Retrospective Study And Meta Analysis Of The Influencing Factors Of Vaginal Delivery After Cesarean Section

Objective Vaginal birth after cesarean section(vaginal birth after cesarean delivery,VBAC)of the influencing factors,provide certain reference for clinical vaginal birth after cesarean section.Methods(1)Retrospective analysis in January 2015 to December 2018 in our hospital maternity hospital cesarean section of full-term pregnancy and willing to try again by vaginal trial production,107 cases of pregnant women,pregnant women related clinical information collection,according to the inclusion criteria,according to the vaginal trialproduce ending divided into VBAC failure group and the vagina after cesarean section(trial of labor after cesarean section,TOLAC)failure group and statistical analysis.(2)Searched the databases of wanfang,VIP,CNKI,Cochrane library,Web of Science,BP,Pubmed,Embase,Ovid,CBM,Springer Link,ebcosco-medline,Elsevier-Science Direct by computer.Relevant clinical literatures of TOLAC from January 1,2005 to February 1,2019 were collected,the heterogeneity test was carried out with Stata 12.0 analysis software,the selection effect model was determined according to the heterogeneity results,and the data were comprehensively and quantitatively analyzed with odds ratio(OR)and95% confidence interval(CI).Finally,sensitivity analysis and publication bias assessment were carried out.Results(1)Among the 107 pregnant women included in the study,78 were in the VBAC group,accounting for 72.9%.Compared with the TOLAC failure group,there were statistically significant differences in vaginal delivery history,cervical dilatation >4 cm,admission for labor,cervical tube regression >50%,body mass index(BMI)<28,and neonatal weight <3500 g.(2)The final analysis data were obtained from 16 literatures,with a total of 21,505 subjects,including 15473 cases in the case group(VBAC group)and6032 cases in the control group(TOLAC failure group).The combined OR value(95%CI)of each factor was:history of vaginal delivery: 2.89(2.30,3.63),cervix dilatation: 1.87(1.37,2.56),admission for labor: 1.63(1.56,1.70),cervical tube regression: 1.58(1.07,2.33),maternal body mass index: 0.97(0.91,1.04),time since last cesarean section: 0.97(0.87,1.08),maternal age: 1.01(0.96,1.06),neonatal weight: 1.02(1.00,1.05).Conclusion(1)In clinical studies,vaginal delivery history,cervical dilatation of >4cm,admission for labor,cervical tube regression of>50%,pregnant women’s BMI<28,neonatal weight <3500 g are favorable factors for VBAC.(2)In the meta-analysis,it was found that vaginal delivery history,admission to hospital with cervical dilatation of >4 cm,admission to labor,cervical tube regression of >50% were favorable factors for vaginal delivery,but no statistically significant differences in maternal body mass index and neonatal weight were found between the two groups.