Analysis Of Influencing Factors Of Cesarean Delivery In Prelabor Rupture Of Membranes At Term

Objective:This study was to analyze the clinical characteristics and explored the influencing factors of cesarean delivery(CD)in primiparous women with prelabor rupture of membranes(PROM)at term.Materials and methods:The pregnant women with PROM(n=221)who were hospitalized in the obstetric department of the First Affiliated Hospital of Dalian Medical University from January 1,2018 to December 31,2020 were taken as the research objects.A retrospective analysis method was used to explore the influencing factors of CD in nulliparas with prelabor rupture of membranes(PROM)at term.The parturient women participating in the study were all singletons,vertex presentations,and had undergone a vaginal trial.The women included were divided into the primiparous group(n=177)and the multiparous group(n=44)according to the parity,and the primiparous group(n=177)were divided into the CD group(n=38)and vaginal delivery(VD)group(n=139)according to the mode of delivery.Through univariate comparison and multivariate stepwise Logistic regression,the comparation of the clinical characteristics between the primiparous group and the perinatal group was made and the independent risk factors for the failure of VD among the primipara with PROM were analyzed.The result of statistical analysis is statistically significant with P<0.05.Results:1.A statistical analysis of the data of all 221 pregnant women who met the inclusion and exclusion criteria with term premature rupture of membranes and undergoing a trial vaginal delivery showed that the proportion of CD of the primiparous group was 21.47%(38/177)which was significantly higher than 6.82%(3/44)in the multiparous group(P<0.05).In addition,compared with multiparas,the primiparous cervical dilatation was smaller at admission,the proportion of induced labor with oxytocin was higher,and the interval between membrane rupture to delivery was longer(P<0.05).2.After a univariate comparison analysis of the clinical data of the women in the primiparous group,a total of 11 variables were found to be statistically different(P<0.05):Among them,compared with the VD group,in the CD group 6 of the variables were higher: BMI(kg/m2)before pregnancy,BMI(kg/m2)before labor,the interval(h)between membrane rupture to delivery,the propotion of residual oligohydramnios,the propotion of clinical chorioamnionitis,the propotion of neonatal head circumference(HC)>35cm,when the other 5 were lower: height(cm),cervical bishop score at admission,cervical dilatation(cm),presentation position score,cervical texture score.3.The results of the univariate comparison were included in the stepwise logistic regression analysis and found that: height(cm),cervical dilatation(cm),cervical texture score are protective factors for CD,BMI(kg/m2)before labor,residual oligohydramnios and neonatal(HC)> 35 cm are independent risk factors for CD.(P<0.05).Conclusion:1.The general factors that affect cesarean section with prelabor rupture of membranes at term are: height,maternal BMI,nulliparity,and neonatal HC,which were similar with the influencing factors of CD in pregnancies without PROM.2.Cervical bishop score at admission is an influencing factor of CD for pregnancies with PROM at term,especially when the cervical dilatation is lesser,the cervical texture is harder,the risk of CD will increase significantly.In addition,presentation position at admission have a significant impact on the mode of delivery.3.The application of oxytocin to induce labor does not significantly increase the proportion of CD with PROM at term,but the interval is prolonged,especially when≥24h,the proportion of CD increases significantly.