Analysis of successful outcome of vaginal delivery in pregnant women after cesarean section and mother-infant outcome

CHEN Minfang

Abstract：Objective To investigate the factors related to the success of vaginal delivery (VBAC) and maternal-infant outcome after cesarean delivery (CD).Methods A retrospective analysis was made on 112 pregnant and maternal cases of TOLAC admitted to our hospital from January 2012 to May 2016. 70 cases of vaginal delivery were successfully divided into VBAC group, 42 cases of vaginal trial production failure, which were divided into control group. The correlation factors between the two groups were compared, and the most important factors affecting the success rate of VBAC were analyzed by logistic regression multivariate analysis. Two groups of pregnant women and neonates were analyzed.Results VBAC single factor analysis: significant differences were detected between VBAC group and control group in the prenatal BMI, gestational weeks, the time of last cesarean section, the history of vaginal delivery, the cervix dilation at admission, and whether the labor was admitted to hospital (P<0.05). Multivariate analysis: Prenatal BMI<30 kg/m2, gestational age less than 40 weeks, with a history of vaginal delivery, admission dilatation is more than 6 cm, from the last cesarean section in 2-6 years time, is the labor group of VBAC has an influence on the success rate. Prenatal BMI (OR=1.782), estational age (OR=1.876), whether there is a history of vaginal delivery (OR=2.129), from the last cesarean section time (OR=1.123), admission dilatation (OR=1.086); in hospital before delivery (OR=1.105). We can conclude that the biggestOR value was detected in patients with a history of vaginal delivery, which is the most important factor in the success rate of VBAC. In the VBAC group, the hospital stay, postpartum infection rate and bleeding volume were significantly lower or lower than the control group (P<0.05). The incidence of pneumonia and the incidence of asphyxia were not significantly different between the two groups (P>0.05) .Conclusion Many factors affected the success rate of VBAC, including the prenatal BMI<30 kg/m2, gestational age of≤40 weeks gestation, vaginal delivery history, admission cervix dilation≥6 cm, from the last cesarean section in 2-6 years. Rate of vaginal birth is the most important factor affecting the success rate of VBAC. More importantly, the perinatal maternal situation can be greatly improved through vaginal trial production in patients treated with cesarean section after pregnancy again.