Analysis On The High-risk Factors Of Delivery Women With Conversion From Vaginal Trial-birth To Cesarean Section During The Intraspinal Delivery Analgesia

ObjectiveTo explore the risk factors of conversion from trial of vaginal labour by intraspinal analgesia to cesarean section.MethodsThe clinical data of 989 delivery women with intraspinal analgesia in Qing Dao Women and Children’s Hospital from August 2020 to February 2021 were retrospectively analyzed,Ninety-two women who were transferred to cesarean section after vaginal trial labor failure were selected as the cesarean delivery section(Cesarean Delivery,CD)group,and 276 women who were randomly selected as the vaginal delivery section(Vaginal Delivery,VD)group during the same period under spinal analgesia.Related clinical indices were compared between the two groups.Results1、The incidence of cesarean section through vaginal trial delivery was 9.3%.2、The perinatal BMI,perinatal gestational weeks,times of labor,uterine orifice during size analgesia,fever during analgesia,fetal weight,times of additional drugs in section group were compared to those of vaginal delivery group,there were statistically significant differences(χ~2=37.80,t=-4.60～37.80,P<0.05).The age,pregnancy complications,analgesic methods of two groups were compared,there were no statistically significant differences(P>0.05).The multivariate logistic regression analysis showed that fever during analgesia(OR=4.815,95%CI=2.394～9.686,P<0.001),fetal weight(OR=1.001,95%CI=1.001～1.002,P<0.001),times of additional drugs(OR=2.233,95%CI=1.134～4.400,P=0.020),the times of labor(OR=0.284,95%CI=0.150～0.537,P<0.001),and uterine orifice during size analgesia(OR=0.740,95%CI=0.554～0.989,P=0.042)were the related factors of conversion from vaginal trial-birth to cesarean section during the intraspinal delivery analgesia.3、The risk factors of transition from vaginal trial labor to cesarean section under Conbined spinal-Epidural anaesthesia(CSEA)were fever during analgesia(95%CI=3.09～18.28,P<0.001),abnormal fetal heart rate after analgesia(95%CI=3.58～119.68,P<0.001),and times of additional drugs(95%CI=1.56～11.80,P=0.01).The risk factor for Epidural Analgesia(EA)was fever(95%CI=2.10～18.87,P<0.001).Conclusion1、The fever during analgesia,fetal weight and times of additional drugs are the risk factors of conversion from vaginal trial-birth to cesarean section during the intraspinal delivery analgesia,the times of labor and uterine orifice during size analgesia are the protective factors.2、Fever during analgesia,abnormal fetal heart rate after analgesia,and times of additional drug are the risk factors for the transition from vaginal trial labor to the cesarean section under combined lumbar and epidural analgesia;fever during epidural analgesia is a risk factor for transvaginal trial labor to cesarean section.3、In clinical practice,labor management should be strengthened,early identification of risk factors of intraspinal labor analgesia through vaginal trial labor to cesarean section should be done,and corresponding preoperative preparation should be done to ensure the safety of mother and baby.