Inlfuence Of The Outcomes Of The Maternal And Infant Coming From Social Factors Cesarean Section And Vaginal Delivery

ObjectiveThe aim of the study was to compare the outcomes of maternal and infant in socialfactors cesarean section and vaginal delivery, in order to find the difference between thetwo deliveries.ObjectFull-term nulliparous women in2010January to2011December were retrospectivelyanalyzed, excluding abnormal pelvis, test-tube baby, macrosomia, abnormal volume ofamniotic fluid, fetal growth restriction, fetal malformation, placenta previa, placentalabruption, elderly primipara, hypertensive disorders in pregnancy, gestational diabetesmellitus, premature rupture of membrane, cesarean section of dystocia, cesarean sectionand hysteromyomectomy at the same time, uterine malformation and pregnant womenwith other medicine and surgical diseases. There were161cases in cesarean sectiongroup and195cases in vaginal delivery group.MethodRecords of pregnant women were collected, such as general records, the amount ofbleeding in2hours of postpartum, breast-feeding in3to5days after postpartum,prenatal complications, blood transfusion. Neonatal sex, birth weight, the character ofamniotic fluid and Apgar score, neonatal jaundice, neonatal pneumonia, days andexpense of hospitalization were also noted. In1to3years, the duration of breast-feeding, the time of re-menstruation, dysmenorrheal, menstrual cycle and theamount of menses, abdominal pain, abnormal outcome of pregnancy，chronic pelvicpain，pain of postoperative incision and urinary incontinence were followed up.Thefrequency of upper respiratory tract infection about infant within half a year and thetimes of pneumonia were recorded.According to the age, parity, gestational age, days and expense of hospitalization, thegeneral conditions of cesarean section and vaginal delivery was compared. According tothe injury of operative and postoperative, the amount of bleeding in2hours ofpostpartum, the incidence of postpartum hemorrhage, breast-feeding in3to5days afterpostpartum, postnatal urinary retention and healing of knife-edge, the difference of3to5days of postpartum between the two groups could be found. According to the sex ratioof newborn, birth weight, the character of amniotic fluid and Apgar score, neonataljaundice and neonatal pneumonia, the birth condition of neonatal of cesarean sectionand vaginal delivery was compared. According to the duration of breast-feeding, time ofre-menstruation, dysmenorrheal, menstrual cycle and the amount of menses, abdominalpain，chronic pelvic pain，incision pain of postoperative, urinary incontinence, thedifference of1to3years of postpartum between the two groups was compared.According to the frequency of upper respiratory tract infection about infant within half ayear, the times of pneumonia, the constitutions of children between cesarean section andvaginal delivery was preliminary estimated. The collected data were analyzed bySPSS17.0software. Data was measured by using K-S test of single sample. If dataaccords with normal distribution, it would be expressed in X±s. The difference wascompared by independent samples t test. If data was non-normal distribution, it wouldbe represented by the median, twenty-fifth and the seventy-fifth percentile.Non-parametric rank sum test (Mann-Whitney) was used to find the differencesbetween the two groups. Count data was compared by chi-square test. When P<0.05 means the difference was statistically significant.Results1. Comparison of the general situations of pregnant women.Two groups of pregnant women were primipara, had no Significant differences inmaternal age and gestational age (P>0.05). Hospitalization days and hospitalizationexpenses in cesarean section group was significantly higher than that of vaginal deliverygroup, the difference was statistically significant (P<0.0001).2. Vaginal delivery.There were189cases of normal delivery. Vacuum extraction was used in5cases (2.5%).There was1case (0.5%) of low forceps. There were173cases the amount of bleedingin2hours of postpartum between100ml and250ml,15cases between250ml and400ml (including2cases more than500ml in24hours),7cases more than400ml. Themain complications of postpartum hemorrhage were9cases (5.6%). The incidence ofplacental abruption, vagina and perineal laceration were low.3. Social factors cesarean section.The average duration of operation was34.6minutes. There were79cases the amount ofbleeding in2hours of postpartum between100ml and250ml,78cases between250mland400ml,4cases more than400ml.There were4cases of postpartum hemorrhage(2.5%). Forceps was used in1case. There was1cases of ligament injury of anesthesiapuncture.4. Comparison of the main complications of intrapartum and postpartum in3-5day.The amount of bleeding in2hours of postpartum of vaginal delivery was significantlylower than that of social factors cesarean section, the difference was statisticallysignificant (P<0.0001). The incidence of postpartum hemorrhage of vaginal deliverygroup was slightly higher than social factors cesarean section, but the difference was notstatistically significant (P=0.286). The difference of start time of breastfeeding betweenvaginal delivery and social factors cesarean section was statistically significant (P<0.0001); vaginal delivery group was shorter. The proportion of sufficient breast milkin vaginal delivery group was higher than that of social factors cesarean section, thedifference was statistically significant (P<0.0001). The proportion of moderate amountsof milk in Social factors cesarean section group was higher than that of vaginal deliverygroup, the difference was statistically significant (P<0.0001). There was no significantdifference in the proportion of small amount of breast milk between the two groups. Thetwo groups had no significant difference in the urinary retention and damage etc.5. Comparison of main complications of postpartum1-3years.The time of re-menstruation in Social factors cesarean section group was longer thanthat of vaginal delivery group, the difference was statistically significant (P=0.029). Theproportion of menstrual flow decreased in cesarean section group is much higher thanthat of vaginal delivery group, the difference was statistically significant (P<0.0001).The incidence of postpartum urinary incontinence in vaginal delivery group was higherthan that of Social factors cesarean section, the difference was statistically significant(P=0.019). The incidence of the prolongation of menstrual period in cesarean sectiongroup was higher than that of vaginal delivery group, the difference was statisticallysignificant (P=0.03). There was no significant difference between the two groups in theduration of breast-feeding, dysmenorrheal obviously lightening, the pain of incision andthe incidence of abnormal pregnancy.6. Comparison of newborn at birth and in3to5days of postpartum.The weight of neonatal in Social factors cesarean section group was higher than that ofvaginal delivery group, the difference was statistically significant (P=0.001).There wasno significant difference in the sex ratio of newborn between the two groups. Theincidence of II degree of meconium-stained in vaginal delivery group was significantlyhigher than that of social factors cesarean section group, the difference was statisticallysignificant (P=0.008). The incidence of III degree of meconium-stained in vaginaldelivery group was also significantly higher than that of social factors cesarean section group, the difference was statistically significant(P=0.001). Apgar scores In1minutes,5minutes,10minutes had no significant difference between the two groups. Theincidence of neonatal jaundice in cesarean section of social factors was higher than thatof vaginal delivery. The difference was statistically significant (P=0.012).There was nosignificant difference between the two groups in neonatal pneumonia.7. The comparison of the situation of children (1-3years old).The incidence of upper respiratory infection and pneumonia were compared. There wasno significant difference between the two groups.Conclusion1. Social factors cesarean section increased the economic burden of society and families,added the amount of bleeding of maternal in2hours of postpartum, affected thesecretion of colostrum and early breast-feeding, increased the incidence of neonataljaundice, to harm the health of maternal and neonatal.2. Social factors cesarean section was one of the main factors of menstrual flowdecreased and the prolongation of menstrual period of maternal, effected the quality oflife of maternal.3. Social factors cesarean section was one of protective factors of postpartum urinaryincontinence. There was no obvious influence in pneumonia in infants and youngchildren.