Parturition analysis of vaginal birth after cesarean section
REN Weijuan ZHANG Wei▲ XUN Shengli SUN Xiao WANG Yifang
Department of Obstetrics and Gynecology, Yangzhou Maternal and Child Care Hospital, Medical College, Yangzhou University, Jiangsu Province, Yangzhou 225002, China
Abstract：Objective To guide the clinical management of birth process of cesarean delivery after cesarean section to improve the safety of TOLAC, it focuses on the labor course of vaginal delivery after cesarean section. Methods A retrospective analysis was conducted on the maternal births delivered at the Maternal and Child Health Hospital of Yangzhou from January 2016 and July 2017: vaginal birth after cesarean section (VBAC), and no previous cesarean section 30 cases were VBAC group. 30 cases of vaginal delivery of non-scarring uterus during the same period were selected as the maternal group and 30 cases of primipara. The three groups were all natural labor, labor without oxytocin and artificial rupture of membranes and other interventions. The total production process, the first stage of labor, the second stage of labor, the third stage of labor were compared among three groups, postpartum hemorrhage and neonatal score were also compared. Results The total length of labor in the VBAC group was significantly shorter than that in the primipara group (P < 0.01), but there was no significant difference between the VBAC group and the multipara group (P > 0.05). The duration of the second stage of labor was significantly longer than that of the multipara group (P < 0.01). There was no significant difference between the VBAC group and the primipara group (P > 0.05). There was no significant difference in the third stage of labor between the three groups. Postpartum hemorrhage, neonatal Apgar score difference was not statistically significant (P > 0.05). Conclusion The clinical manifestations of the first stage labor of VBAC are similar to those of non-scarred vaginal delivery. The normal fetal heart rate allows for full vaginal trial. The second stage of labor of VBAC is similar to that of primipara and requires more patient observation of the second Labor. It is conducive to improving vaginal delivery rate after cesarean section, but large sample studies are necessary
[1] Scott JR. Intrapartum management of trial of labour after caesarean delivery：evidence and experience [J]. BJOG，2014，121（2）：157-162.
[2] Royal College of Obstetricians and Gynaecologists. Birth After Previous Caesarean Birth. Green-top Guideline No.45[EB/OL]. （2015-10-01） [2016-05-10].https：//www.rcog. org.uk/en/guidelines-research-services/guidelines/gtg45/.
[3] 余琳，苏春宏，王晓怡，等.剖宫产术后再次妊娠阴道试产的多中心临床研究[J].中华妇产科杂志，2016，51（8）：581-585.
[4] Mittal S，Pardeshi S，Mayadeo N，et al. Trends in cesarean delivery：rate and indications [J]. J Obstet Gynaecol India，2014，64（4）：251-254. DOI：10.1007/s13224-013-0491-2.
[5] Whitelaw N，Bhattacharya S，McLernon D，et al. Internet information on birth options after caesarean compared to the RCOG patient information leaflet； a web survey [J]. BMC PregnancyChildbirth，2014，14：361.DOI：10.1186/1471-2393-14-361.
[6] Sentilhes L，Vayssière C，Beucher G，et al. Delivery for women with a previous cesarean：guidelines for clinical practice from the French College of Gynecologists and Obstetricians （CNGOF） [J]. Eur J Obstet Gynecol Reprod Biol，2013，170（1）：25-32. DOI：10.1016/j.ejogrb.2013.05. 015.
[7] American College of Obstetricians and Gynecologists. ACOG Practice bulletin no. 115：Vaginal birth after previous cesarean delivery [J]. Obstet Gynecol，2010，116（2 Pt 1）：450-456. DOI：10.1097/AOG.0b013e3181eeb251.
[8] 中华医学会妇产科学分会产科学组.剖宫产术后再次妊娠阴道分娩管理的专家共识（2016）[J].中华妇产科杂志，2016，51（8）：561-564.
[9] Zelop CM，Shipp TD，Repke JT，et al. Outcomes of trial of labor following previous cesarean delivery among women with fetuses weighing>4000 g [J]. Am J Obstet Gynecol，2001，185（4）：903-905. DOI：10.1067/mob.2001.117361.
[10] 时春艳，李博雅.新产程标准及处理的专家共识（2014）[J].中华妇产科杂志，2014，49（7）：486-486.
[11] 张玲玲，任卫娟，荀生丽.妊娠期及分娩期子宫不同部位破裂11例临床特点及防治[J].实用临床医药杂志，2017，21（9）：202-204
[12] 王斯，李亚玲.妊娠期及分娩期宫颈功能变化的研究进展[J].河北医月药，2016，38（10）：1585-1587.
[13] 黄娟.剖宫产术对孕妇产后盆底功能及性功能的影响研究[J].现代诊断与治疗，2017，28（8）：1504-1505.
[14] Harper LM，Cahill AG，Boslaugh S，et al. Association of induction of labor and uterine rupture in women attempting vaginal birth after cesarean：a survival analysis [J]. Am J Obstet Gyneeol，2012，206（1）：51-55.
[15] 李航，马润玫，屈在卿.剖宫产后阴道试产子宫破裂的危险因素及其早期识别 [J]. 中华围产医学杂志，2015， 18（9）：705-708.
[16] Kok N，Wiersma IC，Opmeer BC，et al. Sonographicmeasurement of lower uterine segment thickness to predict uterine rupture during a trial of labor in wonlen with previous Cesarean section：a meta-analysis [J]. Ultrasound Obstet Gynecol，2013，42（2）：132-139.DOI：10.1002／uog.12479.
[17] Jastrow N，Vikhareva O，Gauthier RJ，et al. Can third-trimester assessment of uterine scar in women with prior Cesarean section predict uterine rupture [J]. Ultrasound Obstet Gynecol，2016，47（4）：410-414.Doh 10.1002／uog.15786.
[18] 陈锰，张力，杨帆，等.剖宫产术后瘢痕子宫孕妇的子宫下段厚度与再次妊娠后子宫破裂风险的研究进展[J].中华妇产科杂志，2017，52（6）：425-428.
[19] Bujold E，Jastrow N，Simoneau J，et al. Predictionof complete uterine rupture by sonographic evaluation of the lower uterine segment [J]. Am J Obstet Gynecol，2009， 201（3）：320.el-6.DOI：10.1016／j.ajog.2009.06.014.
[20] Martins WP，Barra DA，Gallarreta FM，et al. Lower uterine segment thickness measurement in pregnant women with previous Cesarean section：reliability analysis using two—and three—dimensional transabdominal and transvaginal ultrasound [J]. Ultrasound Obstet Gynecol，2009， 33（3）：301-306.DOI：10.1002／uog.6224.
2018, Vol. 15 
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