The analysis of safety and influencing factors of the vaginal birth after cesarean section

Abstract

Objective To explore the safety and influence factors of vaginal delivery after cesarean section (VBAC). Methods Retrospectively studied the clinical data of pregnant women undergoing trial of labor after cesarean section (TOLAC) delivered from Foshan Maternal and Child Health Hospital from January 2017 to October 2018. It was divided into the successful group (vaginal birth after cesarean section, VBAC group) and the failure group (trial of labor after cesarean section, TOLAC failure group) based on whether has a success in vaginal birth. Compared the outcomes of VBAC group and TOLAC failure group, and analyzed the independent influence factors of VBAC by multivariate logistic regression. Results (1) From January 2017 to October 2018, a total of 323 pregnant women were admitted to the hospital. The rate of VBAC was 80.2% (259/323); the rate of TOLAC failure was 19.8% (64/323); and the rate of uterine rupture was 0.62% (2/323), occurred in the TOLAC failure group. Both groups had no hysterectomy occurred. (2) The VBAC group′s cephalopelvic score (7.77±1.15) was higher than the TOLAC failure group (7.16±0.70), (t=4.891, P 0.05). (3) The proportion of postpartum hemorrhage equal or greater than 500 ml in the TOLAC failure group was 51.6%(33/64), higher than VBAC group (2.8%, 7/259), ( χ2=105.500, P 0.05). (4) The VBAC group had lower gestational week, birth weight, body length, head circumference and chest circumference than the TOLAC failure group, and the APGAR score in one min was higher than the TOLAC failure group with significant difference (P 3500 g or 4000 g(OR=4.783, 95%CI: 1.431~15.989, P=0.011; OR=16.042, 95%CI: 1.306~196.983, P=0.030)were the independent factors to influence VBAC. Conclusions Under the strict exclusion criteria, systematic prenatal assessment and delivery management, TOLAC is safe and also with high VBAC rate. The cephalopelvic score of pregnant women and fetal weight are the independence factors of VBAC. Key words: Vaginal delivery after cesarean section; Cesarean section; Trial of labor