Investigation on the approach of delivery after previous cesarean section of Xinjiang Uyghur women

Abstract

To explore the appropriate approach of delivery after cesarean section of Uyghur women in primary hospitals in Xinjiang Uyghur Autonomous Region. A total of 5 154 women delivered in Luopu County People Hospital, Hetian Prefecture, Xinjiang Uyghur Autonomous Region from January 2011 to December 2012. Among them, 178 Uyghur women had cesarean section history. The interval between the previous cesarean section and this delivery varied from 1 year to 17 years. The number of cases attempting vaginal labor and the indications of the previous cesarean section were recorded. The indications for the second cesarean section were analyzed. The gestational weeks at delivery, blood loss in 2 hours after delivery, neonatal birth weight, newborn asphyxia, the rate of postpartum fever (≥ 38 °C) and hospitalization days were compared between the two approaches of delivery. (1) Among the 178 cases, 119 cases attempted vaginal labor, the rate of attempting vaginal labor was 66.9% (119/178). A total of 113 cases succeeded in vaginal delivery (the vaginal delivery group), with the successful rate of attempting vaginal delivery of 95.0% (113/119), and the successful rate of vaginal delivery was 63.5% (113/178). For those 119 women succeeded in vaginal delivery, the indications of the previous cesarean sections were as following: pregnancy complications (68.1%, 81/119), macrosomia(5.0%, 6/119), dystocia (14.3%, 17/119), pregnancies complicated with other diseases (5.0%, 6/119) and cesarean section on maternal request (7.6%, 9/119). (2) 15 cases in the cesarean section group had postpartum hemorrhage, with the incidence of 13.3% (15/113). The mean total labor time was (507 ± 182) minutes. 6 cases attempting vaginal delivery failed and turned to cesarean section. (3) 59 cases received the second cesarean section (the cesarean section group). The rate of second cesarean section was 33.1% (59/178). The indications of the second cesarean section were as following: contracted pelvis (5%, 3/59), pregnancy complications (42%, 25/59), macrosomia (20%, 12/59), short interval between the two cesarean sections (≤ 2 years); (12%, 7/59) and cesarean section on maternal request (20%, 12/59). (4) Gestational weeks at delivery, rates of newborn asphyxia in the vaginal delivery and cesarean section groups showed no significant statistical difference (P > 0.05). In the vaginal delivery group, the average blood loss in 2 hours after delivery was (259 ± 213) ml, the rate of postpartum fever was 10.6%, the mean fetal birth weight was (3 272 ± 477)g and the mean hospitalization was (1.8 ± 1.6) d. In the cesarean section group, they were (400 ± 320) ml, 54.2%, (3 539 ± 500)g and (8.7 ± 2.2)d, respectively. There was significant statistical difference (P < 0.01) between the two groups. Vaginal delivery after cesarean section could be attemped in Uyghur pregnant women in Xinjiang primary hospitals, if doctors could choose the indications strictly and monitor closely. These could increase the success rate and safety of vaginal delivery and therefore reduce the cesarean section rate.