Value of clinical guidelines for vaginal birth after cesarean delivery

Abstract

Objective To assess the value of clinical guidelines for safe and successful implementation of vaginal birth after cesarean (VBAC).Methods A retrospective study was conducted,which included 2 002 cases with prior cesarean delivery in the First Maternity and Infant Hospital Affiliated to Tongji University,from January 2009 to July 2013.A total of 116 women with singleton live births and one prior cesarean delivery who attempted VBAC were included.The cases were divided into two groups according to the time of implementation of the VBAC guidelines of our hospital:the research group (n=95) and the control group (n=21).Pregnancy outcomes were evaluated according to whether the VBAC guidelines were implemented.Main outcome measures included the rates of attempting VBAC,postpartum hemorrhage,uterine rupture,neonatal Apgar score and admittance to neonatal unit.Chi-square or t-test were used to analyze the data.Results Following implementation of the VBAC guidelines from January 2012,the rate of trial labor increased to 11.1％ (95/855),compared to 1.8％ (21/1 147) before implementation of the VBAC guidelines.In the research group,93 cases (97.9％,93/95) were successful in VBAC and only two cases failed due to fetal distress or a protracted active phase.The mean intrapartum blood loss in the research group was (246± 127) ml,which was lower than that in the control group [(260±35) ml,t=0.50,P＞0.05].Puerperal morbidity occurred in one patient (1.0％) in the research group,which was higher than that in the control group [0 (0.0％)] (P＞0.05).The length of hospitalization in the research group was (2.1 ±0.8) d,which was longer than that in the control group [(2.1-±-0.5) d,t=0.22,P＞0.05].The neonatal 1 min Apgar score was 8-10 in 88 cases (92.6％) and 4-7 in seven cases (7.4％) in the research group; while the 1 min Apgar score in the control group was 8-10 in all 21 cases (100％) (x2=1.64,P＞0.05).None of the above showed significant difference between the two groups.The mean neonatal birth weight in the research group was (3 290± 632) g,which was higher than that in the control group [(2 837±1 057) g,t=-2.59,P＜0.05].Seventeen neonates (17.9％) in the research group were admitted to neonatal units,which was lower than that in the control group [8 (33.1％),x2=4.15,P＜0.05].There were no serious complications such as uterine rupture,hysterectomy or maternal death in the two groups.Conclusions The value of VBAC guidelines for the safe and successful implementation of VBAC is significant.These guidelines help to ensure maternal and fetal safety,and reduce serious complications caused by failed VBAC. Key words: Vaginal birth after cesarean; Postpartim hemorrhage; Uterine rupture; Pregnancy outcome