The Clinical Analysis Of Trial Of Labor After Cesarean

Objective: Cesarean section is a kind of medical measure for treatment of high-risk pregnancy and dystocia effectively.And now,non medical indications of cesarean section increased gradually.With the implementation of two--child policy,pregnant after cesarean section was increased gradually,the mode of delivery has caused obstetrician's attention.Because of the medical level in our country is unequal,the relationship beween doctor and patient are tensely,and other comprehensive factors,the majority of pregnant women after cesarean section were to cesarean section again,which includes those pregnant women who match the conditions that can delivery by vaginal,while the lever of trial of labor after cesarean is always very low in our country.Vaginal birth after cesarean can avoid the injury of re-cesarean section,reducing the amount of bleeding and hospitalization days,and it is help for women's recovery.Based on the status of delivery in our country,the relevant analysis is less.At present,we will explore the trial of labor after cesarean and reasons of cesarean again in our hospital,and to compare the stage of labor,postpartum hemorrhage,perineal laceration,the rate of operative vaginal delivery and neonate asphyxia in the pregnant women after cesarean section and pregnant women who have no history of cesarean,and analysis which factor is helpful to VBAC,to provide guidance for clinic,to promote delivery naturely.Methods:This is a retrospective case-control study.The pregnant women were head position,single pregnancy after cesarean section,and match the conditions that can delivery by vaginal and have willings to trial of labor,waitting for parturition in the Forth Hospital of Hebei Medical University between January 2015 to January 2017,the total number was 87 cases as the trial of labor after cesarean group;Over the same period,the pregnant women who had non history of cesarean section were 2364 cases,as 1:10 selected 236 cases randomly,including 202 cases who were single fetal,head position trial of lab-or,as the trial of labor non scar uterus group,to explore the mode of delivery and the outcomes of maternal and baby by vaginal delivery;and to analysis the factors were favorable to vaginal birth after cesarean.The pregnant women with history of cesarean section need match the follwing conditions:(1)Singleton and head position,(2)without serious complications,(3)the maternnal's pelvis is normal,(4)the indiction of previous cesarean section is non exist,(5)with history of lower uterine cesarean section,no incision extension,no wound infection,(6)the pregnant women and families support to trial of labor,understanding the risks and sign consent form.For pregnant women without history of cesarean section to trial of labor need to match above(1)(2)(3)(6).Comparing two groups' s the stage of labor,the trial of labor after cesarean section group choose with history of once cesarean section and this is the first time to tial vaginal delivery,the trial of labor non scar uterus group choose primipara.Application of SPSS21.0 statistical software,the measurement normal distribution data compared with the use of Student t test;do not meet the normal distribution,use the median and Mann Whitney U test,The comparison of the rates using chi-squared,Logistic regression was used to analysis the risk factors.P<0.05 indicated that the difference was statistically significant.Results:1 The condition of trial of labor:The total number of delivery in our hospital was 2907 cases from January 2015 to January 2017,including 543 cases have the history of cesarean section,87 cases match the trial of labor's conditions and have the willingness,the rate of trial was 16.02%(87/543),64 cases was vaginal delivery,and the successful rate was 73.56%(64/87),23 cases were converted to cesarean section again;the trial of non uterine scar group were 202 cases,181 cases were vaginal delivery,and the successful rate was 89.60%,21 cases were converted to cesarean section.The rate is different between the two groups(P<0.05).2 The reasons of re-cesarean section:the trial of labor after cesarean converted to cesarean section was maternal intolerance the pain ofcontractions and tension(26.09%,6/23),persistent occipitotransverse and occipitoposterior or high straight(21.74%,5/23);the trial of non uterine scar group converted to cesarean section is persistent occipitotransverse and occipitoposterior(38.10%,8/21)and abnormal labor(33.33%,7/21).3 There was no significant difference in maternal age,gestational age and neonatal weight between the two groups(P>0.05).The trial of labor after cesarean's distance of previous cesarean section time was(4.75±2.28)y,the average thickness of scar is(0.32±0.07)cm.4 No statistically significant in the first and third stage of labor time between the two groups(P>0.05);the trial of labor after cesarean group in the second stage of labor time was shoter than the trial of non uterine scar group,the difference was statistically significant(P<0.05);the trial of labor after cesarean group's postpartum was more than the trial of non uterine scar group,the difference was statistically significant(P<0.05).5 No statistically significant in the rate of I and II degree perineal tear injury between the two groups(P>0.05);in the trial of labor after cesarean group,the rate of episiotomy(67.2% vs 35.4%,OR 3.743,95%CI 2.046-6.850)and operative vaginal delivery(17.2%vs2.8%,OR 7.306,95%CI 2.430-21.966)were higher than the trial of non uterine scar group..6 The rate postpartum hemorrhage was no statistically between the two group(P>0.05);the trial of labor after cesarean group had 1 cases of uterine rupture.7 The rate of neonatal asphyxia was no significant difference between the two groups(P>0.05).8 Pre-pregnancy BMI index,cervical Bishop score and psychological factors were important factors affecting vaginal birth after cesarean.Conclusions:1 VBAC is feasible and safe,does not affect the time of labor,only the blood loss is a little more,the rate of perineotomy and operative vaginal delivery is slightly higher,but does not increase the rate of postpartum hemorrhage and neonatal asphyxia;pre-pregnancy BMI index,the maturity of cervical andpsychological factors is relate with VBAC closely.2 We should establish the management of VBAC,to guide pregnancy,strengthen the education of VBAC,and have a good relationship between doctor and patient,increasing the trust between doctor and patient,paying attention to humanistic care,creating a safe and comfortable environment to delivery.The strict monitoring system and the ability of emergency cesarean section are important conditions to ensure the safety of mother and baby.