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| Effect of different delivery methods on pregnant again pregnancy outcome and neonatal status after cesarean section |
| ZHANG Shan-shan LIANG Xu-xia▲ WEI Yan-fen |
| Department of Obstetrics, Guangxi Zhuang Autonomous Region People′s Hospital, Nanning 530021, China |
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Abstract Objective To investigate the effect of different delivery methods on pregnant again pregnancy outcome and neonatal status after cesarean section. Methods A total of 535 cases of pregnant again natural labor after cesarean section who were admitted to our hospital from January 2018 to January 2019 were selected as the research object, they were divided into vaginal trial of second pregnancy after cesarean section (TOLAC) group (182 patients) and the choice of second cesarean section (ERCS) group (353 patients), different delivery methods were selected according to the wishes of the mother. The TOLAC group was divided into the TOLAC success group (135 cases) and the TOLAC failure group (47 cases) according to the final delivery method. The success rate of TOLAC, vaginal assisted delivery, and trial delivery failure to cesarean delivery were recorded. The basic conditions, maternal delivery complications, and neonatal conditions of the three groups were compared; the vaginal trials of the TOLAC group were analyzed. Results The time since previous cesarean section in the ERCS group was longer than that of TOLAC successful group and TOLAC failure group, the differences were statistically significant (P＜0.05). The success rate of TOLAC vaginal delivery was 74.2%(135/182), the vaginal delivery rate was 6.7% (9/135),and the rate of transfer to cesarean section was 25.8%(47/182). There were no significant differences in the amount of postpartum hemorrhage, incidence of serious postpartum hemorrhage, blood transfusion rate, coagulation dysfunction, incomplete uterine rupture, intestinal obstruction, incidence of deep vein thrombosis, birth weight of newborn and incidence of neonatal asphyxia among the three groups (P＞0.05). The incidence rate of tocolytic weakness in the TOLAC success group was lower than that in the TOLAC failure group and the ERCS group, the differences were statistically significant (P＜0.05). The incidence rate of puerperal infection in the TOLAC successful group was lower than that in the ERCS group, the difference was statistically significant (P＜0.05). The incidence rate of chorioamnionitis in the TOLAC failure group was higher than that in the ERCS group, the difference was statistically significant (P＜0.05). Conclusion Under the premise of strictly grasping the indications of TOLAC, it is safe and feasible for vaginal delivery of natural parturients to be pregnant again after cesarean section. The success rate of TOLAC vaginal delivery is more than 70%. Compared with ERCS, TOLAC reduces the incidence of puerperal infections. And shorten the length of hospitalization, have a better outcome of mother and child. The failure of TOLAC increases the incidence of chorioamnionitis, and the mother and infant situation should be closely monitored during the labor process.
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