The Clinical Analysis Of Vaginal Birth After Cesarean Section

Objective:Cesarean section is a common surgical procedure to solve the difficult labor and obstetric complications in obstetrics.However, over the past twenty years, the rate of caesarean section is higher in China,Showing a trend of abnormal increase。The problem following this is how to choose the mode of delivery for pregnant women with scar uterus.Due to the vast majority of obstetricians and pregnant women worry about the risk of uterine rupture by vaginal delivery, The obstetricians and pregnant women are more likely to choose elective repeat cesarean section(ERCS).Then, the safety of the vaginal birth after cesarean section(VBAC) has become a problem that the obstetricians should be concerned.In this paper, through the analysis of the outcomes of induced labor during Medium-Late Pregnancy of scar uterus and VBAC,To explore the safety and feasibility of VBAC,To analyse the indications and contraindications of trial of labor after previous cesarean delivery(TOLAC),improve the problem of VBAC,establish and perfect the standard procedure for VBAC.Reasonably reduce the rate of caesarean delivery, improve the quality of parturients at labor,ensure the safety of maternal and infant. Methods:This study selected the pregnant women after cesarean section in the Third Clinical College of Zhengzhou University from January 2013 to September 2015, including1:61 cases of induced labor during Medium-Late Pregnancy of scar uterus(Observation Group),randomly selected 72 cases of induced labor during MediumLate Pregnancy of non scar uterus(Control Group). and the clinical data was analysed prospectively.2:Analysis of 96 cases of trial of labor with cesarean section,among them, 78 cases were vaginal delivery(Observation Group).78 cases chosen repeat cesarean section(Control Group1),78 cases of vaginal birth never cesarean section were vaginal delivery(Control Group2), and the clinical data was analysed prospectively,The pregnancy outcome and maternal and infant complications of each group were discussed. Results:1.There was no significant differences in the rate of succeeding induced labor、hospital days 、 Induced labor time 、 blood loss during and after two hours delivery 、curettage rate、soft obstetric canal damage、uterine rupture between the induced labor group and the non scar uterine pregnancy group(P>0.05).2. Analysis of 96 cases of trial of labor with cesarean section,among them, 78 cases were vaginal delivery,the rate of successful trial is 81.3%(78/96).18 cases were converted to cesarean section,secondary uterine atomy5 cases,fetal distress7 cases,active phase arrest2 cases,persistent occiput transverse position1 case, relative cephalopelvic disproportion1 case,Because it’s hard to bear the pain,2 pregnant women divert to cesarean section,1 cases occurred threatened uterine rupture, no uterine rupture occurred.3. The observation group was less than the control group1 in the hospital days and the amount of bleeding,the differences were statistically significant(P<0.05), but there were no significant differences in the blood transfusion, hysterectomy,the weight of infants, Apgar score, asphyxia neonatorum、hysterectomy,threatened uterine rupture(P>0.05).4. There were no significant differences in the hospital days,blood loss during and after two hours delivery,blood transfusion, labor duration, perineum section,the weight of infants, Apgar score, asphyxia neonatorum(P>0.05). Conclusions:1. Whether the women with uterine scar pregnancy induced labor or delivery women with uterine scar,vaginal delivery is a reasonable choice for most of them.Because of the fear of uterine rupture,it is blind to choose cesarean section.2. In order to reduce the risk of vaginal delivery,we should strengthen the publicity and education of pregnancy management,setting up the high-risk clinic about pregnancies with uterine scar.As long as strictly grasp the indications and contraindications of vaginal delivery,carefully evaluate the factors influencing the success of vaginal delivery,elect the appropriate method of induced labor and oxytocin,it is possible to ensure the safety of vaginal delivery.3. To promote natural childbirth of pregnant women with scar uterus has important significance to reduce the rate of cesarean section, to improve the quality of obstetric work.