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| The influence factors of vaginal trial of labor of pregnant women with scar uterus and their pregnancy outcomes by different delivery modes |
| Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University (Nanjing Maternal and Child Health Care Hospital), Jiangsu Province, 210000 |
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Abstract Objective: To explore the influencing factors of vaginal trial of labor after previous cesarean delivery (TOLAC), and to study the pregnancy outcomes after different delivery modes. Methods: From February 2017 to September 2018, 200 pregnant women with scar uterus were divided into two groups according to the prospective cohort study criteria and the desire to give birth of these women. The 63 women in group B were given cesarean delivery, and 137 women in the group A were given TOLAC, which included 114 women with successful TOLAC and 23 women with TOLAC failure. Pregnancy outcomes and neonatal status in each group were recorded, and logistic multivariate analysis was used to analyze the influencing factors of TOLAC. Results: In group A, 114 (83.2%) women were successful TOLAC, and 23 women were TOLAC failure, which included 18 women given up vaginal trial labor due to intense pain during labor, 2 women with persistent posterior occipital position, one woman with tenderness of the lower uterine segment and pain of lower abdomen intensified during uterine contraction, and 2 women because of amniotic fluid Ⅲ degree meconium contamination. In group A, maternal age, BMI, in hospital about to give birth, history of natural labor, and cervix uteri dilatation to be hospital were independent factors for influencing the success of TOLAC. There were no difference in puerperal time, postpartum hemorrhage rate, intrapartum weakness rate, fetal distress rate, neonatal asphyxia rate, and neonatal birth weight between group A and group B (P>0.05), but neonatal Apgar score at 1min after born in group A was significant higher than that in group B (P<0.05). Conclusion: The women > 30 years old and BMI > 30kg/m2 can increase the risk of TOLAC failure. The pregnant women with a history of natural delivery, or their cervix uteri dilatation well when admits to hospital, or to be hospital immediately when about to give birth can improve the success rate of TOLAC. TOLAC does not lead to adverse pregnancy outcomes, but the indications of TOLAC still should be controlled strictly to ensure the safety of women who wanted for TOLAC.
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