An analysis of different delivery modes and outcomes of re-pregnancy after cesarean section

Abstract:

Objective：To investigate the delivery modes，parturition，and outcomes of re-pregnancy after cesarean section. Methods：The clinical data of 630 puerperae of re-pregnancy after cesarean section were retrospectively analyzed，who were admitted to our hospital from January 2015 to December 2017. All the cases were recorded regarding their selections of delivery modes，either elective repeat cesarean section（ERCS） or trial of labor after cesarean section（TOLAC）. The women who chose ERCS delivery were classified as ERCS group，while the women choosing TOLAC were further divided into vaginal birth after cesarean section（VBAC） group（group A） and cesarean section group after failure of vaginal delivery（group B）. The general information（age，body mass index before delivery，gestational weeks，gravidity and parity） was recorded for group A，group B，and the ERCS group. The causes of delivery failure in different modes were analyzed for the TOLAC group，and maternal-infant outcomes were also compared between group A，group B，and the ERCS group. Results：Of the 630 cases，465（73.81%） choosing ERCS were enrolled in the ERCS group，and the remaining 165（26.19%） selected TOLAC，of which 124（75.15%） were enrolled in group A，and 41（24.85%） in group B. There were no significant differences in age，gestational weeks，gravidity，and parity between the three groups（P>0.05）. The BMI before delivery in group B was not significantly different from that in the ERCS group（P>0.05），but the BMIs in group B and the ERCS group were significantly higher than that in group A（P<0.05）. In 165 cases of TOLAC，98（59.39%） underwent spontaneous labor，18（10.91%） received oxytocin induction，and 49（29.70%） were treated with double balloon induction. Among these TOLAC cases，10（10.20%） failed in spontaneous labor，8（44.44%） in oxytocin induction，and 23（46.94%） in double balloon induction. The main reason for failure was that cesarean section was required by the puer－perae. There were no significant differences in the incidence rates of uterine rupture and neonatal respiratory distress syndrome among the three groups(P>0.05). There were no significant differences in the incidence rates of threatened uterine rupture and neonatal admission to intensive care unit between group A and ERCS group（P>0.05），and they were lower than those in group B（P<0.05）. There was no significant difference in the inci－dence rate of postpartum fever between group B and the ERCS group（P>0.05），but the rates in the two groups were both significantly higher than that in group A（P<0.05）. The body mass of neonates was lowest in group A and highest in group B（P<0.05）. Conclusion：ERCS is preferred for re-pregnancy after cesarean section，but TOLAC is more beneficial to maternal-infant health care in China.