Outcome Analysis Of Vaginal Delivery With Scar Uterus After Cesarean Section

Objective: To explore the feasibility and safety of vaginal birth after cesarean section(VBAC)for pregnant women with scar uterus after cesarean section,so as to enhance the self-confidence of pregnant women in choosing vaginal trial delivery after cesarean section and improve the strength of clinical control of cesarean section rate;To summarize the relevant experience of labor process monitoring and management of vaginal delivery with scar uterus in the clinic,so as to provide a reference for obstetric work in the future,better ensure the safety of mother and baby and improve the quality of delivery.Methods: 318 cases of scar uterus pregnancy after cesarean section(TOLAC)were collected from the obstetric ward of our hospital from January 2017 to December 2020,the pregnant women of the two groups were randomly selected as the study group,and302 cases of pregnant women with non-scar uterus who were pregnant again and delivered through the vagina in the obstetric ward of our hospital during the same period were selected as the control group.The clinical data and data of the two groups of pregnant women during their previous hospitalization were collected to study the changes of common clinical indicators such as vaginal delivery outcome,duration of labor,postpartum hemorrhage,length of hospital stay,neonatal outcome and so on.The differences were compared and analyzed to see if they were statistically significant.Results:1.Under the same delivery environment,the number of successful delivery was more than the number of failures,and the vaginal delivery rate of scar uterus was significantly higher than that reported in the previous literature,which was 97.80%(311/318).2.The comparison of general data between the two groups showed that there was no significant difference in age and gestational week between the two groups(P>0.05);There was no significant difference in educational background distribution;The difference of BMI before pregnancy and the interval between two deliveries was statistically significant(P<0.05).The BMI before pregnancy in the study group was higher and the interval between two deliveries was longer.3.There was no significant difference in the distribution of complications during pregnancy between the two groups.4.The comparison of delivery between the two groups showed that the time of the first and second stage of labor and the total stage of labor in the study group were longer than those in the control group,the difference was statistically significant(P<0.05),but there was no significant difference in the time of the third stage of labor between the two groups(P>0.05);The incidence of postpartum hemorrhage,lateral resection and midwifery,uterine rupture and labor analgesia in the study group were significantly higher than those in the control group(P<0.05);There was no significant difference in artificial placental detachment and hospital stay between the two groups(P>0.05).5.The comparison of neonatal outcomes between the two groups showed that the number of newborns with weight greater than 2500 g in the control group was higher than that in the study group,the difference was statistically significant(P<0.05),but there was no significant difference in neonatal score and neonatal asphyxia(P>0.05).Conclusion:1.The success rate of vaginal trial delivery of second pregnancy after cesarean section is high,there are no serious complications between mothers and infants,which is feasible and safe.It can significantly reduce the rate of direct cesarean section,save medical costs and shorten hospital stay;2.Although the incidence of postpartum hemorrhage and uterine rupture in vaginal delivery with scar uterus is slightly higher than that in vaginal delivery with non-scar uterus good maternal and fetal outcomes can be obtained by timely detection and treatment;3.Lateral episiotomy,vaginal midwifery and labor analgesia have a high incidence in vaginal delivery of scar uterus,and their implementation rate can be appropriately improved in clinical work;4.Strengthening the labor process monitoring of scar uterus vaginal delivery,accurately and quickly judging the critical situation and the occurrence of common complications,and actively anticipating,can effectively ensure the implementation of scar uterus vaginal delivery.