Department of Perinatal Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.
School of Public Health, Capital Medical University, Beijing 100069, China.
Chin Med J (Engl). 2018 Apr 20;131(8):933-938. doi: 10.4103/0366-6999.229897.
In the mainland of China, the trial of labor after cesarean section is still a relatively new technique. In this study, we aimed to investigate the effects of labor onset, oxytocin use, and epidural anesthesia on maternal and neonatal outcomes for vaginal birth after cesarean section (VBAC) in a tertiary hospital in China.
This was a retrospective study carried out on 212 VBAC cases between January 2015 and June 2017 in Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Relevant data were acquired on a form, including maternal age, gravidity and parity, body mass index before pregnancy, weight gain during pregnancy, type of labor onset, gestational age, the use of oxytocin and epidural anesthesia, birth mode, the duration of labor, and neonatal weight. The factors affecting maternal and neonatal outcomes for cases involving VBAC, especially with regards to postpartum hemorrhage (PPH) and fetal distress, were evaluated by univariate analysis and multivariable logistic regression.
Data showed that 36 women (17.0%) had postpartum hemorrhage (PPH) and 51 cases (24.1%) featured fetal distress. Normal delivery took place for 163 infants (76.9%) while 49 infants (23.1%) underwent operative vaginal deliveries with forceps. There were 178 cases (84.0%) of spontaneous labor and 34 cases (16.0%) required induction. Oxytocin was used in 54 cases (25.5%) to strengthen uterine contraction, and 65 cases (30.7%) received epidural anesthesia. The rate of normal delivery in cases involving PPH was significantly lower than those without PPH (61.1% vs. 80.1%; χ = 6.07, P = 0.01). Multivariate logistic analysis showed that the intrapartum administration of oxytocin (odds ratio [OR] = 2.47; 95% confidence interval [CI] = 1.07-5.74; P = 0.04) and birth mode (OR = 0.40; 95% CI = 0.18-0.87; P = 0.02) was significantly associated with PPH in VBAC cases. Operative vaginal delivery occurred more frequently in the group with fetal distress than the group without (49.0% vs. 14.9%, χ = 25.36, P = 0.00). Multivariate logistic analysis also revealed that the duration of total labor (OR = 1.01; 95% CI = 1.00-1.03; P = 0.04) and the gestational week of delivery (OR = 1.08; 95% CI = 1.05-1.11; P = 0.00) were significantly associated with fetal distress in VBAC.
The administration of oxytocin during labor and birth was identified as a protective factor for PPH in VBAC while birth mode was identified as a risk factor. Finally, the duration of total labor and the gestational week of delivery were identified as risk factors for fetal distress in cases of VBAC. This information might help obstetricians provide appropriate interventions during labor and birth for VBAC.
在中国内地，剖宫产术后再次经阴道分娩（VBAC）仍是一项相对较新的技术。本研究旨在探讨中国某三甲医院 VBAC 中临产方式、缩宫素使用和硬膜外麻醉对母婴结局的影响。
这是一项回顾性研究，纳入 2015 年 1 月至 2017 年 6 月在北京妇产医院行 VBAC 的 212 例病例。通过表格获取包括母亲年龄、孕次和产次、孕前 BMI、孕期体重增加、临产方式、孕周、缩宫素和硬膜外麻醉使用、分娩方式、产程时间和新生儿体重等相关数据。采用单因素分析和多因素 logistic 回归评估 VBAC 相关母婴结局的影响因素，特别是产后出血（PPH）和胎儿窘迫。
36 例（17.0%）产妇发生 PPH，51 例（24.1%）出现胎儿窘迫。163 例（76.9%）新生儿经阴道自然分娩，49 例（23.1%）经产钳助产分娩。178 例（84.0%）为自发临产，34 例（16.0%）需引产。54 例（25.5%）使用缩宫素加强宫缩，65 例（30.7%）行硬膜外麻醉。发生 PPH 的病例中自然分娩率明显低于无 PPH 的病例（61.1%比 80.1%；χ=6.07，P=0.01）。多因素 logistic 分析显示，VBAC 中缩宫素的使用（比值比[OR]=2.47；95%置信区间[CI]：1.07-5.74；P=0.04）和分娩方式（OR=0.40；95%CI：0.18-0.87；P=0.02）与 PPH 显著相关。有胎儿窘迫的病例中转剖宫产分娩的发生率明显高于无胎儿窘迫的病例（49.0%比 14.9%，χ=25.36，P=0.00）。多因素 logistic 分析还显示，总产程时间（OR=1.01；95%CI：1.00-1.03；P=0.04）和分娩孕周（OR=1.08；95%CI：1.05-1.11；P=0.00）与 VBAC 中的胎儿窘迫显著相关。
本研究发现，VBAC 中缩宫素的使用是 PPH 的保护因素，而分娩方式是 PPH 的危险因素。此外，总产程时间和分娩孕周是 VBAC 中胎儿窘迫的危险因素。这些信息可能有助于产科医生在 VBAC 期间提供适当的干预措施。
