Maternal and perinatal Outcome with Vaginal Birth After Cesarean in Hebei Province of china: a cross-sectional study

Abstract Background In recent decades, cesarean section rate have increased significantly in China. The delivery mode of women with a previous cesarean delivery remains contentious. We conducted a study to analyze the maternal and perinatal outcome of vaginal birth after cesarean or repeat cesarean delivery, in a period the one-child policy convert to the universal two-child policy.Methods We used the data from Maternal Near Miss Surveillance System of Hebei province between 2013 and 2017. In the analysis, we included women with singleton deliveries between 28 and 42 gestation weeks who had a single prior cesarean delivery. We used logistic regression with a robust variance estimator to examine trends in vaginal birth after cesarean. We also assessed the association between vaginal birth after cesarean and maternal and perinatal adverse outcomes.Results 53,769 women with a previous caesarean section deliveries were included from 274,665 of total participants. There were 3,415 (6.4%) women delivered by vaginal birth after cesarean and 50,354 (93.6%) by repeat cesarean delivery. Between 2013 and 2016, the rate of vaginal birth after cesarean showed a upward trend, from 6.2% to 7.0%. But in 2017, it had declined to 5.2%. Compared to women with repeat cesarean delivery, women with vaginal birth after cesarean have lower absolute rates of severe maternal morbidity and mortality, especially significantly in incidence of blood transfusion, but have higher incidence of intrapartum stillbirth, newborns with low 5-minute Apgar score less than 7 and neonatal death.Conclusions Most of maternal adverse outcomes risk of vaginal birth after cesarean was not higher than repeat cesarean delivery, but the risk of perinatal adverse outcomes has increased in vaginal birth after cesarean.