cesarean section transfer,maternal and fetal outcomes.In addition,according to the study group: the control group= 1:1 ratio randomly selected the same period of term-pregnant,single-birth,and cephalic presentation,vaginal trial will,and in the third trimester or at the time of labor after senior asset physician evaluation can be carried out vaginal trial,the final outcome of vaginal delivery was 247 cases.The age,gestational age,height,parturient BMI,neonatal sex,neonatal weight,onset of labor,integrity of fetal membranes and amniotic fluid characteristics of the two groups were analyzed by univariate analysis.Variables with statistical significance were selected and analyzed by Logistic regression model of binary variables.The OR values of each variable were calculated,and the risk factors or protective factors were judged.Result1.Among the women who failed vaginal trial production,84.2%(209/247)of the cesarean section in the first stage of labor and the primary three indications for cesarean section were: fetal distress(43.0%,90/209),relative head stagnation(22.9%,48/209),abnormal labor(11.4%,24/209);15.8%(38/247)of women with cesarean section in the second stage of labor,the primary three cesarean indications are: relative head stagnation(39.4%,15/38),the persistent occipital(post)position(36.9%,14/38),fetal distress(21.1%,8/38).General data of patients with cesarean section during different labor periods:age,gestational age,height,parturient BMI,neonatal birth weight,intraoperative blood loss were not statistically significant(P>0.05).2.When transferring to cesarean section in the second stage of labor,the probability of uterine incision,prolonged use of antibiotics,puerperal infection,and intestinal obstruction respectively were 10.5%(4/38),23.6%(9/38),15.7%(6/38),10.5%(4/38),which were higher than 1.9%(4/209),9.5%(20/209),5.2%(11/209)2.8%(6/209)in the first labor,and the difference was statistically significant(P<0.05).Urinary retention,postpartum hemorrhage,neonatal light/severe asphyxia,and neonatal to NICU rates in the first and second stages of labor respectively were 2.3%(5/209),2.3%(5/209),1.9%(4/209,0.9%(2/209)and 5.2%(2/38),7.8%(3/38),2.6%(1/38),2.6%(1/38),and the difference was not statistically different(P >0.05).3.Univariate analysis of cesarean section of failed vaginal trial delivery and vaginal delivery showed that the age of pregnant women,gestational age,parturient BMI,neonatal weight,amniotic fluid nature,induction of labor,premature rupture of membranes were difference statistically(P<0.05).Subsequently Logistic regression analysis showed that age ≥35 years(OR=3.633,95%CI 1.554-8.497,P < 0.01),gestational age ≥41 weeks(OR=1.981,95%CI 1.127-3.483,P < 0.05),parturient BMI≥30kg/m2(OR=5.511,95%CI 3.204-9.481,P < 0.01)and neonatal weight≥4000g(OR=3.274,95%CI 1.532-6.996,P < 0.01)and premature rupture of membranes(OR=1.923,95%CI 1.158-3.194,P<0.05)were risk factors of transferring to cesarean section in vaginal trial production.Conclusion1.Fetal distress,relative head stagnation are the main reasons of transferring to cesarean section during vaginal trial production.It is necessary to strengthen the strict grasp of these indications in clinical practice,avoid over-diagnosis and reduce cesarean section rate.2.It will increase the rate of materal-child complications when transferring to cesarean section in the second stage of labor,we need to solove abnormal conditions actively,avoid trial production invalidly and transfer to cesarean section appropriately.When transferring during the second stage of labor,it is necessary to prevent the occurrence of puerperal infection and intestinal obstruction,and recommended to prolong the use of antibiotics.3.Advanced age,BMI ≥ 30kg/m2,macrosomia,extended pregnancy and premature rupture of membranes are the risk factors for transferring to cesarean section in vaginal trial production.