| Objectives: To analyze the general characteristics of vaginal trial delivery of second pregnancy after primary cesarean section,trial delivery and pregnancy outcome.To provide the basis for the standard management of vaginal trial delivery after cesarean section.Methods: Analyzed retrospectively from January 2018 to June 2020 in anhui medical university affiliated maternity and child care hospital childbirth scar uterus puerpera clinical data,Through the inclusion and exclusion criteria of VBAC,225 parturient women with successful trial delivery were selected as the VBAC group,Then VBAC group according to whether or not to use labor analgesia is divided into VBAC1 group(use labor analgesia),VBAC2 group(unused labor analgesia),randomly selected from the same period in our hospital childbirth primipara and multipara 149 cases as control group,each divided into primipara and multipara group,The general characteristics,trial delivery and pregnancy outcome of each group were analyzed.In addition,the general information and pregnancy outcomes of 16 women who had converted to cesarean section during trial delivery were collected.Results: 1.The gestational age of the VBAC group was lower than that of the primipara group and the multipara group,and the difference was statistically significant(P <0.05).the age,gestational number and body mass index of the VBAC group were higher than those of the primipara group,and the difference was statistically significant(P < 0.05),no statistical difference compared with group multipara.the length of stay and hospitalization cost of the VBAC group were higher than those of the multipara group,and the difference was statistically significant(P < 0.05),compared with primipara group no statistical difference.2.The duration of the first stage of labor,the second stage of labor and the total stage of labor in the VBAC group were shorter than those in the primipara group,the difference was statistically significant(P < 0.05),The duration of the first stage of labor,the second stage of labor and the total stage of labor in the VBAC group were longer than those in the multipara group,the difference was statistically significant(P < 0.05),and the third labor VBAC failure group time compared with primipara and multipara group,had no statistical difference(P > 0.05).3.The intervention rate and labor analgesia rate in the VBAC group were lower than those in the primipara group,and the difference was statistically significant(P<0.05).episiotomy rate and forceps midwifery rate higher than that of primipara group,there was no statistically significant difference(P >0.05),VBAC group Labor analgesia rate,episiotomy rate,forceps midwifery rate is higher than that of multipara group,the difference was statistically significant(P <0.05),The intervention rate in the VBAC group is slightly higher than the multipara group,there was no statistically significant difference(P >0.05).There was no significant difference in the amount of bleeding,postpartum bleeding rate,placental abruption rate and other complications between the VBAC group and the primipara group and the postpartum group(P > 0.05).4.There was no significant difference between VBAC1 group and VBAC2 group in perineal lateral resection rate,forceps midwife rate and neonatal complication rate(P >0.05),Overall incidence of childbirth complications in the VBAC1 group were lower than those in the VBAC2 group,with statistical significance(P < 0.05).5.The birth weight of the VBAC group was lower than that of the primipara group and the multipara group,and the fetal distress rate was higher than that of the multipara group,and the difference was statistically significant(P < 0.05).6.In this study,16 patients with transfer to cesarean section were collected,Reasons for surgery include the fetal head does not match the pelvis,labor stagnation,pain intolerance,Threatening uterine rupture?,Fetal distress.Prior to the operation,there was a pregnant woman with a suspected threatened uterine rupture,The intraoperative evidence was threatening uterine rupture,There were no adverse reactions in the newborn,There were no adverse reactions in the neonates of the other 15 cases.Conclusions: In the VBAC group,the gestational week of delivery was smaller,the birth weight of the newborn was lower,there were fewer interventions during delivery,and the duration of labor was between primipara and multipara.Labor analgesia could be given after comprehensive consideration during the trial labor,and VBAC trial labor did not increase the adverse outcomes of mother and child.The delivery room should be equipped with an operating room to prepare for emergency cesarean delivery,and the cooperation of midwives,clinicians and neonatologists to ensure the safety of mothers and babies. |
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