Analysis Of The Method And Outcome Of Pregnancy After Cesarean Section

Objective:To analyze the choice and outcome of pregnancy after cesarean section.Methods:Data on obstetric treatment of 1144 cases of repregnant women after cesarean section in the First Affiliated Hospital of Kunming Medical University from July 1,2016 to June 30,2017 was retrospectively analyzed to analyze the choice and outcome.The cases were divided into two groups according to the women's preferences and doctors' assessment,522 cases of TOLAC(trial of labor after cesarean)group and 622 cases of refused TOLAC group(C group).The TOLAC group were further divided into 405 cases of successful TOLAC group(A group)and 117 cases o f failed TOLAC group(B group).The gestational age,gestational weeks,BMI(body mass index),the time of last cesarean section,the first indication of cesarean section,previous vaginal trial or vaginal childbirth history,Bishop score,repeated indication of cesarean section,postpartum blood loss,postpartum bleeding rate,blood transfusion rate,the rate of scar cleavage in the uterus,the effect of induced labor on rupture of uterus,ICU rate after delivery,hospitalization days,birth weight,Apgar score,NICU rate after delivery were evaluated.Result:In all 1144 pregnant women,522 women eligible for TOLAC.405 cases of successful TOLAC,the success rate of TOLAC was 77.59%.There were 8 cases of uterine scarring,and no one case of complete uterine rupture and puerperal.There was one neonatal infant died prematurely due to premature birth and mild asphyxia in A group whose mother severed preeclampsia and hypoalbuminemia.There were two neonatal infants due to preterm labor and severe asphyxiation after cesarean section whose mother had dangerous placenta,the family abandoned the rescue.1.Prenatal data were compared among the three groups.Between A group and B group in the gestational age,the time of last cesarean section,Bishop score the difference were statistically significant(P<0.05).Between A group and C group in the gestational age,BMI,the time of last cesarean section,the first indication of cesarean section,previous vaginal trial or vaginal childbirth history,Bishop score,the first indication of cesarean section the difference were statistically significant(P<0.05).The BMI,Bishop score,the first indication of cesarean section between B group and C group,the difference were statistically significant(P<0.05).The gestational weeks among the three groups,there was no significant difference(P>0.05).The main indication of the first cesarean section was the mothers' request among the three groups.2.Postpartum situations were compared among the three groups.The mean postpartum blood loss,blood transfusion rate,hospitalization days in A group was significantly lower than the other two groups(P<0.05);when B group compared with C group,there was no significant difference(P>0.05).The blood transfusion rate in A group was significantly highest than the other two groups(P<0.05),however the B group was lowest.The ICU rate after delivery in A group was lower than that in C group(P<0.05).The rate of repeated cesarean section in B group was higher than that in C group because of the cephalopelvic disproportion,fetal distress,and scar pain.However,the rate of repeated cesarean section in C group was higher than that in the B group because of the scar uterus,giant child,placental factors.The rate of scar cleavage in the uterus among the three groups,there was no significant difference(P>0.05).Between A group and B group,there was no significant difference with the effect of induced labor on rupture of uterus(P>0.05).3.Newborn situations were compared among the three groups.The mean birth weight in A group was significantly lower than the other two groups(P<0.05);when B group compared with C group,there was no significant difference(P>0.05).The frist minute Apgar score in the A group was higher than that in the C group(P<0.05).The 5 minutes Apgar score in the three groups,there was no significant difference.The NICU rate after delivery in B group was significantly highest than the other two groups(P<0.05);when A group compared with C group,there was no significant difference(P>0.05).The main indication of the newborns transferred to the NICU after birth was the primary cause among the three groups.Conclusions:1.The gestational age,BMI,the time of last cesarean section,previous vaginal trial or vaginal childbirth history,Bishop score,the first indication of cesarean section,birth weight are the influencing factors of the success rate of TOLAC.2.Previous vaginal trial or vaginal childbirth history is a favorable factor for the success of TOLAC.3.Under close supervision,according to the actual situation of the cesarean section scar uterus pregnancy patients in vaginal trial production process again to select the suitable induction delivery method like the CRB balloon promote cervical mature,oxytocin strengthening contractions,artificial rupture do not increase the risk of uterine scar rupture.4.For cesarean section scar uterus pregnancy patients with vaginal trial production the willingness and condition chose to TOLAC is a reasonable option.And VBAC can reduce postpartum hemorrhage,transfusion rate,shorten hospitalization days,and meanwhile reduce the second cesarean section rate.