关键词: 剖宫产后阴道分娩, 剖宫产术, 再, 危险因素, 妊娠结局

Abstract: Objective: To assess the maternal and infant outcomes of vaginal birth after cesarean(VBAC), and to identify those influencing factors. Methods: A total of 210 pregnant women who underwent VBAC in our hospital from January 2015 to December 2016 were retrospectively analyzed.  All of them had a singleton pregnancy with cephalic presentation, term birth and trial of labor after casarean (TOLAC), without any pregnancy complication. Those cases were divided into two groups according to the mode of delivery: the successful TOLAC group (VBAC group) and the failed TOLAC group. The maternal-infant outcomes and other clinical data were compared. Results: The total success rate of TOLAC was 80.5% (169/210). Forty one women underwent the failed TOLAC, due to fetal distress or a non-progress of labor. The independent influencing factors of VBAC were as follows:  a prior vaginal birth (OR=9.61，95%CI：1.20-76.96), spontaneous labor(OR=5.88，95%CI：2.36-14.64) and body mass index (BMI, OR=0.86，95%CI：0.76-0.97), in which a prior vaginal birth and spontaneous labor were the protective factors and high BMI was the risk factors of VBAC. The area under curve(AUC) of  the graphic receive operator characteristic (ROC) curve was 0.76. The intrapartum blood loss and the proportion  who required of blood transfusion in the VBAC group were significantly lower than those in the failed TOLAC group (P＜0.05).  There were no significant differences in the incidence of neonates asphyxia and proportion of neonates who had to be admitted to intensive care unit between the two groups(P＞0.05). Conclusions: The independent influencing factors of VBAC were the prior vaginal birth, spontaneous labor and BMI. The individualized assessment of VBAC, and the prediction model based on the influencing factors in future, may be helpful to improve the success rate of TOLAC.

Key words: Vaginal birth after cesarean, Cesarean section, repeat, Risk factors, Pregnancy outcome