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

doi:10.3877/cma.j.issn.2095-3259.2019.04.010

Abstract

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<0.001). The rate of prenatal vaginal bleeding in VBAC group (6.3%, 4/64) was higher than that in VBAC group (1.2%, 3/259), P=0.033; There was no significant difference in both groups in the Bishop score, amniotic fluid index and amniotic fluid volume (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<0.001); The uterine rupture rate in the TOLAC failure group was 3.2%(2/64), higher than that in VBAC group (0/259), ( χ²=8.144, P=0.017); There was no significant difference in the ratio of postpartum hemorrhage equal or greater than 1000 ml between two groups (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<0.05). (5) Multivariate logistic regression analysis showed that the cephalopelvic score of pregnant women (OR=0.610, 95%CI: 0.420~0.887, P=0.010) and fetal weight >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

Zhengping Liu, Shuzhen Wu, Jiaming Rao, Ruifeng Ou, Demei Lu, Yan Liu. The analysis of safety and influencing factors of the vaginal birth after cesarean section[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2019, 08(04): 235-240.

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Figures/Tables 3

References 18

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一般情况及产前检查		VBAC组(n＝259)	TOLAC失败组(n＝64)	t/χ²值	P值
年龄(岁)		?	?	1.752	0.625
?	<30(例，%)	104(40.2)	27(42.2)	?	?
?	30～34(例，%)	109(42.1)	22(34.4)	?	?
?	35～40(例，%)	42(16.2)	14(21.9)	?	?
?	≥40(例，%)	4(1.5)	1(1.6)	?	?
学历(%)		?	?	0.841	0.657
?	小学及以下(例，%)	10(3.9)	1(1.6)	?	?
?	中学(例，%)	148(58.3)	38(60.3)	?	?
?	大学及以上(例，%)	96(37.8)	24(38.1)	?	?
身高(cm，±s)		157.4±5.2	157.7±5.2	0.169	0.681
孕前或孕前12周体重(kg，±s)		54.0±7.5	55.4±6.9	1.053	0.306
入院时体重(kg，±s)		65.0±7.9	65.5±7.0	0.243	0.622
入院时BMI(±s)		26.19±2.96	26.30±2.85	0.077	0.782
孕次(±s)		2.99±1.02	3.08±1.24	0.363	0.547
产次(±s)		1.26±0.51	1.20±0.57	0.578	0.448
既往顺产史(例，%)		61(23.6)	10(15.6)	1.880	0.170
Bishop评分(±s)		7.61±2.40	7.61±1.88	0	0.983
头盆评分(±s)		7.77±1.15	7.16±0.70	4.891	<0.001
羊水指数(±s)		111.00±85.5	106.10±35.70	0.156	0.693
羊水最大深度(mm，±s)		42.18±13.60	45.50±13.00	2.740	0.099
产前阴道出血率(例，%)		3(1.2)	4(6.3)	－	0.033^a

一般情况及产前检查		VBAC组(n＝259)	TOLAC失败组(n＝64)	t/χ²值	P值
年龄(岁)		?	?	1.752	0.625
?	<30(例，%)	104(40.2)	27(42.2)	?	?
?	30～34(例，%)	109(42.1)	22(34.4)	?	?
?	35～40(例，%)	42(16.2)	14(21.9)	?	?
?	≥40(例，%)	4(1.5)	1(1.6)	?	?
学历(%)		?	?	0.841	0.657
?	小学及以下(例，%)	10(3.9)	1(1.6)	?	?
?	中学(例，%)	148(58.3)	38(60.3)	?	?
?	大学及以上(例，%)	96(37.8)	24(38.1)	?	?
身高(cm，±s)		157.4±5.2	157.7±5.2	0.169	0.681
孕前或孕前12周体重(kg，±s)		54.0±7.5	55.4±6.9	1.053	0.306
入院时体重(kg，±s)		65.0±7.9	65.5±7.0	0.243	0.622
入院时BMI(±s)		26.19±2.96	26.30±2.85	0.077	0.782
孕次(±s)		2.99±1.02	3.08±1.24	0.363	0.547
产次(±s)		1.26±0.51	1.20±0.57	0.578	0.448
既往顺产史(例，%)		61(23.6)	10(15.6)	1.880	0.170
Bishop评分(±s)		7.61±2.40	7.61±1.88	0	0.983
头盆评分(±s)		7.77±1.15	7.16±0.70	4.891	<0.001
羊水指数(±s)		111.00±85.5	106.10±35.70	0.156	0.693
羊水最大深度(mm，±s)		42.18±13.60	45.50±13.00	2.740	0.099
产前阴道出血率(例，%)		3(1.2)	4(6.3)	－	0.033^a

临床结局			VBAC组(n＝259)	TOLAC失败组(n＝64)	t/χ²值	P值
母亲结局			?	?	?	?
?	产后24 h总出血量(ml，±s)		322±96	501±215	9.99	<0.001
?	产后出血≥500 ml(例，%)		7(2.8)	33(51.6)	105.500	<0.001
?	产后出血≥1000 ml(例，%)		0	1(1.6)	－	0.203^a
?	输血率(例，%)		3(1.2)	2(3.1)	－	0.258^a
?	子宫破裂率^b(例，%)		0	2(3.2)	8.144	0.017
新生儿结局			?	?	?	?
?	胎龄(周，±s)		37.6±2.7	38.5±2.7	5.764	0.017
?	新生儿性别		?	?	0.004	0.947
?	?	男(例，%)	159(61.4)	39(60.9)	?	?
?	?	女(例，%)	100(38.6)	25(39.1)	?	?
?	出生体重(g)		2941.9±574.7	3243.1±555.1	14.283	<0.001
?	?	胎儿身长(cm，±s)	48.1±3.5	49.3±3.0	7.172	0.008
?	?	胎儿头围(cm，±s)	32.0±1.9	32.8±2.0	9.932	0.002
?	?	胎儿胸围(cm，±s)	31.7±2.5	32.8±2.6	9.964	0.002
?	1 min Apgar评分(分)		?	?	10.545	0.005
?	?	0～2(例，%)	2(0.8)	2(3.1)	?	?
?	?	3～6(例，%)	0	2(3.1)	?	?
?	?	7～10(例，%)	257(99.2)	60(93.8)	?	?
?	5 min Apgar评分		?	?	4.544	0.103
?	?	0～2(例，%)	2(0.8)	0	?	?
?	?	3～6(例，%)	0	1(1.6)	?	?
?	?	7～10(例，%)	257(99.2)	63(98.4)	?	?
?	即时转新生儿科(例，%)		29(11.2)	9(14.1)	0.406	0.524

临床结局			VBAC组(n＝259)	TOLAC失败组(n＝64)	t/χ²值	P值
母亲结局			?	?	?	?
?	产后24 h总出血量(ml，±s)		322±96	501±215	9.99	<0.001
?	产后出血≥500 ml(例，%)		7(2.8)	33(51.6)	105.500	<0.001
?	产后出血≥1000 ml(例，%)		0	1(1.6)	－	0.203^a
?	输血率(例，%)		3(1.2)	2(3.1)	－	0.258^a
?	子宫破裂率^b(例，%)		0	2(3.2)	8.144	0.017
新生儿结局			?	?	?	?
?	胎龄(周，±s)		37.6±2.7	38.5±2.7	5.764	0.017
?	新生儿性别		?	?	0.004	0.947
?	?	男(例，%)	159(61.4)	39(60.9)	?	?
?	?	女(例，%)	100(38.6)	25(39.1)	?	?
?	出生体重(g)		2941.9±574.7	3243.1±555.1	14.283	<0.001
?	?	胎儿身长(cm，±s)	48.1±3.5	49.3±3.0	7.172	0.008
?	?	胎儿头围(cm，±s)	32.0±1.9	32.8±2.0	9.932	0.002
?	?	胎儿胸围(cm，±s)	31.7±2.5	32.8±2.6	9.964	0.002
?	1 min Apgar评分(分)		?	?	10.545	0.005
?	?	0～2(例，%)	2(0.8)	2(3.1)	?	?
?	?	3～6(例，%)	0	2(3.1)	?	?
?	?	7～10(例，%)	257(99.2)	60(93.8)	?	?
?	5 min Apgar评分		?	?	4.544	0.103
?	?	0～2(例，%)	2(0.8)	0	?	?
?	?	3～6(例，%)	0	1(1.6)	?	?
?	?	7～10(例，%)	257(99.2)	63(98.4)	?	?
?	即时转新生儿科(例，%)		29(11.2)	9(14.1)	0.406	0.524

影响因素		回归系数	标准误	Wald χ值	P值	OR(95%CI)
头盆评分		－0.494	0.191	6.711	0.010	0.610(0.420～0.887)
胎儿出生体重(g)^a		?	?	?	?	?
?	3000～3499	0.866	0.517	2.803	0.094	2.377(0.863～6.551)
?	3500～3999	1.565	0.616	6.462	0.011	4.783(1.431～15.989)
?	>4000	2.775	1.280	4.704	0.030	16.042(1.306～196.983)

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