Discussion Of Vaginal Birth After Cesarean Section

Aims:With the object of mid-pregnancy and full-term pregnancy women after cesarean section and the method of analyzing relative clinical data,this study attempts to discuss the choice of mode for secondary delivery after cesarean section, birth outcomes, infant and maternal complications, hospitalization costs, the number of hospitalization days and so on; to analyze the affecting factors of vaginal delivery after cesarean section;to sum up vaginal birth process after cesarean section; to change the old view---"once cesarean, cesarean forever "and set up the new view--"though previous cesarean, vaginal birth is still passable"; to reduce the rate of cesarean section and improve the quality of obstetric delivery.Methods:This study selected the subsequent pregnancy pregnant women after cesarean section admitted in Tengzhou Central People’s Hospital during April2011-2012in August, including49cases of mid-pregnancy and156cases of full-term pregnancy. The latter was divided into vaginal birth after cesarean section group (VBAC group) and repeat cesarean section (RCS group).Trial vaginal group was further divided into the successful one and the failure one. Selected clinical data of pregnant women was prospectively studied. The VBAC group and RCS group, successful trial vaginal group and the failure trial vaginal group are compared to explore the birth outcomes, infant and maternal complications, and factors affecting vaginal birth aspects. Results1.49cases of cesarean section mid-pregnancy group were successfully delivered through the overcast period without any uterine rupture, postpartum hemorrhage.2.Of156cases of cesarean section at full-term pregnancy group,90cases were cesarean section for the second time, the surgery rate was57.7%,66cases of vaginal trial production,48cases of successful trial production, successful trial production rate was72.7%, vaginal delivery rate was30.8%, including15cases of naturally eutocia,33cases of vaginal delivery (vacuum extraction Midwifery+episiotomy),18cases of cesarean section after cervical dilation stagnation, and the affecting factors are persistent occiput transverse position, fetal distress, threatened uterine rupture, pregnant women can not tolerate labor pain.3.VBAC group is significantly lower than the RCS group in the amount of bleeding during labor, puerperal infection, neonatal jaundice, neonatal wet lung, the cost of hospitalization and the number of days (P<0.05), there is no significant difference in neonatal Apgar score (p>0.05). Comparing the successful trial production group with the failure one, the difference was statistically significant in the weight of pregnant women from the two groups, the number of vaginal deliveries, fetal weight, the level of the head-first-exposure (P<0.05), the difference was not statistically significant in gestational age, scar thickness (P>0.05), the successful trial production group was significantly lower than t the failure one in birth outcomes, uterine rupture, postpartum hemorrhage, puerperal infection rates and other aspects, there is no significant difference in neonatal asphyxia.Conclusion The secondary pregnancy after cesarean section is not absolute indication for cesarean section. Vaginal delivery can be chosen, and the success rate is higher. The premise of trial production is a comprehensive understanding of previous cesarean section surgical indications, surgical approach, wound healing, two pregnancy interval, the pregnancy history and color Doppler ultrasound monitoring of the lower uterine segment scar thickness, fully communicate with pregnant women that comply with vaginal trial production conditions and signed the agreement, carry out the implementation of the "one to one" Doula and closely monitoring the progress of delivery, offer timely symptomatic treatment for abnormal situation or even cesarean section if necessary. Compared with the RCS, advantages of VBAC outweigh the disadvantages, because the trial production can reduce surgical patients’ postpartum hemorrhage puerperal infection and other complications after another operation, and it also reduces the economic burden of patients with good maternal and neonatal outcomes, thus, the cesarean section rate can be reduced and the quality of obstetric delivery will be improved.