Pregnancy Outcome By Mode Of Delivery In Mild Risk Pregnancies

Objective The study aimed to examine effect of mode of delivery on pregnancy outcomes in primiparaous women with a single mild risk factor, in attempt to provide evidence for reducing primary cesarean delivery rate.Methods A nine-year retrospective cohort study was conducted in28,925deliveries from1January2005to31December2013at the1st Affiliated Hospital of Kunming Medical University. Five thousand six hundred and fifty four cases of multipara、multiple pregnancies、gestational age<28weeks、intrauterine death and women with life severe maternal or fetal complications were excluded, leaving23,271single cases.Among them,9,027cases with each of the following complications such as advanced maternal age (AMA), preterm, pre-eclampsia, gestational diabetes mellitus (GDM), some mild surgical and medical complications, large for gestational age(LGA), small for gestational age (SGA), single nuchal umbilical cord and≥2loops were included for final analysis. Relationship between each of the nine mild risk factors and mode of delivery was analyzed, and pregnancy outcomes by mode of deliveries were compared.Results1、After adjusted confounding factors for maternal education level、body mass index(BMI) before pregnancy、number of antenatal care visits, AMA (OR2.86,95%CI2.51-3.25,P<0.001)-. pre-eclampsia (OR1.87,95%CI1.55-2.26, P<0.001)、mild surgical and medical complications(OR1.12,95%CI1.02-1.23, P-0.02)、LGA(OR2.46,95%CI2.18-2.78,P<0.001) and>2loops of nuchal umbilical cord (OR2.58,95%CI2.07-3.21, P<0.001) were significant risk factors for cesarean delivery(CD); preterm (OR0.82,95%CI0.70-0.96,P=0.014) and SGA(OR0,73,95%CI0.65-0.82,P<0.001) were protective factors for CD. GDM (P=0.1). The single nuchal umbilical cord were no related with CD (P=0.991).2.There were no significant differences in adverse maternal and perinatal outcomes by mode of delivery in AMA, single and multiple nuchal umbilical cords (P>0.05).3.The rate of each of the following adverse outcomes was higher in CD than in VD:①.severe PPH (1.7%vs0,P=0.019), transfusion (2.84%vs0.21%, χ2=7.21,P=0.007) and neonatal respiratory complications (19.89%vs12.42%,χ2=5.83, P=0.016) in preterm group;②.NICU admission for treatment (25.20%vs9.22%,χ2=12.21, P<0.001) in pre-eclampsia group;③.NICU admission for treatment(17.06%vs10.70%,χ2-12.02, P=0.001) in GDM group;④.Maternal ICU admission (0.73%vs0.06%, χ2=6.05,P=0.014)、Apgar score<7@5min(0.73%vs0.06%, x2=6.05, P=0.014) and NICU admission for treatment (15.16%vs8.03%, x2=29, P<0.001) in group with mild surgical and medical complications;⑤.NICU admission for treatment (30.03%vs14.09%,x2=38.931,P<0.001). phototherapy(9.56%vs5.32%,χ2=6.80,P=0.009)、sepsis (6.48%vs3.76%,χ2=3.97,P=0.046) in SGA group.Conclusion Although the risk of CD increased in pregnancy with some single mild risk factors, the maternal and neonatal outcomes still could be achieved under the improved medical systems.