Clinical analysis of 1 068 pregnant women with previous cesarean section in Northern China

Abstract

Objective To investigate the delivery mode of pregnant women with prior cesarean section in Northern China, and their clinical characteristics. Methods A multi-center observational study of 1 068 women who had prior cesarean delivery in 24 medical centers in Northern China was conducted between December 2013 and May 2014. The clinical data, including general condition, antenatal examination results, delivery mode, and maternal and fetal outcomes, were collected and compared between vaginal delivery and cesarean section. Mann-Whitney U test and Chi-square test were used for statistical analysis. Results The median age of the 1 068 women were 32 years (range, 18-45 years). Thirty-seven (3.5%) had a history of prior vaginal delivery. There were seven twin pregnancies and all delivered by cesarean section. Thirty-five women had suspected uterine rupture and underwent cesarean section, but were confirmed without uterine rupture during the operation. There was no maternal and fetal/neonatal death. Of the 1 068 women, 43(4.0%) had successful vaginal birth and 1 025 (96.0%) underwent repeat cesarean sections. Compared with cesarean section group, vaginal delivery group tended to have a greater thickness of the lower uterine segment in the third trimester as shown by ultrasound [(3.3±0.9) vs (2.9±1.1) mm, Z=-2.240, P=0.025], a higher percentage of prior vaginal delivery [16.2%(6/37) vs 4.6%(31/673), χ2=9.570, P=0.009], a lower rate of regular antenatal examination [58.1%(25/43) vs 73.2%(742/1 013), χ2=4.737, P=0.026], a shorter hospital stay[(3.7±2.4) vs (5.9±3.8) d, Z=-6.043, P=0.000], and lower 1-min Apgar score (9.1±2.2 vs 9.9±3.9, Z=-2.410, P=0.016), but without difference in the 5-min Apgar score (9.9±0.4 vs 9.6±1.3, Z=-0.947, P=0.344). Conclusions Rate of vaginal delivery for women with prior cesarean section in Northern China is low. Vaginal birth with prior cesarean section is relatively safe, especially for those with a previous history of vaginal delivery. Key words: Vaginal birth after cesarean; Trial of labor; Delivery, obstetric; Multicenter study