Objective To investigate the characteristics of labor in Chinese women who successfully have vaginal birth after cesarean section (VBAC). Methods A retrospective cohort study was conducted in a hospital with 1000 beds between January 1 2015 and December 31 2017. A total 657 parturients with VBAC were selected. Women were divided into two groups according to previous cesarean section with or without trial of labor. Labor curves were analyzed and interval-censored regression was used to estimate the duration of labor. Results The 95th percentile for the first stage of labor in VBAC was 13.03 hours, and labor accelerated after 4 cm of cervical dilation in both groups. The dilation rate in the trial of labor group was superior to that in the non-trial of labor group at 6–10 cm of dilation. After 6 cm, labor accelerated much faster in the trial of labor group than in the non-trial of labor group. Conclusions Management of labor in parturients with VBAC whose cervical dilation is >6 cm should be treated differently according to previous cesarean section with or without trial of labor. If there is trial of labor in a previous delivery, the duration of labor should be shortened.

Background Evidence-based medicine has shown that successful vaginal birth after cesarean (VBAC) is associated with fewer complications than an elective repeat cesarean. Although spontaneous vaginal births and reductions in cesarean delivery (CD) rates have been advocated, the risk factors for VBAC complications remain unclear and failed trials of labor (TOL) can lead to adverse pregnancy outcomes. Methods To construct an antepartum predictive scoring model for VBAC. Retrospective analysis of charts from 1062 women who underwent TOL at no less than 28 gestational weeks with vertex singletons and no more than one prior CD. Results We constructed our scoring model based on the following variables: maternal age, previous vaginal delivery, interdelivery interval (time between prior cesarean and the following delivery), presence of prior cesarean TOL, dystocia as prior CD indication, intertuberous diameter, maternal predelivery body mass index, gestational age at delivery, estimated fetal weight, and hypertensive disorders. Previous vaginal delivery was the most influential variable. The nomogram showed an area under the curve of 77.7% (95% confidence interval, 73.8–81.5%; sensitivity, 78%; specificity, 70%; cut-off, 13 points). The Kappa value to judge the consistency of the results between the predictive model and the actual results was 0.71(95% confidence interval 0.65–0.77) indicating strong consistency. We used the cut-off to divide the VBAC women into two groups according to the success of the TOL. The maternal and neonatal outcomes such as labor time, number of deliveries by midwives, postpartum hemorrhage, uterine rupture, neonatal asphyxia, puerperal infection were significantly different between the two groups. Conclusions Our predictive scoring model incorporates easily ascertainable variables and can be used to personalize antepartum counselling for successful TOLs after cesareans.

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<abstract><p>In this paper, we are concerned with the fractional Schrödinger-Hatree-Maxwell type system. We derive the forms of the nonnegative solution and classify nonlinearities by appling a variant (for nonlocal nonlinearity) of the direct moving spheres method for fractional Laplacians. The main ingredients are the variants (for nonlocal nonlinearity) of the maximum principles, i.e., <italic>narrow region principle</italic> (Theorem 2.3).</p></abstract>

Background Spontaneous umbilical cord vascular rupture(UCVR)is a rare but catastrophic event, and may lead to fetal blood loss and severe perinatal morbidity and mortality. UCVR remains difficult to diagnose, so when it happen, the effective treatment is a key to improve the pregnancy outcomes.UCVR as an obstetric emergency situation especially for neonate, whether rapid response team(RRT) could have effectiveness on the pregnancy outcomes is rare reported. Methods A retrospective cohort study of twelve patients with spontaneous UCVR from 2012 to 2022 were undertaken. Data and images of UCVR were collected via the electronic case system.Demographic and clinical characteristics were collected by researchers. Results Twelve patients were diagnosed by postpartum placental examination and pathological examination. The mean age of participants was (29.67 ± 3.75) years, the mean BMI was (20.48 ± 2.43)kg/m2, the mean gestational age at which rupture occurred was (37.33 ± 2.61)weeks. The decision to delivery interval(DDI) was from 5 to 15 minutes.2 of them were marginal umbilical cord insertion, 5 were velamentous insertion. 9 cases were bloody amniotic fluid. Although all the umbilical cord lengths were within the normal range (38–70 cm), 5 had the umbilical cord around their necks. 10 were vein rupture, 1 was artery and 1 was both atery and vein rupture. About the pregnancy complications, mainly complicated with fetal distress,premature rupture of the membranes(PROM) ,anemia, velamentous cord insertion(VCI), GDM and racket placenta. 6 of them with abnormal placental insertion. all the neonates were admitted to the neonatal intensive care unit (NICU)for 1 to 63 days. Except for one case of stillbirth during the vaginal labour, there were 11 livebirths who underwent cesarean section. One died two days after birth due to severe complications.They were mainly complicated with hypoxic ischemic encephalopathy(HIE),severe neonatal asphyxia and neonatal pneumonia. But with a well prognosis after more than 1 year’s follow-up. Conclusions Early identification of spontaneous UCVR by FHR and character of amniotic fluid during labour is important. Once vascular rupture occurs, obstetric RRT should be activated and the emergency CS should be performed with shorter DDI to reduce perinatal mortality.

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