A Clinical Research On Vaginal Delivery After Cesarean-scar Pregnancy,the Related Influencing Factors,and The Pregnancy Outcomes

Objective:This paper discusses vaginal delivery after a cesarean-scar pregnancy,the related influencing factors,and the pregnancy outcomes.Method:1186 cases of pregnant or laboring women who had undergone vaginal delivery after a previous cesarean-scar pregnancy in the recent three years are chosen for this study.A retrospective analysis of their clinical data is conducted.Based on the personal willingness of these women and their obstetricians' comprehensive assessment,541 of them chose to attempt a trial of labor after cesarean and 645 had another caesarean section.Among the 541 cases,420 succeeded(Group A),with a success rate of 77.63%(420/541).There were 121 cases of conversion to caesarean section after an unsuccessful trial of labor(Group B),the failure rate of trial of labor reaching 22.37%(121/541).Comparisons were done between data of the two groups,including age of the women,the gestational age,the prenatal BMI;interval between the pregnancy and the caesarean section;having or not history of trial of labor or vaginal birth;the Bishop scores during their stay;the interval between the operation and the pregnancy;the amount of postpartum bleeding;the rate of severe postpartum bleeding;rate of blood transfusion;rate of hysterorrhexis;rate of caesarean scar rupture;occurrence rate of ICU-admission after labor;length of hospital stay;the relationship between labor induction and caesarean scar rupture during the trial of labor;birth weight of newborns;5min Apgar scores of newborns;and occurrence rate of NICU-admission after birth.Results:1.Compared Group A with Group B,no statistically significant difference is found between Group A and Group B in age,pre-pregnancy BMI,and gestational age;2.the success rate obviously increased in the attempt for trial of labor after cesarean when the interval between the caesarean section and the pregnancy equals 2?Y?3 or when there was a previous trial or labor or vaginal birth;the rate of success obviously increased in trial of labor when the Bishop score was above 6.3.Group A had lower amount of postpartum bleeding,lower rate of severe postpartum bleeding and blood transfusion,and shorter hospital stay.4.no statistically significant difference is found between rate of tubal rupture or caesarean scar rupture.Induction methods such as CRB sacculus,oxytocin,and artificial rupture of membranes did not increase rate of tubal rupture or caesarean scar rupture.No statistically significant difference is found between the 5min Apgar scores of newborns from the two groups or between the occurrence rate of NICU-admission.5.Group A had lighter birth weight and higher 1 min Apgar score.6.One case of hysterorrhexis is found in Group A and none in Group B.In Group B,major indications among the indications for another C-section after trial of labor failed include fetal distress in uterus,intolerance of pain from contractions,and abnormal labor process.Conclusions:1.Influencing factors for success rate of trial of labor after an caesarean section include the interval between the caesarean section and the pregnancy,history of trial of labor and vaginal birth,Bishop score,and birth weight of newborn.2.Having history of trial of labor or vaginal birth is a favorable factor for the success rate of trial of labor after an caesarean section.3.Under close monitoring,appropriate selection of induction methods such as CRB sacculusc for cervical ripening,oxytocin to strengthen contractions,and artificial rupture of membranes do not increase rate of hysterorrhexis or caesarean scar rupture.4.For those who are willing or have the condition for trial of labor,with the comprehensive assessment of obstetricians they should be allowed to try.A successful trial of labor decreases the amount of postpartum bleeding,the rate of blood transfusion,the hospital stay,and lowers the occurrence rate of another cesarean section.5.Major indications among the indications for another C-section after trial of labor failed include fetal distress in uterus,intolerance of pain from contractions,and abnormal labor process.