Clinical Study On Vaginal Birth After Cesarean

Objective: To investigate the related influencing factors,condition of delivery and pregnancy outcome on VBAC,to improve the awareness of VBAC by clinicians and provide a certain value reference for clinical practice.Methods: In First Hospital of Lanzhou University from January 2015 to December 2017,there were 57 cases with vaginal birth after cesarean delivery as study group(VBAC group).In contrast,15 cases with a failed trial of labor after cesarean section(TOLAC failure group),According to exclusion standard and inclusion standard,to 1:2 ratio screened 114 cases with elect to repeat cesarean section(ERCS group),and 114 cases by vaginal births with no previous cesarean(VBNC group)as control groups.The clinical data were compared and analyzed with VBAC group.Results: 1.The total 935 women who had only 1 cesarean section and single pregnancy,the incidence of repeat cesarean deliveries was 92.30%(863/935),Among them,the proportion of pregnant women who with simple scar uterine cause was up to 26.10%(244/935),only 7.70%(72/935)women chose to TOLAC.2.Comparison between group VBAC and TOLAC failure group:(1)The single factor analysis of VBAC: past vaginal delivery history,cervical dilatation≥4cm,gestational age≥40w and neonatal mass ≥4000g were significantly different(P < 0.05).(2)Pregnancy outcomes of the two groups: there was no significant difference in neonatal outcome between the two groups(P > 0.05);postpartum hemorrhage,puerperal infection,incomplete uterine rupture,and hospitalization days,the amount of postpartum hemorrhage were significantly different,P < 0.05.3.Comparison between VBAC group and TOLAC failure group:(1)the general situation between the two groups was no statistical difference(P > 0.05).(2)The second stage of labor time in the VBAC group was shorter(P < 0.05),there was no significant difference in the third stage of labor time between the two group;There were significant differences between the two groups in obstetric forceps delivery and perineal lateral incision(P < 0.05).(3)There was no significant difference between the two groups in pregnancy outcomes(P > 0.05).4.(1)There was no significant difference between the two groups in the general situation(P > 0.05).(2)The pregnancy outcomes between VBAC group and ERCS group: the amount of postpartum hemorrhage and hospitalization days were significantly different(P < 0.05).5.The pregnancy outcomes between the ERCS group and TOLAC failure group : postpartum hemorrhage,incomplete uterine rupture rate in TOLAC failure group is higher than the ERCS group,P < 0.05;in complete uterine rupture,puerperal infection and neonatal asphyxia,neonatal NICU,the amount of postpartum hemorrhage and hospitalization days,P > 0.05,there was no significant the differences between the two groups.Conclusion: 1.Most of the pregnant women after cesarean section choose to repeated cesarean section,only 7.7% women chose to TOLAC.2.The success of VBAC is influenced by various factors.3.Compared with VBNC group,the VBAC group has a shorter time and more active intervention at the second stage of labor.In the VBAC group,the uterine contractions were enhanced by artificial rupture of membranes,the use of oxytocin was less.It may be linked to obstetricians’ concerns that the use of oxytocin increases the risk of uterine rupture.4.There was no difference in pregnancy outcome between VBAC and VBNC groups.Compared with ERCS,VBAC has a shorter hospitalization time,less postpartum blood loss,and good maternal outcomes,while TOLAC failure can increase the risk of postpartum hemorrhage,incomplete uterine rupture and other related complications.