A Study On Influencing Factors Of Vaginal After Cesarean & The Application Effect Of Labor Analgesia During Vaginal Delivery After Cesarean Section

Part ?.A study on influencing factors of vaginal birth after cesareanObjective To explore the occurrence and influencing factors of vaginal birth after cesarean,so as to provide measures for improving the success rate of delivery.Methods 249 pregnant women with vaginal birth after cesarean were selected from July 2014 to February 2017,multifactorial logistic stepwise regression analysis was used to explore the influencing factors.Results Logistic stepwise regression analysis showed that vaginal birth after cesarean was significantly affected by myometrial thickness of lower segment of uterus,doula,Spontaneous labor,from the previous cesarean section time and history of vaginal births(all P< 0.05).Conclusion Myometrial thickness of lower segment of uterus,doula,Spontaneous labor,from the previous cesarean section time and history of vaginal births are influencing factors for the success rate of vaginal birth after cesarean.Part ?.The application effect of labor analgesia during vaginal delivery after cesarean sectionObjective The impact of intraspinal anesthesia for labor analgesia on trial of labor after cesarean is investigated by analyzing the observations from 249 pregnant women.The data was collected about the time of delivery,analgesic effect,24 hours after delivery bleeding volume,childbirth outcome,indications for cesarean section,using oxytocin,neonatal Apgar score,postpartum related adverse reactions during labor and delivery,postpartum satisfaction,postpartum lactation start time and postpartum 24 h lactation.Methods 249 pregnant women are selected from xx Maternal and Child Health Hospital from July 2014 to February 2017.They all understood their rights and signed the observed consent forms.When the subjects of observation began regular contractions,they were sent into the labor room and reviewed the psychological questionnaire related to the research.Based on the needs of analgesia,the subjects are separated into the analgesia group where 134 subjects received analgesia routine,the control group where 115 cases didn?t receive analgesia routine.The maternal-controlled sufentanil combined with ropivacaine and spinal-epidural block labor analgesia was used as the analgesic method.The analgesic effect by the VAS method when the cervix dilatation of the subject is 1cm ~ 3cm and 8cm ~ 10 cm,and the motor nerve block by postpartum analgesia maternal line bromage score were determined by the anesthesiologists.They were also responsible for dealing with side effects after anesthesia,such as headache,nausea,vomiting,hypotension,fever,itching.All these as well as delivery mode,indications for cesarean section,delivery time,postpartum hemorrhage,using oxytocin and neonatal score were recorded after delivery.The satisfaction of the research subjects,the time of initiation of lactation,and the amount of the lactation after delivery were also recorded.Results The analgesia group cesarean section rate was significantly lower than the control group,the rate of surgery due to social factors in the analgesic group was significantly lower than that in the control group.There was no significant difference in other cesarean section indications between the two groups.The first time of labor,VAS score were better in analgesic group,the oxytocin use rate was significantly higher than that of the control group.The incidence of fever and itching in the analgesia group was significantly higher than that in the control group,the time of initiation of lactation in the analgesia group was significantly shorter than that in the control group,and the satisfaction degree of the analgesia group was significantly higher than that of the control group.The results do not show significant difference in the second labor time,postpartum hemorrhage,incidence of headache,nausea,vomiting,hypotension,postpartum 24 h lactation or neonatal asphyxia.Conclusions Intraspinal anesthesia could significantly reduce maternal pain caused by the delivery process,as well as shorten the delivery process without increasing postpartum hemorrhage.It does not increase cesarean section rate,nor serious complications.It also promotes early open milk,which is conducive for breastfeeding.In summary,doula accompany with delivery analgesia improves the quality of delivery and maternal satisfaction.