A Meta-analysis Of The Maternal And Infant Outcomes Of Different Delivery Methods In The Re-pregnancy Of Scarred Uterus

Background and purpose:Our country is one of the countries with a higher rate of cesarean section in the world.It is reported that the rate of cesarean section in my country has increased rapidly after 1980.A large-scale survey in 2011 showed that the average rate of cesarean section in China was as high as 54.5%.With the opening of the two-child policy,many pregnant women who have undergone cesarean section choose to have a second child,and there are more and more problems facing re-pregnancy after cesarean section.In 2010,the United States encouraged trial of labor after previous cesarean delivery(TOLAC)to minimize selective repeat cesarean delivery(ERCD),thereby increasing cesarean delivery.Re-pregnancy vaginal delivery(vagina birth after cesarean delivery,VBAC).TOLAC is still controversial about the safety of mothers and babies,and the analysis and research conclusions of various articles are not consistent.This article collects some related studies on the maternal and infant outcomes of TOLAC,VBAC and ERCD that have been published at home and abroad,and systematically analyzes them to verify the influence of TOLAC and VBAC on these factors,so as to provide a certain degree of promotion and application of TOLAC.Clinical guiding significance.method:Search Pub Med,Cochrane Library,Embase,China Biomedical Literature Database(CBM),Chinese Journal Full-text Database(CKNI),Wanfang and other databases through computer,and manually search all research reports and conference content that cannot be retrieved by computer,Included in the initial study.The search time limit is controlled to January 2021.After two reviewers independently screened the literature,extracted relevant data,and evaluated the risk of bias in the included studies,R 4.0.3 software was used for meta-analysis.Results:A total of 16 articles were included in this Meta-analysis.Some articles also discussed the pregnancy outcomes of TOLAC,VBAC and ERCD.The 16 articles are all retrospective analysis,including 5 studies on postpartum hemorrhage,7 studies on the incidence of postpartum hemorrhage,9 studies on uterine rupture,4 studies on hysterectomy,and 7 studies on puerperal infection.,9 studies of blood transfusion,5studies of average hospital stay,3 studies of hospitalization expenses,8 studies of neonatal Apgar score <7,and 9 studies of neonatal treatment in NICU.Meta-analysis results showed: 1.Uterine rupture rate in TOLAC group and ERCD group [RR=1.83,95%CI(1.33,2.53),P<0.05],puerperal infection [RR=0.47,95%CI(0.25,0.90),P<0.05],Apgar score of newborns<7 points [RR=2.16,95%CI(1.66,2.80),P<0.05]The difference was statistically significant;while the incidence of PPH [RR=0.86,95%CI(0.49,1.50),P>0.05],blood transfusion rate [RR=0.94,95%CI(0.59,1.51),P>0.05],hysterectomy rate [RR=0.43,95%CI(0.14,1.37),P >0.05],the treatment rate of neonates admitted to NICU [RR=1.04,95%CI(0.96,1.13),P>0.05] was not statistically different,TOLAC can increase the incidence of uterine rupture and reduce the rate of puerperal infection compared with ERCD.2.The incidence of PPHF in the VBAC group and the ERCD group [RR=0.74,95%CI(0.62,0.89),P < 0.05],postpartum hemorrhage [MD=-102.11,95%CI(-192.37;-11.85),P < 0.05],puerperal infection [RR=0.35,95%CI(0.25,0.48),P <0.05],average hospital stay[MD=-2.25,95%CI(-2.77;-1.73),P < 0.05],Hospitalization expenses [MD=-3143.15,95%CI(-3807.23;-2479.06),P<0.05],Apgar score of newborns<7 points[RR=1.90,95%CI(1.24,2.92),P<0.05],Newborns were sent to NICU [RR=0.82,95%CI(0.71,0.95),P < 0.05] were statistically significant,blood transfusion[RR=0.43,95%CI(0.17,1.08),P>0.05] and Uterine rupture [RR=1.12,95%CI(0.03,42.13),P>0.05] was not statistically significant.It shows that VBAC can significantly reduce postpartum hemorrhage,puerperal infection,neonatal NICU rate,reduce the average hospital stay,and reduce medical expenses.Conclusions:1.VBAC can significantly reduce postpartum hemorrhage,puerperal infection,neonatal NICU rate,reduce the average hospital stay,and reduce medical expenses.2.TOLAC has a higher risk of uterine rupture than ERCD,but does not increase the risk of hysterectomy.For TOLAC pregnant women,the rationality of trial delivery should be fully evaluated.3.TOLAC have a higher risk than ERCD neonates with Apgar<7,but they do not increase the risk of neonates being sent to NICU for treatment.4.Standardized TOLAC after a full evaluation is a safe and feasible way of delivery for pregnant women who have a second pregnancy after a lower uterine cesarean section.