| Objective:To analyze the comparison of vaginal delivery pregnancy after cesarean section with different medical resources.Methods:The clinical data of pregnant women with previous cesarean section and re-pregnant women with previous cesarean section were collected from July 2013 to December 2018 in the First Affiliated Hospital of Kunming Medical University and from January 2014 to December 2018 in Zhenxiong County People's Hospital of Zhaotong City,Yunnan Province respectively.The single pregnant women,pregnant women with gestational weeks?28 weeks and pregnant women with previous cesarean section(scar uterus)were selected as the research objects.Among them,4,363 cases of pregnant women were re-pregnant after cesarean section in the First Affiliated Hospital of Kunming Medical University.A total of 1,658 cases of single live births with a history of cesarean section were included in study group 1.There were 4,938 women who were pregnant again after cesarean section in Zhenxiong County People's Hospital.Among them,3,210 women who attempted vaginal delivery with a single live birth with a history of cesarean section were included in study group 2.The demographic characteristics of the two groups of parturients were compared and analyzed,including age,educational background,previous vaginal delivery history and pregnancy complications,including gestational weeks of delivery,spontaneous uterine contraction,delivery mode,postpartum hemorrhage,blood transfusion and uterine rupture,newborn birth weight,Apgar score in 5 minutes,and whether the newborn was admitted to neonatal ICU.Results:1.The proportion of re-pregnancy in the previous cesarean section history during the study period was 12.3%(4363/35471),the VBAC rate in the study group 1 was 38.0%(1658/4363),and the VBAC success rate was 83.8%(1389/1658);In Zhenxiong County People's Hospital,12.1%(4938/40809)of the previous cesarean section were re-pregnant.The VBAC rate in this hospital(study group 2)was 65.0%(3210/4938),and the VBAC success rate was 83.6%(2683/3210).Compared with the two groups,there was no significant difference in the ratio of scar uterus and VBAC success rate between the two groups(2:0.290,P>0.05).the VBAC rate in study group 1 was significantly lower than that in study group 2(2:460.331,P<0.05).2.the average age of study group 1(2:38.949,P<0.05),the proportion of over 35 years old(2:434.552,P<0.05),the proportion of bachelor degree or above(2:919.454,P<0.05)and pregnancy complications(2:499.636,P<0.05)are higher than those of study group 1,while the proportion of patients under 30 years old(2:837.115,P>0.05)and patients with previous vaginal delivery history in study group 1 are significantly lower than those in study group 2(2:135.969,p<0.05)3.in the comparison of pregnancy outcomes between the two groups of VBAC patients,the proportion of patients with premature birth(<37 weeks)(2:77.469,P<0.05),the proportion of patients with all pregnancy complications(2:449.636,P<0.05),the amount of postpartum hemorrhage? 1500 ml(2:10.250,P<0.05),the proportion of patients with blood transfusion(2:33.799,P<0.05)and the neonatal occupancy NICU rate(2:5.656,P<0.05)in study group 1 are significantly higher than those in study group 2.However,the average gestational age(t:-9.860,P<0.05),newborn birth weight(t:-6.288,P<0.05)and Apgar score<7 minutes@5 minutes ratio(2:5.130,P<0.05)in study group 1 were significantly lower than those in study group 2.The incidence rate of postpartum hemorrhage?1500ml(1.6%),the rate of blood transfusion required(3.1%)and Apgar score<7 minutes@5 minutes(0.6%)in study group 1,while the incidence rate of postpartum hemorrhage?1500ml(0.5%),the rate of blood transfusion required(0.6%),and the rate of Apgar score<7 minutes@5 minutes(1.5%)in study group 2 are all relatively low.the uterine rupture rate in both groups is lower than 0.2%.the overall pregnancy outcome of mother and son is good,and there is no maternal or newborn death.4.compared with study group 1,study group 2 had a history of vaginal delivery(or:2.76,95%ci:2.06-3.71,p<0.05),a greater opening of the uterine orifice than 3cm on admission(or:3.33,95%ci:2.30-4.83,p<0.05),and premature rupture of membranes(or:1.44,95%ci:1.16-1.80,p<0.05)are all factors affecting the success of VBAC.Conclusion(s):VBAC is carried out in medical institutions with different medical resources.Despite the differences in medical conditions and patient composition,good maternal and infant outcomes have been achieved,suggesting vaginal delivery after cesarean section is an alternative delivery method. |
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