Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, 325027, Wenzhou, China.
Department of Obstetrics and Gynecology, The Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou, China.
BMC Pregnancy Childbirth. 2022 Jul 23;22(1):589. doi: 10.1186/s12884-022-04919-1.
With the development of China's two-child-policy, vaginal birth after cesarean section (VBAC) has aroused public concern. It is important to understand the labour characteristics and intrapartum management of women attempting VBAC to enhance the rates of successful VBAC. The purpose of our research was to investigate the differences in the characteristics of labor, intervention measures and perinatal outcomes between women who had a VBAC and primiparas or multiparas not undergoing VBAC, providing clinical references of intrapartum management for women who are planning a VBAC.
This observational retrospective study enrolled all women who laboured spontaneously and who had a VBAC (n = 139) at the Second Affiliated Hospital of Wenzhou Medical University in China between 2016 and 2019. They were allocated into VBAC group A (the previous cesarean section was performed before dilation of the cervix) and VBAC group B (the previous cesarean section was performed after dilation of the cervix). The primipara control group included 149 primiparae, and the multipara control group included 155 multiparae with second vaginal birth. Durations of labor, intervention measures and perinatal outcomes were compared among the groups.
The durations of labor, intrapartum interventions and maternal and neonatal outcomes in VBAC group A were similar to those of the VBAC group B. However, all women who had a VBAC and those in VBAC group A had shorter first, second and the total stages of labor than primiparae. All women with VBAC and those in VBAC group B had longer second stage of labor, but shorter third stage of labor than multiparae. Oxytocin, labor analgesia and artificial rupture of membranes were administered less often in women with VBAC than in primiparae, while phloroglucinol was administered more often in women with VBAC than in multiparae. Women who had a VBAC were more likely to receive episiotomy and had higher incidences of postpartum hemorrhage than primipara and multipara women.
Labor characteristics, intrapartum interventions and perinatal outcomes in women who had a VBAC with cervical dilation were similar to those in women who had a VBAC without cervical dilation before the previous cesarean section, but differed significantly from those of multiparae and primiparae who did not undergo VBAC.
随着中国二孩政策的发展，剖宫产后阴道分娩（VBAC）引起了公众的关注。了解尝试 VBAC 的妇女的分娩特征和产时管理对于提高 VBAC 的成功率非常重要。我们的研究目的是探讨 VBAC 妇女与未经 VBAC 的初产妇和经产妇在分娩特征、干预措施和围产结局方面的差异，为计划 VBAC 的妇女提供产时管理的临床参考。
本观察性回顾性研究纳入了 2016 年至 2019 年在中国温州医科大学附属第二医院自发分娩并接受 VBAC 的所有妇女（n=139）。她们被分为 VBAC 组 A（前次剖宫产在宫颈扩张前进行）和 VBAC 组 B（前次剖宫产在宫颈扩张后进行）。初产妇对照组包括 149 例初产妇，经产妇对照组包括 155 例经产妇第二胎阴道分娩。比较了各组的分娩持续时间、干预措施和围产结局。
VBAC 组 A 的分娩持续时间、产时干预措施和母婴结局与 VBAC 组 B 相似。然而，所有接受 VBAC 的妇女和 VBAC 组 A 的妇女的第一、第二和总产程都比初产妇短。所有接受 VBAC 的妇女和 VBAC 组 B 的妇女的第二产程较长，但第三产程较短。VBAC 妇女使用缩宫素、分娩镇痛和人工破膜的频率低于初产妇，而 VBAC 妇女使用 phloroglucinol 的频率高于经产妇。VBAC 妇女行会阴切开术的可能性更高，产后出血的发生率高于初产妇和经产妇。
宫颈扩张的 VBAC 妇女的分娩特征、产时干预措施和围产结局与前次剖宫产前宫颈扩张的 VBAC 妇女相似，但与未经 VBAC 的经产妇和初产妇明显不同。
