Clinical analysis of delivery mode of 576 cases of re-pregnancy after cesarean section / 中国基层医药

ABSTRACT

Objective To explore the choice of re - pregnancy delivery mode after cesarean section. Methods From January 2015 to December 2017,a retrospective study was performed on 576 pregnant women who received re-pregnancy after cesarean section in National Nuclear Corporation 416 Hospital and randomly selected 40 cases of vaginal birth after cesarean delivery(VBAC),40 cases of cesarean section after trial of labor after cesarean delivery(TOLAC) and 40 cases of elective repeat cesarean delivery(ERCD) for comparative analysis.The postpartum hemorrhage,neonatal Apgar score, hospitalization time, hospitalization expenses and complication were compared. Results All the 159 pregnant women chose transvaginal trials and 112 had successful vaginal delivery.The success rate of delivery was 70.4%.Compared with the other two groups,the VBAC group had less postpartum hemorrhage [(172.50 ± 59.86) mL,(281.25 ± 192.05 ) mL, ( 260.00 ± 125.68 ) mL],less average hospital stay [(3.9 ± 0.9)d,(5.7 ± 1.5) d, (4.6 ± 0.7) d] and lower medical expenses [(6 491.79 ± 1 104.78), (11 871.96 ± 1 784.30),(10 724.69 ± 1 843.63 )], and the differences were statistically significant ( F =7. 086,26. 243, 123.488;P=0.001,0.000,0.000).The neonatal Apgar score,incidence rates of complications ( incomplete uterine rupture,postpartum hemorrhage,urinary retention,thrombotic disease and neonatal conversion) had no statistically significant differences between the two groups ( all P>0.05).The TOLAC failed to change to the cesarean section group compared with the ERCD group,the average hospitalization cost was more [(11 871.96 ± 1 784.30) CNY, (10 724.69 ± 1 843.63)CNY],the average hospitalization days was longer [(5.7 ± 1.5) d,(4.6 ± 0.7) d],the difference was statistically significant (P=0.000,0.005).The postpartum hemorrhage volume,neonatal Apgar score, complications had no statistically significant differences between the two groups( all P>0.05).Conclusion It is safe and feasible to perform vaginal trials under close monitoring without vaginal trials. It is safe and feasible to perform vaginal trials under strict monitoring.Even if the vaginal trial fails to change to cesarean section,it will not increase the occurrence of serious complications.Infant outcomes are good.