The Clinical Analysis Of Trial Of Labor After Cesarean Section

Objective To study the feasibility and safety of trial of labor after cesarean section(TOLAC).Methods 124 cases of the pregnant women who desire a vaginal delivery were recruited between January 2015 and December 2017 from Qilu Hospital of Shandong University.The cases consisted of 111 cases with successful TOLAC(including 31 cases with term labor,35 cases of premature labor,45 cases of induced labor)and 13 cases with failed TOLAC.Patients with term labor were divided into two groups,patients with successful TOLAC(31 cases)and those with elective repeat cesarean delivery(13 cases).Patients with premature labor udergoing a successful TOLAC were divided into two groups,patients with obstetrics complication(25 cases)and simple premature labor group(10 cases).Patients with induced labor udergoing a successful TOLAC were divided into two groups,induced labor were done for maternal factors(24 cases)and fetal factors(21 cases).The purpose of this document is to review the influence factors of TOLAC in patients with term labor and to study the feasibility and safety of TOLAC in different populations such as term labor,premature labor,induced labor.Results1.The overall successful rate of TOLAC was 89.5%,of which the rate was 70.5%in patients with term labor.The reason of failed TOLAC in patients with term labor are as follows,pain during parturition,doctors' intervention,fetal distress,abnormal amniotic fluid,persistent occipital posterior position,incomplete uterine rupture.2.For patients with term labor attempting TOLAC,there was statistical significnace in BMI,vaginal delivery,spontaneous labor,and postpartum days of hospitalization between the successful group and the failed group(P<0.05).There was no significant difference in age,gestational age,hemorrhage at birth,neonatal Apgar score,and uterine rupture(P>0.05).3.For patients with premature labor udergoing a successful TOLAC,Apgar score was 8.4±2.4 points in obstetric complications group,while the counterpart in simple preterm group was 9.7±0.5.The difference between the two groups was statistically significant(P<0.05).There was no significant difference between the two groups in age,gestational age,perineal incision,intrapartum hemorrhage,and postpartum days of hospitalization(P>0.05).4.For patients with induced labor udergoing a successful TOLAC,the gestational age,BMI of maternal factors group were 30.8±2.7 weeks,29.7±2.9 Kg/m2,while the counterpart in fetal factors group were 33.4±3.7 weeks,27.0±3.6 Kg/m2 respectively.There was significant difference between the two groups(P<0.05).There was no statistical significance between the two groups in the history of vaginal delivery,the amount of blood loss and postpartum days of hospitalization(P>0.05).Conclusions1.The history of vaginal delivery and spontaneous labor are favorable to a successfulTOLAC for patients with term labor.High BMI and non-medical factors(patients'lack of strong intention and doctors' intervention)are unfavorable factors.2.The was no significant difference except postpartum days of hospitalization between the patients with term labor udergoing successful TOLAC and the failed one.More patients should be given the opportunity to attempt TOLAC.3.As for the maternal outcomes from VBAC in patients with premature labor,there is no statistical significance in patients with obstetrics complication or not.The difference in Apgar score was statistically significant4.The maternal outcomes from VBAC in Patients with induced labor for maternal factors are similar to those for fetal factors.