Analysis of Factors and Maternal and Fetal Outcomes for Successful Trial of Labor after Cesarean Section
Objective:To explore the factors of trial of labor after cesarean(TOLAC)and analyze the outcomes of mother and fetus.Methods:A total of 308 pregnant women who underwent TOLAC in the Department of Ob-stetrics of Chengdu Women and Children Center Hospital from January 2019 to June 2023 were selected as the study group,and 308 pregnant women who underwent direct cesarean section with scarred uterus during the same period were selected as the control group.The study group was divided into two subgroups according to the successful results:vaginal delivery success group(VBAC group)and trial delivery failure to cesarean section group(RCD group).Clinical data such as the general conditions of pregnant women at admission and the out-comes of mother and fetus were recorded,and the univariate and multivariate analysis was performed to analyze the factors influencing success of VBAC.Results:①A total of 10243 pregnant women were pregnant again after cesarean section,with a TOLAC rate of 3.01％and 254 cases in the VBAC group,with a success rate of 82.46％.The top three factors for conversion surgery were suspected fetal distress,pain and unwillingness to try labor,sus-pected uterine rupture or threatened uterine rupture.②The 24-hour blood loss,newborn body mass,hospitaliza-tion days and hospitalization cost of the study group were lower than those of the control group(P＜0.05).In the study group,the 24-hour blood loss,newborn body mass,complication rate,hospitalization days and hospitaliza-tion cost in VBAC group were all lower than those in RCD group(P＜0.05).③There was no statistically signifi-cant difference in the incidence of neonatal asphyxia,blood transfusion and complications between the study group and the control group(P＞0.05).④The univariate analysis of factors affecting the success of VBAC showed that the height and Bishop score of pregnant women in VBAC group were higher than those in RCD group.Pregnant women in VBAC group had ruptured membranes at admission,had a history of delivery or in-duced labor for more than 24 weeks,and hadnatural labor was higher than those in RCD group.The uterine height and estimated fetal weight of pregnant women in VBAC group were lower than those in RCD group(P＜0.05).There was no statistically significant difference between the VBAC group and the RCD group in induction of labor by oxytocin and balloon plus oxytocin(P＞0.05).⑤Multivariate Logistic regression analysis showed that the height of pregnant women ≥ 160 cm(OR 2.461,95％CI 1.343-6.402)and Bishop score ≥6(OR 3.420,95％CI 1.224-9.560),membranous rupture on admission(OR 10.557,95％CI 1.295-86.075),and natural labor(OR 7.083,95％CI 2.659-18.868)were independent favorable factors for the success of VBAC(P＜0.05).Conclu-sions:Vaginal delivery after cesarean section has good social and economic benefits.For pregnant women who are willing to undergo TOLAC,a comprehensive assessment should be made based on the height,Bishop score,uterine height,fetal size,etc,when admitted to the hospital to improve the probability of successful delivery.At the same time,monitoring should be strengthened during delivery and early decision should be made to reduce adverse outcomes and ensure the safety of mother and fetus.
After cesarean sectionVaginal deliveryPregnancy outcome
万方数据
维普
