A Clinical Analysis On The Surgical Indications And Delivery Outcome In The Transition From Failed Vaginal Trial Production To Cesarean Delivery

Objective:Based on a five-year span clinic data of the surgical indications and delivevery outcome in the transition from failed vaginal trial production to cesarean delivery in the affiliated hospital of Yanan University,this paper analyzes the ratio changes of the surgical indications in the transition from failed vaginal trial production to cesarean delivery,comparing the influence on delivery outcome when transferring to cesarean delivery at different stages of labor,and in this way provides theoretical evidence for adopting effective intervention measures and selecting the best transferring time so as to decrease the rate of failed vaginal trial productions that transferring to cesarean delivery and improve poor delivery outcomes.Method:Here we select 34777 cases of pregnant women in the affiliated hospital of Yanan University from January 1,2012 to December 31,2016 and take the 843 cases of failed vaginal trial production that transferring to cesarean delivery as clinical research objects to have a retrospective analysis on the transform rate to cesarean delivery,surgical indications in the transition and the influence on delivery outcomes when transferring at different stages of labor.Results:1.The total number of delivery increased year by year from 2016 to 2012.The cesarean rate in 2013 was 53.13% which was the highest;the lowest was 40.89% appeared in 2015,and the average cesarean rate was 45.88%.The transform rate to cesarean delivery in 2012 and 2016 was 5.24% and 3.56% respectively,which presented a decline trend,and the difference has statistical significance(P= 0.000).2.During the 5 years,fetal distress was the first or second surgical indication for transferring to cesarean delivery;abnormal labor stages,which once was the first,turned to be the third indication;social factors were always in the third or fourth;relative cephalopelvic disproportion climbed from the forth to the second and there were no position changes for other indications.3.Pregnant women who transferred to cesarean delivery at the second labor stage present obviously higher rates of fetal head delivery difficulty,uterus incision extension,weak uterine contraction,postpartum hemorrhage,postoperative fever,abdominal incision infection than those transferred at the first labor stage and the difference has statistical significance(P < 0.05).4.The birth asphyxia rate of those transfer at the second labor stage is significantly higher than those at the first labor stage and the difference has statistical significance(P < 0.05).Conclusion:1.The total rates of cesarean delivery and failed vaginal trial production transferring to cesarean delivery are declining,but still at a higher level.2.The fetal distress is one of the important surgical indications of the transition,and the indication of relative cephalopelvic disproportion is on the rise.When vaginal trial production fails and transfers to cesarean delivery,we need to pay close attention to fetal distress and relative cephalopelvic disproportion.3.The rate of mother-infant complications is higher when transferring to cesarean delivery at the second labor stage than at the first labor stage,therefore,try to avoid transferring at the second labor stage.If the transfer has to be done at the second labor stage,we shall strengthen the measures to prevent postpartum mother-infant complications.4.Strengthen the management of pregnancy,childbirth;strictly supervise the indications of transition to cesarean delivery and detect,diagnose and treat abnormalilities during labor stages early.Try our best to reduce the transform rate to cesarean delivery and improve poor delivery outcomes.