Clinical Study On Vaginal Delivery Of Second Pregnancy With Scar Uterus

Objective:The purpose of this study is to compare the clinical case information between the successful vaginal delivery group and the failed vaginal trial delivery group of women with scar uterus pregnancy again,the role of the vaginal delivery mode in improving the clinical effect of such pregnant women and the factors causing the success of vaginal delivery were analyzed;Secondly,by comparing the clinical case information of low-level water sac combined with oxytocin intravenous drip,natural parturition,Doula delivery and analgesic delivery and other methods of induction of labor and intervention for women who have successfully delivered through vagina with scar uterus again,the effects of different methods of induction of labor and intervention on improving the clinical effects of such women are analyzed.Through the analysis of the above two aspects,this study summarizes how to improve the vaginal delivery of scarred uterus efficiently and safely,sorts out a set of safe delivery plans suitable for the mothers with scarred uterus in our hospital,provides more reasonable individual evaluation and labor intervention methods for the vaginal trial delivery of the mothers with scarred uterus again and improves the vaginal delivery success rate of such mothers,and ensures the safety of mothers and babies with scarred uterus again,To a certain extent,the cesarean section rate can be reasonably reduced and the obstetric work quality can be improved.Methods:The clinical data of 394 pregnant women with scarred uterus who were admitted to XX Hospital from January 2017 to January 2021 were retrospectively analyzed.According to the different delivery modes,they were divided into three groups:the second elective cesarean section group after cesarean section(ERCS group)control group,the vaginal delivery group after cesarean section(VBAC group)experimental group 1,and the second vaginal trial failure group after cesarean section(Tolac failure group)experimental group 2,including 242 cases in ERCS group and 120 cases in VBAC group,32 cases in Tolac failure group.The general conditions(age,body mass index(BMI),time from the previous cesarean section,gestational week of delivery),maternal pregnancy outcomes(postpartum hemorrhage,hospitalization expenses,hospitalization time),and neonatal pregnancy outcomes(Apgar score and neonatal weight)were compared among the three groups.Single factor analysis was used to analyze the influencing factors of VBAC.In addition,according to the different methods of induction of labor used in the delivery process,120 pregnant women who delivered via vagina were divided into the natural labor group,the water capsule+oxytocin group and the oxytocin group.The intervention methods used in the delivery process were different.At the same time,120 pregnant women who delivered via vagina were divided into the non use analgesia group,the doula group and the analgesia group according to the different intervention measures.The clinical effects of the three groups of pregnant women were comparedResults:First:Analysis of influencing factors of vaginal delivery after cesarean section1.From 2017 to 2020,Baoshan second hospital received a total of 394 women who were pregnant again after cesarean section,including 152 women who underwent vaginal trial delivery and 242 women who voluntarily chose cesarean section again.Among the 152 Tolac mothers,120 were successful in trial delivery,and the overall VBAC rate was 78.9%.32 failed in trial delivery were converted to cesarean section,and the failure rate of trial delivery was 21.1%.The reasons for the failure of trial delivery were:threatened uterine rupture in 5(5/32,15.6%),fetal heart distress in 10(10/32,31.2%),amniotic fluid fetal distress in 13(13/32,40.6%),placental abruption in 3(3/32,9.4%),atypical amniotic fluid embolism in 1(1/32,3.1%);Finally,the number of parturients included in the VBAC group,TOLAC failure groupand ERCs group was 120,32 and 60 respectively.2.There was no significant difference in age,pregnancy,delivery,gestational week,delivery interval and natural delivery history among VBAC,TOLAC failure group and ERCS groups(P>0.05);The BMI of the three groups of parturients before delivery was statistically different(P<0.05);The maternal BMI before delivery in the VBAC group was significantly lower than that in the other two groups.3.The comparison of pregnancy outcomes among the three groups of VBAC,TOLAC failure group and ERCS showed that there was a statistical difference in the amount of bleeding during delivery among the three groups(P<0.05).The amount of bleeding in TOLAC failure group group was higher than that in VBAC group,which was statistically significant(P<0.05).There was no significant difference in Apgar scores at 1 minute,5 minutes and 10 minutes among the three groups(P>0.05).The birth weight of newborns in the VBAC group was lower than that in the Tolac group,with a statistical difference(P<0.05),and the hospitalization time and hospitalization expenses of mothers in the VBAC group were significantly lower than those in the other two groups.4.Univariate logistic regression model found that the risk of trial delivery failure increased by 0.649 times for every 1 point decrease in cervical score(or=1.649,95%Cl:1.323-2.055).Second:Effects of different methods of induced labor and intervention on maternal and infant outcomes of VBAC1.The comparison of basic clinical data between the natural parturient group and the induced labor group showed that there was no significant difference between the two groups in age,delivery interval,pregnancy times,delivery times,BMI before delivery,gestational weeks of delivery and the proportion of natural delivery history(P>0.05);The cervical score of induced labor group was significantly higher than that of natural labor group[(4.0±0.9),(5.9±0.9),t=-11.7],P<0.01.2.Natural parturient group,water bag+oxytocin group and oxytocin group,to compare the parturient effects of the three groups.After comparison,there was no significant difference in the total labor time,postpartum hemorrhage,perineum laceration or lateral incision,and Apgar score of newborns among the three groups(P>0.05).In terms of hospitalization days,compared with the natural labor group,the number of hospitalization days in the water capsule+oxytocin group was less,and the difference was statistically significant(P<0.05);However,there was no significant difference between oxytocin group,natural labor group and water bag+oxytocin group(P>0.05).In terms of hospitalization expenses,compared with the natural labor group,the hospitalization expenses of oxytocin group were less,and the difference was statistically significant(P<0.05);However,there was no significant difference in hospitalization expenses between the water capsule+oxytocin group,the natural labor group and the oxytocin group(P>0.05).3.According to the different intervention methods adopted in the delivery process,120 cases of parturients who delivered via vagina were divided into three groups:no analgesia group,doula group and painless group,and the clinical effects of the three groups of parturients were compared.After comparison,there was no significant difference among the three groups in postpartum hemorrhage,perineal laceration or lateral incision,hospitalization days,hospitalization expenses and Apgar score of newborns(P>0.05).In terms of total labor process time,the total labor process time of Doula group and painless group was shorter than that of the group without analgesia(P<0.05)4.According to the different manual intervention methods,152 parturients undergoing vaginal trial delivery were divided into three groups:no analgesia group,doula group and painless group,and the labor effects of the three groups were compared.The success rate of vaginal delivery in the non intervention group was 80.82%,the success rate of vaginal delivery after Doula delivery intervention was 81.67%,and the success rate of vaginal delivery in the analgesic delivery group after intervention was 73.68%It can be seen that the success rate of vaginal delivery after corresponding clinical intervention is significantly higher than that without intervention(P<0.05).In addition,there was no uterine rupture in all groups during delivery,and there was no statistical difference between the two groups(P>0.05).Conclusions:1.As long as the corresponding indications and contraindications of vaginal delivery of cicatricial uterus are strictly controlled,vaginal delivery of cicatricial uterine pregnancy is proved to be safe and feasible again.2.The main factors affecting the success of TOLAC are the weight before delivery,the weight of the newborn and the cervical score.3.Appropriate clinical methods of induction of labor in VBAC mothers,such as low balloon placement combined with oxytocin intravenous drip or direct oxytocin intravenous drip,can reduce the patient’s hospitalization costs and hospitalization days without increasing the risk of mother and baby.4.Appropriate clinical interventions,such as Doula and analgesia delivery,can shorten the labor process,get humanistic care,reduce the pain time of uterine contraction,and will not increase the risk of uterine rupture,greatly improve the success rate of vaginal delivery,and will not affect the maternal and infant outcomes.The VBAC of our hospital has reached the national level.Within the scope of meeting the standard of vaginal trial delivery,VBAC mothers do not have serious perinatal complications,which is safe and feasible;it is of great significance to carry out comprehensive pregnancy management and individualized evaluation for pregnant women who become pregnant again after cesarean section,prepare various measures in advance,and formulate a set of Tolac scheme suitable for pregnant women who become pregnant again after cesarean section in our hospital,which can effectively reduce the cesarean section rate of pregnant women and improve the VBAC rate and maternal and infant outcomes.