[The influence of the intrapartum inventions on the maternal and neonatal outcomes of vaginal birth after cesarean]

Zhonghua Yi Xue Za Zhi. 2017 Feb 21;97(7):512-516. doi: 10.3760/cma.j.issn.0376-2491.2017.07.008.
[Article in Chinese]

Abstract

Objective: To investigate the maternal and neonatal outcomes after different intrapartum interventions for vaginal birth after cesarean (Vaginal Birth After Cesarean-section, VBAC). Methods: One hundred and forty three cases in Beijing Obstetrics & Gynecology Hospital, Capital Medical University from January 2015 to November 2016 were selected retrospectively.The relationship between the intrapartum inventions such as induction style, oxytocin usage and spinal analgesia and the maternal and neonatal outcomes such as delivery way, labor time, postpartum hemorrhage and fetal distress were analyzed in pregnant women underwent VBAC. Results: (1) Maternal and neonatal outcomes: No maternal and newborn deaths occurred in the 143 cases of VBAC.One hundred and thirteen cases underwent vaginal delivery (79.0%) and 30 cases underwent operative vaginal delivery (21.0%). Twenty-four cases (16.8%) occurred postpartum hemorrhage, 32 cases (24.3%) fetal distress, and 2 (1.4%) asphyxia.(2) Intrapartum inventions: 123 cases (86.0%) were spontaneous onset of labor and 20 cases (14.0%) induction of labor.41 cases (30.6%) used oxytocin during labor to strengthen contractions, 37 cases (25.9%) underwent spinal analgesia.The operative vaginal delivery rate in the induction labor group was significantly higher than that in natural labor group (P<0.05). The duration of the first stage, second stage and total labor in the group using oxytocin were significantly longer than those in the group not using oxytocin (P<0.05). The rate of operative vaginal delivery in the group using oxytocin was significantly higher than that in the group not using oxytocin (P<0.05). The duration of the first stage, second stage and total labor in analgesia group were significantly longer than those in the group not using analgesia (P<0.05). The incidence of postpartum hemorrhage and operative vaginal delivery in analgesia group was significantly higher than those in the group not using analgesia (P<0.05). Conclusion: Oxytocin may increase the rate of vaginal delivery in VBAC.Spinal analgesia and oxytocin may prolong the labor time and increase the incidence of postpartum hemorrhage in VBAC.

目的:探讨不同产时干预方法对剖宫产术后阴道分娩(VBAC)母婴结局的影响。 方法:回顾性分析2015年1月至2016年11月在首都医科大学附属北京妇产医院围产医学科实施剖宫产术后阴道分娩的143例孕妇。分析VBAC孕妇产时干预如临产方式、产程中缩宫素使用情况以及椎管内分娩镇痛与母婴结局如分娩方式、产程时限、产后出血及胎儿窘迫的关系。 结果: (1)母婴结局:143例VBAC中无孕产妇及新生儿死亡。阴道分娩113例(79.0%),产钳助产30例(21.0%),24例(16.8%)发生产后出血,32例(24.3%)胎儿窘迫,2例(1.4%)新生儿窒息。(2)产时情况:123例(86.0%)自然临产,20例(14.0%)引产,41例(30.6%)在产程中使用缩宫素加强宫缩,椎管内分娩镇痛37例(25.9%)。按照不同的干预方式比较发现:引产组的产钳助产率明显高于自然临产组(P<0.05),使用缩宫素者组的第一、第二及总产程时限明显长于未使用缩宫素组(P<0.05),使用缩宫素组的产钳助产率明显高于未使用缩宫素组(P<0.05),分娩镇痛组的第一、第二及总产程时限明显长于未使用分娩镇痛组(P<0.05),分娩镇痛组产后出血的发生率及产钳助产率明显高于未使用分娩镇痛组(P<0.05)。 结论:引产和催产可能会增加VBAC的产钳助产率,分娩镇痛及使用缩宫素可能延长VBAC产程时限,分娩镇痛可能增加VBAC的产后出血发生率及产钳助产率。.

Keywords: Labor analgesia; Oxytocin; VBAC.

MeSH terms

  • Cesarean Section
  • Female
  • Humans
  • Infant, Newborn
  • Labor, Induced
  • Postpartum Hemorrhage
  • Pregnancy
  • Retrospective Studies
  • Vaginal Birth after Cesarean*