Analysis Of Pregnancy Outcome Of Pregnant Women With Vaginal Delivery After Cesarean Section

Research background:After centuries of exploration,with the operation,operation methods,anesthesia technology and application of effective antibiotics,cesarean section has become a mature operation and plays an irreplaceable role in the rescue of maternal and perinatal life,has become one of the important surgical obstetrics cesarean section.As the operation time is short,easy to operate,and can bring more economic benefits,It has once been sought after by obstetricians and maternal,which led to the cesarean section rate continues to rise.According to the WHO reported,in order to save the lives of the mother and children,the medical needs of cesarean section accounted for only 10% to 15%.Therefore,WHO Regulate the rate of cesarean section should be controlled below 15%.With the increase of cesarean section rate,the risk of perinatal mortality and neonatal asphyxia rate was not significantly decreased,but increased the near and long-term risk of surgery.2010 WHO reported that China is one of the countries with the highest rate of cesarean section,cesarean delivery accounted for 46% of China’s birth rate.Since then the national maternal and child workers are trying to reduce the rate of cesarean section.Although the upward trend in cesarean section rate trend has been controlled,but due to the relaxation of China’s family planning policy,a pair of couples are allowed to have two children,Because the past ten years’ high rate of cesarean section,A lot of women with a scar uterus again face fertility problems.How to choose the appropriate mode of delivery for this group of people,ensure maternal and child safety,reduce the total rate of cesarean section in China,become an urgent problem.Because of repeated cesarean section is the most common independent indications for cesarean section,so choose the right people for trial of labor after cesarean section(TOLAC)and subsequent vaginal delivery(VBAC)is an important mechanism to reduce the rate of cesarean section.one of the biggest barriers to VBAC is the lack of patient access to TOLAC.Because of various reasons,most of the pregnant women who had a history of cesarean section will select cesarean section again.Objective:To investigate the incidence and pregnant outcome on vaginal birth after cesarean section(VBAC),sum up the suitable people for TOLAC and the favorable factors for VBAC,Which could improve the rate of successful TOLAC,reduce the cesarean section rate,to provide some guidance to protect the maternal perinatal safety.Methods:From July 2015 to October 2016,clinical data of 170 patients with uterine scar admitted in the third Obstetric ward of Tai’an an CentralHospital were studied retrospectively.There were 70 cases for trial of labor after cesarean section(TOLAC group),50 cases of successful trial(VBAC group),20 cases of TOLAC failure(TOLAC failure group),100 cases of cesarean section(ERCS group),Respectively compared with non scar uterus vaginal delivery of full-term primipara 100 cases(VBNC group).To description of scar uterus pregnancy result and the pros and cons of the choose way of delivery.Results:(1)The main delivery way of the uterus scar were still in cesarean section again,accounted for 71%.(2)Pregnant women with uterine scar pregnancy can also choose vaginal delivery,VBAC accounted for 29%in all uterus scar,but VBAC in uterus scar accounted for 71.4%,the result of vaginal delivery was beyond satisfaction.(3)In the incidence of postpartum hemorrhage,puerperal infection,hospitalization between the cesarean section again group and the VBAC group,difference with significance(P<0.05).In the Apgar score,weight difference,transition between the cesarean section again group and the VBAC group,difference with no significance(P>0.05).The results showed that the VBAC group has the smaller postpartum hemorrhage and puerperal infection rate,has the shorter hospital stay.(4)No significant difference was noted between the VBAC group and the VBNC group on episiotomy,the use of forceps,Postpartum hemorrhage rate,hospitalization,Apgar score,transition(P>0.05).The VBAC group has the longer total stage of labor.(5)There is significant difference on Maternal age,body mass index(BMI),cervical score(Bishop score),gestational age and fetal weight between VBAC group and Failure group(TOLAC failure group).Conclusions:The main delivery way of the uterus scar were still in cesarean section again,Scar uterus as a single indication of cesarean section still accounted for the vast majority of the total number of cesarean section.Scar uterus is no longer the absolute indication of cesarean section,vaginal delivery can be selected,and the success rate is higher.We should fully understand the maternal age,gestational age,BMI,cervical score,whether had history of vaginal delivery or VBAC history,the indication of previous cesarean section,uterine incision type,wound healing,two pregnancy interval and ultrasound of lower uterine segment scar thickness,estimation of fetal weight size etc before trial of labor.Then choose the appropriate population population for trial of labor,and communicate with pregnant women and their families about the advantages and disadvantages of the trial,and sign the agreement.Close monitoring of production process,such as abnormal,timely treatment,if necessary,emergency cesarean section.When compared with ERCS,VBAC has obvious advantages,because VBAC can reduce the reoperation to patients with postpartum hemorrhage,puerperal infection,postoperative adhesion,chronic pelvic pain and infertility and other complications,can also reduce the economic burden of the patients,with good maternal and neonatal outcomes,can reduce the cesarean section rate,improve the quality of obstetric delivery.The staff have matching and supporting the delivery of equipment,monitoring system and implement emergency cesarean section and neonatal resuscitation advanced hospitals should be vigorously promoted.