Clinical Analysis Of Vaginal Birth After Cesarean

Objective:Analyze and discuss the factors influencing vaginal birth after cesarean section(VBAC)and the maternal-infant outcome,aiming to provide some basis for women with 1 cesarean history to choose the delivery mode and provide some references for clinicians.Methods:Selected 786 cases of pregnant women with a history of 1 cesarean section hospitalized in our hospital from January 2016 to January 2019.78 cases chose trial of labor after cesarean(TOLAC)and 58 cases succeeded.Selected the 58 cases with successful TOLAC as the VBAC group.According to the case control study method and the proportion of 1:2,selected 116 cases of pregnant women with non-scarred uterus and full-term vaginal delivery(VBNC group)and 116 cases of pregnant women who directly chose elective repeat cesarean section(ERCS group)as the control groups.20 cases of pregnant women with VBAC after failed TOLAC as the TOLAC failure group.Result:I.Comparison of intrapartum situations and birth outcomes between the VBAC group and the VBNC group:(1)There was no statistical difference between the two groups in age,gestational age,body mass index and neonatal weight of the pregnant women.(2)The VBAC group took shorter time than the VBNC group in terms of the second stage of labor;there was no significant difference in the duration of the third stage of labor between the two groups;and no significant difference was found between the two groups in artificial rupture of fetal membrane;the VBNC group used more oxytocin than the VBAC group.(3)In terms of postpartum hemorrhage,uterine rupture,neonatal asphyxia and puerperal infection,P>0.05,there was no statistical difference between the two groups.2.Comparison between the VBAC group and the ERCS group:(1)There was no statistical difference between the two groups in age,gestational age,body mass index and neonatal weight of the pregnant women.(2)No uterine rupture was found in the VBAC group and no complete uterine ruptUre was found in the ERCS group and all were incomplete uterine rupture.There was no statistical difference between the two groups in puerperal infection,neonatal asphyxia and uterine rupture,P>0.05.Both postpartum hemorrhage and hospitalization days of the VBAC group were less than those of the ERCS group,and the difference was statistically significant.3.Comparison between the VBAC group and the TOLAC failure group:(1)There was no statistical difference between the two groups in age and body mass index of the pregnant women;in tenns of vaginal delivery history and uterine orifice opening,P<0.05,there were statistically significant differences between the two groups,and these two factors are conducive to the success of vaginal delivery;in terms of neonatal weight and gestational age,P<0.05,there were statistically significant differences between the two groups,and these two factors are not conducive to the success of vaginal delivery.(2)In terms of pregnancy outcome and neonatal asphyxia,P>0.05,there was no statistical difference between the two groups.There were statistically significant differences between the two groups in postpartum hemorrhage,puerperal infection and hospitalization days,and the TOLAC failure group was marked by higher occurrence rate of the above consequences.There were statistically significant differences between the two groups in postpartum hemorrhage and incomplete rupture of uterus,and the VBAC group had lower occurrence rate of the above consequences than the TOLAC failure group.Both groups had no complete uterine rupture.4.Comparison of pregnancy outcomes between the TOLAC failure group and the ERCS group:There were statistically significant differences between the two groups in puerperal infection and incomplete rupture of uterus,and the TOLAC failure group was significantly higher than the ERCS group;there was no significant difference in postpartun hemorrhage and neonatal asphyxia between the two groups.5.The proportion of TOLAC and ERCS in this study:From Jan.2016 to Jan.2019,there were 786 pregnant women with a history of one cesarean section at the lower uterine segment and singleton pregnancy at normal head position in our hospital,and 78 of them chose TOLAC,with a TOLAC rate of 9.92%;708 of them chose ERCS,with the ERCS rate of 90.08%.Conclusion:1.There is no difference in the outcome of pregnancy between VBAC group ana VBNC group.The second stage of labor of VBAC group is shorter than that of VBNC.Artificial rupture of membrane is adopted more in VBAC group,but less oxytocin,which may be related to the considering of using oxytocin can increase the possibility of uterine rupture.2.The postpartum hemorrhage and hospital stay of the VBAC group are less than that of the ERCS group,but there is no significant difference in neonatal asphyxia and puerperal infection.3.The success of TOLAC can be affected by many factors.The possibility of puerperal infection and incomplete uterine rupture of failed TOLAC are higher than that of ERCS,and the possibility of postpartum hemorrhage,puerperal infection and incomplete uterine rupture are higher than that of VBAC.4.Most of pregnant women who had caesarean section in the past prefer to choose ERCS,and 9.92%pregnant women prefer to choose TOLAC.