{"paper_id":"0db9b0ee-e681-4231-9847-f520588d0e2a","body_text":"Study on demographic and sociological factors influencing the outcome of vaginal trial of labor for subsequent pregnancies after cesarean section | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Study on demographic and sociological factors influencing the outcome of vaginal trial of labor for subsequent pregnancies after cesarean section Xiaocheng Nie, Lin Chen, Li Ao, Xuan Wang, Juncui XU This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5843109/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To explore the demographic and sociological factors influencing the outcome of trial of labor after cesarean (TOLAC) during subsequent pregnancy, aimed at improving the success rate of TOLAC. Methods Adopting a prospective nested case-control study.Follow up on the vaginal trial outcomes of 562 pregnant women with scar uterus who met the inclusion criteria.132 cases of scarred uterus transferred to cesarean section were included in the study group and 430 scarred uterus cases of successful vaginal delivery were included in the control group.Compare the differences between the two groups in demographic sociology and obstetric conditions and further conduct correlation analysis on indicators with statistical differences between groups. Results Single factor comparison between groups showed statistical differences between the two groups in terms of education level, vaginal delivery history over 28 weeks, natural labor, cervical score, and intraspinal delivery analgesia (P<0.05).There was no statistically significant difference in age and ethnicity(P>0.05).Multivariate logistic regression analysis showed a negative correlation between educational level and vaginal trial delivery failure in scarred uterus pregnancy (OR=0.692, P<0.05),The negative correlation was discovered between known confounding factors (≥ 28 weeks of vaginal delivery history, natural labor, cervical score, intraspinal delivery analgesia) and TOLAC failure(P<0.05) . There was no interaction between educational level and the various known confounding factors included (OR=1, P>0.05) . Conclusion Educational level is an independent factor affecting the outcome of TOLAC, and there is a negative correlation between educational level and TOLAC failure.Therefore,it is necessary to strengthen scientific education, psychological guidance, and psychological support for pregnant women with scarred uterus who have lower educational level in order to improve the success rate of TOLAC. Health sciences/Diseases Health sciences/Health care Health sciences/Health occupations Health sciences/Medical research Health sciences/Risk factors After cesarean section Second pregnancy Vaginal trial Population sociology 1. Background In recent years, the global cesarean section rate has continued to rise, resulting in a large number of scarred uteruses [1] . Repeated cesarean sections after repregnancy of scarred uteruses further increase the cesarean section rate and the complications of cesarean section surgery, forming a vicious cycle [2] . Approximately 50% of the increase in cesarean section rates is due to cesarean section again [3] , and over 97% of pregnant women with scarred uterus undergo cesarean section again [4] . In order to reduce the cesarean section rate and minimize the complications of cesarean section, guidelines and expert consensus from multiple countries advocate and encourage natural childbirth for pregnant women with scarred uterus [5] . Therefore, it has become an inevitable trend to vigorously carry out vaginal trial of labor after cesarean section(TOLAC), and the success rate of TOLAC varies from 60% to 80% in different countries [6] . Whether the success rate of TOLAC can be further improved not only directly affects the cesarean section rate and the complications of cesarean section, but also directly affects the implementation of China's three child policy. For example, after the first cesarean section, if the second child is delivered vaginally, it greatly reduces the risk of a third pregnancy (such as uterine incision pregnancy, dangerous placenta previa, uterine rupture, etc.), and women's concerns about the risk of a third pregnancy are significantly reduced.On the contrary, if both of the first two pregnancies are performed by caesarean section, women often give up their three child plan due to fear of the risk of a third pregnancy, which is not conducive to the implementation of the national three child policy. Therefore, it is urgent to further improve the success rate of TOLAC. The success rate of TOLAC is the result of multiple factors working together. Currently, research on improving the success rate of TOLAC is almost focused on diseases and diagnosis, while research on demographic sociology is extremely rare.In order to explore the demographic and sociological factors that affect TOLAC outcomes and further improve TOLAC success rates, we conducted a prospective nested case-control study. 2. Materials And Methods 2.1 Research object Pregnant women with scarred uterus whose due date is between June 2022 and June 2024 and who meet the following inclusion criteria. 2.1.1 Inclusion Criteria: Referring to the expert consensus on the management of vaginal delivery after cesarean section in China (2016) regarding the indications and contraindications for TOLAC [6] , the inclusion criteria are as follows: ① Pregnant women with scarred uterus who have had a history of cesarean section once, and whose previous cesarean section had no incision elongation, no late postpartum hemorrhage, postpartum infection, etc.② There are no other surgical scars on the uterus except for the cesarean section incision.③ The interval between this pregnancy and the previous cesarean section is ≥ 18 months. ④ This pregnancy is ≥ 28 weeks. ⑤ Live fetus. ⑥ Head position. ⑦ There are no indications for cesarean section other than scarred uterus. ⑧ Ultrasound shows continuous muscle layer in the original incision of the uterus. ⑨ Estimated fetal weight<4kg Those who have received TOLAC education and are willing to undergo vaginal trials. 2.1.2 exclusion criteria： ① There are internal and external complications or obstetric complications that are not suitable for vaginal delivery. ② Ultrasound examination shows placental attachment to the scar site of the uterine incision.③ History of uterine rupture in the past.④ Fetal death during trial delivery.⑤ Missing persons. 2.2 Research methods and grouping： Using a nested case-control study, the vaginal trial outcomes of pregnant women with scarred uterus who met the inclusion criteria were followed up. Those who underwent cesarean section (including those who requested to give up continuing the trial) were included in the study group, and those who successfully underwent vaginal delivery were included in the control group. This study was approved by the ethics committee, and each research subject signed an informed consent form to participate in the study.All methods were carried out in accordance with relevant guidelines and regulations in China. 2.3 Vaginal trial and cesarean section Pregnant women with scarred uterus who meet the inclusion criteria shall undergo vaginal trial delivery after being fully informed and signing the informed choice of delivery method, with blood preparation and emergency cesarean section preparation. During the trial delivery, one-on-one management shall be carried out, and observation shall be conducted for 2 hours in the delivery room after vaginal delivery. Routine ultrasound examination of uterine incision muscle continuity shall be conducted after delivery; Emergency cesarean section is performed to terminate pregnancy when the pregnant woman gives up continuing vaginal trial or shows signs of cesarean section other than scarred uterus during vaginal trial. 2.4 Research Indicators Obtain information on seven indicators, including age, ethnicity, education level, history of vaginal delivery at ≥ 28 weeks of pregnancy, natural labor, cervical score at admission, and labor analgesia, for two groups of cases through the HIS system. Compare the differences in each indicator between groups and conduct further correlation analysis on the indicators with statistical differences between groups. 2.5 Statistical processing Statistical analysis was conducted using SPSS 26.0 software. Quantitative data with normal distribution are expressed as mean ± standard deviation (X ± S) and independent sample t-test is used; The binary data is represented by frequency (n) and rate (%), and X 2 test or corrected X 2 test is used.Perform a multivariate unconditional logistic regression analysis on indicators that show statistical differences in single factor comparisons and are believed to potentially affect trial delivery outcomes, with P<0.05 indicating statistically significant differences. 3. Results 3.1 Single factor intergroup comparison A total of 562 pregnant women with scarred uterus who met the inclusion criteria underwent vaginal trial delivery, including 132 cases in the study group (converted to cesarean section) and 430 cases in the control group (successful vaginal delivery). The success rate of vaginal trial delivery was 76.51%, which is consistent with the 60% -80% reported in reference [6] . There was no statistically significant difference in age and ethnicity between the two groups of cases (P>0.05), but there were statistically significant differences (P<0.05) in education level, history of vaginal delivery ≥ 28 weeks, natural labor, cervical score, and pain relief during intraspinal delivery, as shown in Table 1. Table 1 Single factor comparison between groups factor study group（n=132） control group（n=430） statistc P 95% CI Age(years) 31.70±3.21 32.28±3.42 t=1.225 0.221（Bilateral） （-0.353,1.517） nationaliy ethnic minory 4（3%） 14（3.3%） X2=0.017 0.898（Bilateral） The Han nationality 128(97%) 416（96.7%） degree of education Junior college or below 64（48.48%） 136（31.63%） X2=12.520 0.000 (Bilateral) College degree or above 68（51.52%） 294（68.37%） History of vaginal delivery at ≥ 28 weeks of pregnancy yes 6（4.5%） 58（13.5%） X2=8.004 0.005 (Bilateral) no 126（95.5%） 372（86.5%） Natural labor yes 32（24.2%） 222（51.6%） X2=30.580 0.000 (Bilateral) no 100（75.8%） 208（48.4%） Cervical score 3.72±1.44 4.70±1.97 t=4.358 0.000 (Bilateral) (0.532, 1.415) labor analgesia yes 32（24.2%） 178（41.4%） X2=12.697 0.000（Bilateral） no 100（75.8%） 252（58.6%） 3.2 Multivariate logistic regression analysis Correlation analysis was conducted on factors that showed statistical differences in Table 1 and were believed to affect the final mode of delivery. Educational level was used as the independent variable (X), the final mode of delivery was used as the dependent variable (Y), and factors such as vaginal delivery history at ≥ 28 weeks of pregnancy (Z1), natural labor (Z2), cervical score (Z3), and intraspinal delivery analgesia (Z4) were recognized by current domestic and foreign expert consensus or guidelines [6,7] as covariates (Z). Multivariate unconditional logistic regression analysis was performed. Firstly, a univariate logistic regression analysis was conducted between the mode of delivery and educational level, as shown in Model 1 in Table 2. Secondly, logistic regression analysis was conducted again after fine-tuning the variables in the regression model by introducing Z1, as shown in Model 2 in Table 2.Finally, logistic regression analysis was conducted by fully adjusting the variables of the regression model by introducing Z1, Z2, Z3, and Z4. At the same time, the interaction between the independent variables and each covariate was tested, as shown in Model 3 in Table 2. Table 2 Logistic regression analysis and interaction test between delivery mode and educational level B Wald P OR 95.0% CI model1 degree of education -0.315 8.968 0.003 0.73 （0.594,0.897) constant 0.274 0.312 0.577 1.316 model2 degree of education -0.344 10.26 0.001 0.709 (0.575,0.875) History of vaginal delivery at ≥ 28 weeks of pregnancy -1.368 4.661 0.031 0.255 (0.074,0.882) constant 1.896 4.668 0.031 6.662 model3 degree of education -0.45 7.259 0.007 0.638 (0.46,0.885) History of vaginal delivery at ≥ 28 weeks of pregnancy -1.722 4.738 0.03 0.179 (0.038,0.843) Natural labor -1.226 5.043 0.025 0.293 (0.101,0.856) Cervical score -0.33 4.021 0.045 0.719 (0.521,0.993) labor analgesia -1.189 6.513 0.011 0.305 (0.122,0.759) Interaction between X and Z 0.01 0.567 0.452 1.000 (0.984,1.037) constant 6.955 9.346 0.002 1.05E+03 3.3 Regression Model Evaluation The results of the univariate logistic regression analysis between delivery mode and education level showed a negative correlation between the independent variable (X) and the dependent variable (Y) (OR=0.73, P<0.05). After fine-tuning and fully adjusting the model variables, the independent variable X and the dependent variable Y showed a stable negative correlation (OR=0.638, P<0.05). The interaction test between the independent variable X and the covariate Z showed no interaction between the independent variable and each covariate, indicating that education level is an independent factor affecting TOLAC outcomes (OR=1000, P>0.05). 4. Discussion 4.1 In recent years, with the adjustment of China's birth policy, the number of scarred uterine pregnancies has been increasing. The risk of scarred uterine pregnancy (such as uterine incision pregnancy, dangerous placenta previa) cannot be avoided, and with the increase of cesarean section frequency, the incidence of the above complications increases accordingly [9] . Obstetric medical workers and pregnant women are facing severe challenges. Further exploring the factors that affect the outcome of TOLAC, how to improve or reasonably utilize the factors that are highly correlated with the success rate of TOLAC, and how to reduce the short - and long-term complications of cesarean section by further improving the success rate of TOLAC have become hot topics and urgent issues for discussion among obstetric workers in China [10-11] . 4.2 This study found a negative correlation between education level and TOLAC failure. Lower education level is a risk factor for TOLAC failure, while higher education level reduces the risk of TOLAC failure, indicating that higher education level is a protective factor for TOLAC failure. At the same time, it was found that education level is an independent factor affecting TOLAC outcomes, which may be related to the following factors. Firstly, the four major elements of childbirth are labor force, birth canal, fetus, and social psychological factors [12] . Education level belongs to the category of social factors. Pregnant women with lower education levels lack sufficient and correct understanding of the process, advantages and disadvantages, risks, and emergency measures of scar uterus vaginal delivery, and to some extent have blind fear psychology [5,13] . They are more likely to worry and anxiety during vaginal trial delivery due to the risks of scar uterus vaginal delivery (such as uterine rupture), so they are more likely to give up continuing the trial delivery and actively request a cesarean section during the trial delivery process; Secondly, pregnant women with lower levels of education may experience increased opportunities for forced cesarean section due to psychological factors such as blind anxiety and fear during the TOLAC process, even if they do not voluntarily give up vaginal trials; Again, pregnant women with lower levels of education may experience further stress during the TOLAC process due to insufficient psychological support from their families [13] . This study also showed that a history of vaginal delivery at ≥ 28 weeks of gestation, natural labor, high cervical score at admission, and the use of labor analgesia were all protective factors for TOLAC failure, which is consistent with previous research results at home and abroad [11,14,15,16,17,18] .Social psychological factors are one of the four major elements of vaginal delivery, among which social factors have a broader connotation, including age, ethnicity, cultural level, economy, region, faith, etc. This study revealed the relationship between demographic and sociological factors such as age, ethnicity, educational level, and history of vaginal delivery at ≥ 28 weeks of gestation and TOLAC outcomes. 4.3 In summary, educational level is an independent factor affecting the outcome of TOLAC, and there is a negative correlation between educational level and TOLAC failure. Therefore, it is necessary to strengthen prenatal science education, psychological guidance, and spiritual support for pregnant women with scarred uterus who have lower educational levels in order to improve the success rate of TOLAC. As for the deeper and more complex correlation between educational level and TOLAC outcomes, further research is needed. Declarations Data availability statement: As the paper has not been officially published and the research subjects have not been authorized in writing to disclose the data, the datasets generated and/or analyzed during this study are not publicly available, but can be obtained from the corresponding author upon reasonable request. If necessary, you can contact us through the following email address. References Yijun Liu,Chenyu Jiang,Xinghui Liu. Interpretation of SOGC Postcesarean Vaginal Trial Guidelines (2019 Edition) [J]. Journal of Practical Obstetrics and Gynecology, 2019, 35 (12): 914-918. Santas G，Santas F.Trends of caesarean section rates in Turkey[J]．Journal of obstetrics and gynaecology，2018,38(5):658—662． Barber EL,Lundsberg LS,Belanger K，et a1.Indications contributing to the increasing cesarean delivery rate[J].Obstetrics and Gynecology，2011，118(1):29-38． Yunxiu Li,Huiting Yin,Liqiong Zhou, etc. Exploration of a predictive model for vaginal delivery after cesarean section [J]. Chinese Journal of Family Planning and Obstetrics and Gynecology,2020,12 (7): 88-92. Xiaoming Chen,Zhenyu Chen.Research progress on predictive models for vaginal delivery of recurrent pregnancy after cesarean section [J]. Chinese Modern Doctor, 2021,59 (25):184-188. Obstetrics Group of the Obstetrics and Gynecology Branch of the Chinese Medical Association Expert consensus on vaginal delivery management for re pregnancy after cesarean section (2016) [J]. Chinese Journal of Obstetrics and Gynecology, 2016, 51 (8):561-564. American College of Obstetricians and Gynecologists.Vaginal Birth After Cesarean Delivery[J].Obstetrics and Gynecology,2019,133(2):e110-127. Yu Xing,Xuan Chen.Research progress on vaginal trial for re- pregnancy after cesarean section [J].International Journal of Obstetrics and Gynecology, 2021, 48 (1): 99-104. Society of Gynecologic 0ncology，American College of 0bstetricians and Gynecologists and the Society for Maternal-Fetal Medicine,Cahill AG，et a1.Placenta accreta spectrum[J].American journal of obstetrics and gynecology，2018,219(6): B2-B16． Tian Mou,Yan Wang,Guoli Liu, etc. Clinical application of 7 predictive models for vaginal delivery after cesarean section in China [J]. Journal of Peking University (Medical Edition), 2016, 48 (5): 795-800. Cuizhu Sun,Xia Sun,Jia Wei,etc. Predictive analysis of factors related to vaginal delivery after cesarean section [J]. Chinese Journal of Family Planning and Obstetrics and Gynecology, 2022, 14 (4): 52-57. Xing Xie,Beihua Kong,and Tao Duan are editors in chief. Obstetrics and Gynecology 9th edition Beijing: People's Health Publishing House,2018:163-165. Editor in Chief Xiaocheng Nie.Diagnosis and Treatment Techniques for Scared Uterine Pregnancy [M]. First Edition Chengdu: Sichuan University Press, 2023: 64-75. Sabol B，Denman MA，Guise JM．Vaginal birth after cesarean:an effective method to reduce cesarean [J]．Clinical Obstetrics and Gynecology,2015，58(2):309-319． Weijian Zeng,Wei Gu,Yiling Ke,etc. Exploration of Predictive Factors for Successful Vaginal Trial Delivery after Cesarean Section [J]. Chinese Journal of Obstetrics and Gynecology, 2019, 20 (3): 196-198. Haumonte JB,Raylet M,Christophe M，et al.French validation and adaptation of the Grobman nomogram for prediction of vaginal birth after cesarean delivery [J].Journal of Gynecology Obstetrics and Human Reproduction,2018,47（3）:127-131. Yan Long,Li Lin.Measures and value of preventing uterine cavity infection in patients undergoing artificial rupture induced abortion [J].Journal of Practical Obstetrics and Gynecology,2016,32 (3):170-172. Meiling Zeng,Libi Liang,Hailan Guan.Clinical application of guided instruments in full-term vaginal delivery with scarred uterus re pregnancy [J].Jilin Medical Journal,2017,38 (4):643-645. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-5843109\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Article\",\"associatedPublications\":[],\"authors\":[{\"id\":405630408,\"identity\":\"d2089d6e-6861-43ec-ac5e-32891abe5e80\",\"order_by\":0,\"name\":\"Xiaocheng Nie\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/UlEQVRIiWNgGAWjYDACZiBOAGIDEOdjA4hkbDxAtBbGmQ0MEkCqAb8WGABpYeYFa2FgwKvFnJ35mMSDGht5c/bew69td9jU6bYfBtpSYxONS4tlM1uyQcKxNMOdPefSrHPPpEmYnUkEajmWltuAyz2HeQwfJLAdTjC4kWNmnNt2WMLsAFALY8NhPFr4PxxI+AfUcv+NmbElSMv5h4S08DA+SGwD2cJj/JgRpOUGQVvYjA0S+9IMN5zJMWPsbUuT3HYDaEsCPr+cP/xM8sc3G3mD42eMP/xss+E3O5/+8MGHGhucWpABmwScmUCEchBg/kCkwlEwCkbBKBhhAADzJ2N4kVssMAAAAABJRU5ErkJggg==\",\"orcid\":\"\",\"institution\":\"Maternal and Child Health Hospital of Sichuan Province\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Xiaocheng\",\"middleName\":\"\",\"lastName\":\"Nie\",\"suffix\":\"\"},{\"id\":405630409,\"identity\":\"2941f0dc-9ecc-486a-bd6f-4e7bf4a5f5ed\",\"order_by\":1,\"name\":\"Lin Chen\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Maternal and Child Health Hospital of Sichuan Province\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Lin\",\"middleName\":\"\",\"lastName\":\"Chen\",\"suffix\":\"\"},{\"id\":405630410,\"identity\":\"859eca8b-3c2a-4abf-97fb-90a2e3ef7412\",\"order_by\":2,\"name\":\"Li Ao\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Maternal and Child Health Hospital of Sichuan Province\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Li\",\"middleName\":\"\",\"lastName\":\"Ao\",\"suffix\":\"\"},{\"id\":405630411,\"identity\":\"a21948f8-6eff-4b52-a7b8-d02f13381b28\",\"order_by\":3,\"name\":\"Xuan Wang\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Maternal and Child Health Hospital of Sichuan Province\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Xuan\",\"middleName\":\"\",\"lastName\":\"Wang\",\"suffix\":\"\"},{\"id\":405630412,\"identity\":\"9915e1e7-d0a4-4225-a305-4fdfac9823e0\",\"order_by\":4,\"name\":\"Juncui XU\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Maternal and Child Health Hospital of Sichuan Province\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Juncui\",\"middleName\":\"\",\"lastName\":\"XU\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2025-01-16 15:23:24\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-5843109/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-5843109/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":84664979,\"identity\":\"dd7af496-9e38-4bb9-b261-f92e902ceefd\",\"added_by\":\"auto\",\"created_at\":\"2025-06-16 05:33:41\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":596567,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5843109/v1/3f9d17f0-f336-4cee-a534-d5f3e78b8f77.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Study on demographic and sociological factors influencing the outcome of vaginal trial of labor for subsequent pregnancies after cesarean section\",\"fulltext\":[{\"header\":\"1. Background\",\"content\":\"\\u003cp\\u003eIn recent years, the global cesarean section rate has continued to rise, resulting in a large number of scarred uteruses \\u003csup\\u003e[1]\\u003c/sup\\u003e. Repeated cesarean sections after repregnancy of scarred uteruses further increase the cesarean section rate and the complications of cesarean section surgery, forming a vicious cycle \\u003csup\\u003e[2]\\u003c/sup\\u003e. Approximately 50% of the increase in cesarean section rates is due to cesarean section again\\u003csup\\u003e\\u0026nbsp;[3]\\u003c/sup\\u003e, and over 97% of pregnant women with scarred uterus undergo cesarean section again\\u003csup\\u003e\\u0026nbsp;[4]\\u003c/sup\\u003e. In order to reduce the cesarean section rate and minimize the complications of cesarean section, guidelines and expert consensus from multiple countries advocate and encourage natural childbirth for pregnant women with scarred uterus\\u003csup\\u003e\\u0026nbsp;[5]\\u003c/sup\\u003e. Therefore, it has become an inevitable trend to vigorously carry out vaginal trial\\u0026nbsp;of labor after cesarean\\u0026nbsp;section(TOLAC), and the success rate of TOLAC varies from 60% to 80% in different countries\\u003csup\\u003e\\u0026nbsp;[6]\\u003c/sup\\u003e. Whether the success rate of TOLAC can be further improved not only directly affects the cesarean section rate and the complications of cesarean section, but also directly affects the implementation of China\\u0026apos;s three child policy. For example, after the first cesarean section, if the second child is delivered vaginally, it greatly reduces the risk of a third pregnancy (such as uterine incision pregnancy, dangerous placenta previa, uterine rupture, etc.), and women\\u0026apos;s concerns about the risk of a third pregnancy are significantly reduced.On the contrary, if both of the first two pregnancies are performed by caesarean section, women often give up their three child plan due to fear of the risk of a third pregnancy, which is not conducive to the implementation of the national three child policy. Therefore, it is urgent to further improve the success rate of TOLAC. The success rate of TOLAC is the result of multiple factors working together. Currently, research on improving the success rate of TOLAC is almost focused on diseases and diagnosis, while research on demographic sociology is extremely rare.In order to explore the demographic and sociological factors that affect TOLAC outcomes and further improve TOLAC success rates, we conducted a prospective nested case-control study.\\u003c/p\\u003e\"},{\"header\":\"2. Materials And Methods\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003e2.1 Research object\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003ePregnant women with scarred uterus whose due date is between June 2022 and June 2024 and who meet the following inclusion criteria.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e2.1.1 Inclusion Criteria:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eReferring to the expert consensus on the management of vaginal delivery after cesarean section in China (2016) regarding the indications and contraindications for TOLAC\\u003csup\\u003e[6]\\u003c/sup\\u003e, the inclusion criteria are as follows: ① Pregnant women with scarred uterus who have had a history of cesarean section once, and whose previous cesarean section had no incision elongation, no late postpartum hemorrhage, postpartum infection, etc.② There are no other surgical scars on the uterus except for the cesarean section incision.③ The interval between this pregnancy and the previous cesarean section is \\u0026ge; 18 months. ④ This pregnancy is \\u0026ge; 28 weeks. ⑤ Live fetus. ⑥ Head position. ⑦ There are no indications for cesarean section other than scarred uterus. ⑧ Ultrasound shows continuous muscle layer in the original incision of the uterus. ⑨ Estimated fetal weight\\u0026lt;4kg Those who have received TOLAC education and are willing to undergo vaginal trials.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e2.1.2 exclusion criteria：\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e① There are internal and external complications or obstetric complications that are not suitable for vaginal delivery. ② Ultrasound examination shows placental attachment to the scar site of the uterine incision.③ History of uterine rupture in the past.④ Fetal death during trial delivery.⑤ Missing persons.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e2.2 \\u0026nbsp;Research methods and grouping：\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eUsing a nested case-control study, the vaginal trial outcomes of pregnant women with scarred uterus who met the inclusion criteria were followed up. Those who underwent cesarean section (including those who requested to give up continuing the trial) were included in the study group, and those who successfully underwent vaginal delivery were included in the control group. This study was approved by the ethics committee, and each research subject signed an informed consent form to participate in the study.All methods were carried out in accordance with relevant guidelines and regulations in China.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e2.3 Vaginal trial and cesarean section \\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003ePregnant women with scarred uterus who meet the inclusion criteria shall undergo vaginal trial delivery after being fully informed and signing the informed choice of delivery method, with blood preparation and emergency cesarean section preparation. During the trial delivery, one-on-one management shall be carried out, and observation shall be conducted for 2 hours in the delivery room after vaginal delivery. Routine ultrasound examination of uterine incision muscle continuity shall be conducted after delivery; Emergency cesarean section is performed to terminate pregnancy when the pregnant woman gives up continuing vaginal trial or shows signs of cesarean section other than scarred uterus during vaginal trial.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e2.4 Research Indicators \\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eObtain information on seven indicators, including age, ethnicity, education level, history of vaginal delivery at \\u0026ge; 28 weeks of pregnancy, natural labor, cervical score at admission, and labor analgesia, for two groups of cases through the HIS system. Compare the differences in each indicator between groups and conduct further correlation analysis on the indicators with statistical differences between groups.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e2.5 Statistical processing \\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eStatistical analysis was conducted using SPSS 26.0 software. Quantitative data with normal distribution are expressed as mean \\u0026plusmn; standard deviation (X \\u0026plusmn; S) and independent sample t-test is used; The binary data is represented by frequency (n) and rate (%), and X\\u003csup\\u003e2\\u003c/sup\\u003e test or corrected X\\u003csup\\u003e2\\u003c/sup\\u003e test is used.Perform a multivariate unconditional logistic regression analysis on indicators that show statistical differences in single factor comparisons and are believed to potentially affect trial delivery outcomes, with P\\u0026lt;0.05 indicating statistically significant differences.\\u003c/p\\u003e\"},{\"header\":\"3. Results\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003e3.1 Single factor intergroup comparison\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eA total of 562 pregnant women with scarred uterus who met the inclusion criteria underwent vaginal trial delivery, including 132 cases in the study group (converted to cesarean section) and 430 cases in the control group (successful vaginal delivery). The success rate of vaginal trial delivery was 76.51%, which is consistent with the 60% -80% reported in reference \\u003csup\\u003e[6]\\u003c/sup\\u003e. There was no statistically significant difference in age and ethnicity between the two groups of cases (P\\u0026gt;0.05), but there were statistically significant differences (P\\u0026lt;0.05) in education level, history of vaginal delivery \\u0026ge; 28 weeks, natural labor, cervical score, and pain relief during intraspinal delivery, as shown in Table 1.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 1 Single factor comparison between groups\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"590\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 84px;\\\"\\u003e\\n \\u003cp\\u003efactor\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 93px;\\\"\\u003e\\n \\u003cp\\u003estudy group（n=132）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 113px;\\\"\\u003e\\n \\u003cp\\u003econtrol group（n=430）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 75px;\\\"\\u003e\\n \\u003cp\\u003estatistc\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003eP\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e95% CI\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 84px;\\\"\\u003e\\n \\u003cp\\u003eAge(years)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 93px;\\\"\\u003e\\n \\u003cp\\u003e31.70\\u0026plusmn;3.21\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 113px;\\\"\\u003e\\n \\u003cp\\u003e32.28\\u0026plusmn;3.42\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 75px;\\\"\\u003e\\n \\u003cp\\u003et=1.225\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003e0.221（Bilateral）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e（-0.353,1.517）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 84px;\\\"\\u003e\\n \\u003cp\\u003enationaliy\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003eethnic minory\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 93px;\\\"\\u003e\\n \\u003cp\\u003e4（3%）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 113px;\\\"\\u003e\\n \\u003cp\\u003e14（3.3%）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 75px;\\\"\\u003e\\n \\u003cp\\u003eX2=0.017\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003e0.898（Bilateral）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003eThe Han nationality\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 93px;\\\"\\u003e\\n \\u003cp\\u003e128(97%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 113px;\\\"\\u003e\\n \\u003cp\\u003e416（96.7%）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 84px;\\\"\\u003e\\n \\u003cp\\u003edegree of education \\u0026nbsp;\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003eJunior college or below\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 93px;\\\"\\u003e\\n \\u003cp\\u003e64（48.48%）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 113px;\\\"\\u003e\\n \\u003cp\\u003e136（31.63%）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 75px;\\\"\\u003e\\n \\u003cp\\u003eX2=12.520\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003e0.000\\u003c/p\\u003e\\n \\u003cp\\u003e(Bilateral)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003eCollege degree or above\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 93px;\\\"\\u003e\\n \\u003cp\\u003e68（51.52%）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 113px;\\\"\\u003e\\n \\u003cp\\u003e294（68.37%）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 84px;\\\"\\u003e\\n \\u003cp\\u003eHistory of vaginal delivery at \\u0026ge; 28 weeks of pregnancy\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003eyes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 93px;\\\"\\u003e\\n \\u003cp\\u003e6（4.5%）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 113px;\\\"\\u003e\\n \\u003cp\\u003e58（13.5%）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 75px;\\\"\\u003e\\n \\u003cp\\u003eX2=8.004\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003e0.005\\u003c/p\\u003e\\n \\u003cp\\u003e(Bilateral)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003eno\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 93px;\\\"\\u003e\\n \\u003cp\\u003e126（95.5%）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 113px;\\\"\\u003e\\n \\u003cp\\u003e372（86.5%）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 84px;\\\"\\u003e\\n \\u003cp\\u003eNatural labor\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003eyes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 93px;\\\"\\u003e\\n \\u003cp\\u003e32（24.2%）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 113px;\\\"\\u003e\\n \\u003cp\\u003e222（51.6%）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 75px;\\\"\\u003e\\n \\u003cp\\u003eX2=30.580\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003e0.000\\u003c/p\\u003e\\n \\u003cp\\u003e(Bilateral)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003eno\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 93px;\\\"\\u003e\\n \\u003cp\\u003e100（75.8%）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 113px;\\\"\\u003e\\n \\u003cp\\u003e208（48.4%）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 84px;\\\"\\u003e\\n \\u003cp\\u003eCervical score\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 93px;\\\"\\u003e\\n \\u003cp\\u003e3.72\\u0026plusmn;1.44\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 113px;\\\"\\u003e\\n \\u003cp\\u003e4.70\\u0026plusmn;1.97\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 75px;\\\"\\u003e\\n \\u003cp\\u003et=4.358\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003e0.000\\u003c/p\\u003e\\n \\u003cp\\u003e(Bilateral)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e(0.532,\\u003c/p\\u003e\\n \\u003cp\\u003e1.415)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 84px;\\\"\\u003e\\n \\u003cp\\u003elabor analgesia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003eyes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 93px;\\\"\\u003e\\n \\u003cp\\u003e32（24.2%）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 113px;\\\"\\u003e\\n \\u003cp\\u003e178（41.4%）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 75px;\\\"\\u003e\\n \\u003cp\\u003eX2=12.697\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 83px;\\\"\\u003e\\n \\u003cp\\u003e0.000（Bilateral）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003eno\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 93px;\\\"\\u003e\\n \\u003cp\\u003e100（75.8%）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 113px;\\\"\\u003e\\n \\u003cp\\u003e252（58.6%）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e3.2 \\u0026nbsp; Multivariate logistic regression analysis\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eCorrelation analysis was conducted on factors that showed statistical differences in Table 1 and were believed to affect the final mode of delivery. Educational level was used as the independent variable (X), the final mode of delivery was used as the dependent variable (Y), and factors such as vaginal delivery history at \\u0026ge; 28 weeks of pregnancy (Z1), natural labor (Z2), cervical score (Z3), and intraspinal delivery analgesia (Z4) were recognized by current domestic and foreign expert consensus or guidelines \\u003csup\\u003e[6,7]\\u003c/sup\\u003e as covariates (Z). Multivariate unconditional logistic regression analysis was performed. Firstly, a univariate logistic regression analysis was conducted between the mode of delivery and educational level, as shown in Model 1 in Table 2. Secondly, logistic regression analysis was conducted again after fine-tuning the variables in the regression model by introducing Z1, as shown in Model 2 in Table 2.Finally, logistic regression analysis was conducted by fully adjusting the variables of the regression model by introducing Z1, Z2, Z3, and Z4. At the same time, the interaction between the independent variables and each covariate was tested, as shown in Model 3 in Table 2.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 2 Logistic regression analysis and interaction test between delivery mode and educational level\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 55px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 150px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003eB\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003eWald\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003eP\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003eOR\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 119px;\\\"\\u003e\\n \\u003cp\\u003e95.0% CI\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 55px;\\\"\\u003e\\n \\u003cp\\u003emodel1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 150px;\\\"\\u003e\\n \\u003cp\\u003edegree of education\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e-0.315\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e8.968\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e0.003\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e0.73\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 119px;\\\"\\u003e\\n \\u003cp\\u003e（0.594,0.897)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 150px;\\\"\\u003e\\n \\u003cp\\u003econstant\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e0.274\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e0.312\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e0.577\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e1.316\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 119px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 55px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 150px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 119px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"3\\\" valign=\\\"top\\\" style=\\\"width: 55px;\\\"\\u003e\\n \\u003cp\\u003emodel2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 150px;\\\"\\u003e\\n \\u003cp\\u003edegree of education\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e-0.344\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e10.26\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e0.709\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 119px;\\\"\\u003e\\n \\u003cp\\u003e(0.575,0.875)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 150px;\\\"\\u003e\\n \\u003cp\\u003eHistory of vaginal delivery at \\u0026ge; 28 weeks of pregnancy\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e-1.368\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e4.661\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e0.031\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e0.255\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 119px;\\\"\\u003e\\n \\u003cp\\u003e(0.074,0.882)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 150px;\\\"\\u003e\\n \\u003cp\\u003econstant\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e1.896\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e4.668\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e0.031\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e6.662\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 119px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 55px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 150px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 119px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"6\\\" valign=\\\"top\\\" style=\\\"width: 55px;\\\"\\u003e\\n \\u003cp\\u003emodel3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 150px;\\\"\\u003e\\n \\u003cp\\u003edegree of education\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e-0.45\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e7.259\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e0.007\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e0.638\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 119px;\\\"\\u003e\\n \\u003cp\\u003e(0.46,0.885)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 150px;\\\"\\u003e\\n \\u003cp\\u003eHistory of vaginal delivery at \\u0026ge; 28 weeks of pregnancy\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e-1.722\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e4.738\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e0.03\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e0.179\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 119px;\\\"\\u003e\\n \\u003cp\\u003e(0.038,0.843)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 150px;\\\"\\u003e\\n \\u003cp\\u003eNatural labor\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e-1.226\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e5.043\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e0.025\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e0.293\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 119px;\\\"\\u003e\\n \\u003cp\\u003e(0.101,0.856)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 150px;\\\"\\u003e\\n \\u003cp\\u003eCervical score\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e-0.33\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e4.021\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e0.045\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e0.719\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 119px;\\\"\\u003e\\n \\u003cp\\u003e(0.521,0.993)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 150px;\\\"\\u003e\\n \\u003cp\\u003elabor analgesia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e-1.189\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e6.513\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e0.011\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e0.305\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 119px;\\\"\\u003e\\n \\u003cp\\u003e(0.122,0.759)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 150px;\\\"\\u003e\\n \\u003cp\\u003eInteraction between X and Z\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e0.01\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e0.567\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e0.452\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e1.000\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 119px;\\\"\\u003e\\n \\u003cp\\u003e(0.984,1.037)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 55px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 150px;\\\"\\u003e\\n \\u003cp\\u003econstant\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 66px;\\\"\\u003e\\n \\u003cp\\u003e6.955\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e9.346\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 58px;\\\"\\u003e\\n \\u003cp\\u003e0.002\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e1.05E+03\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 119px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e3.3 Regression Model Evaluation\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe results of the univariate logistic regression analysis between delivery mode and education level showed a negative correlation between the independent variable (X) and the dependent variable (Y) (OR=0.73, P\\u0026lt;0.05). After fine-tuning and fully adjusting the model variables, the independent variable X and the dependent variable Y showed a stable negative correlation (OR=0.638, P\\u0026lt;0.05). The interaction test between the independent variable X and the covariate Z showed no interaction between the independent variable and each covariate, indicating that education level is an independent factor affecting TOLAC outcomes (OR=1000, P\\u0026gt;0.05).\\u003c/p\\u003e\"},{\"header\":\"4. Discussion\",\"content\":\"\\u003cp\\u003e4.1 In recent years, with the adjustment of China\\u0026apos;s birth policy, the number of scarred uterine pregnancies has been increasing. The risk of scarred uterine pregnancy (such as uterine incision pregnancy, dangerous placenta previa) cannot be avoided, and with the increase of cesarean section frequency, the incidence of the above complications increases accordingly\\u003csup\\u003e\\u0026nbsp;[9]\\u003c/sup\\u003e. Obstetric medical workers and pregnant women are facing severe challenges. Further exploring the factors that affect the outcome of TOLAC, how to improve or reasonably utilize the factors that are highly correlated with the success rate of TOLAC, and how to reduce the short - and long-term complications of cesarean section by further improving the success rate of TOLAC have become hot topics and urgent issues for discussion among obstetric workers in China\\u003csup\\u003e\\u0026nbsp;[10-11]\\u003c/sup\\u003e.\\u003c/p\\u003e\\n\\u003cp\\u003e4.2 This study found a negative correlation between education level and TOLAC failure. Lower education level is a risk factor for TOLAC failure, while higher education level reduces the risk of TOLAC failure, indicating that higher education level is a protective factor for TOLAC failure. At the same time, it was found that education level is an independent factor affecting TOLAC outcomes, which may be related to the following factors. Firstly, the four major elements of childbirth are labor force, birth canal, fetus, and social psychological factors\\u003csup\\u003e\\u0026nbsp;[12]\\u003c/sup\\u003e. Education level belongs to the category of social factors. Pregnant women with lower education levels lack sufficient and correct understanding of the process, advantages and disadvantages, risks, and emergency measures of scar uterus vaginal delivery, and to some extent have blind fear psychology \\u003csup\\u003e[5,13]\\u003c/sup\\u003e. They are more likely to worry and anxiety during vaginal trial delivery due to the risks of scar uterus vaginal delivery (such as uterine rupture), so they are more likely to give up continuing the trial delivery and actively request a cesarean section during the trial delivery process; Secondly, pregnant women with lower levels of education may experience increased opportunities for forced cesarean section due to psychological factors such as blind anxiety and fear during the TOLAC process, even if they do not voluntarily give up vaginal trials; Again, pregnant women with lower levels of education may experience further stress during the TOLAC process due to insufficient psychological support from their families \\u003csup\\u003e[13]\\u003c/sup\\u003e. This study also showed that a history of vaginal delivery at \\u0026ge; 28 weeks of gestation, natural labor, high cervical score at admission, and the use of labor analgesia were all protective factors for TOLAC failure, which is consistent with previous research results at home and abroad \\u003csup\\u003e[11,14,15,16,17,18]\\u003c/sup\\u003e.Social psychological factors are one of the four major elements of vaginal delivery, among which social factors have a broader connotation, including age, ethnicity, cultural level, economy, region, faith, etc. This study revealed the relationship between demographic and sociological factors such as age, ethnicity, educational level, and history of vaginal delivery at \\u0026ge; 28 weeks of gestation and TOLAC outcomes.\\u003c/p\\u003e\\n\\u003cp\\u003e4.3 \\u0026nbsp;In summary, educational level is an independent factor affecting the outcome of TOLAC, and there is a negative correlation between educational level and TOLAC failure. Therefore, it is necessary to strengthen prenatal science education, psychological guidance, and spiritual support for pregnant women with scarred uterus who have lower educational levels in order to improve the success rate of TOLAC. As for the deeper and more complex correlation between educational level and TOLAC outcomes, further research is needed.\\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eData availability statement:\\u003c/strong\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eAs the paper has not been officially published and the research subjects have not been authorized in writing to disclose the data, the datasets generated and/or analyzed during this study are not publicly available, but can be obtained from the corresponding author upon reasonable request. If necessary, you can contact us through the following email address.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eYijun Liu,Chenyu Jiang,Xinghui Liu. Interpretation of SOGC Postcesarean Vaginal Trial Guidelines (2019 Edition) [J]. Journal of Practical Obstetrics and Gynecology, 2019, 35 (12): 914-918.\\u003c/li\\u003e\\n\\u003cli\\u003eSantas G，Santas F.Trends of caesarean section rates in Turkey[J]．Journal of obstetrics and gynaecology，2018,38(5):658\\u0026mdash;662．\\u003c/li\\u003e\\n\\u003cli\\u003eBarber EL,Lundsberg LS,Belanger K，et a1.Indications contributing to the increasing cesarean delivery rate[J].Obstetrics and Gynecology，2011，118(1):29-38．\\u003c/li\\u003e\\n\\u003cli\\u003eYunxiu Li,Huiting Yin,Liqiong Zhou, etc. Exploration of a predictive model for vaginal delivery after cesarean section [J]. Chinese Journal of Family Planning and Obstetrics and Gynecology,2020,12 (7): 88-92.\\u003c/li\\u003e\\n\\u003cli\\u003eXiaoming Chen,Zhenyu Chen.Research progress on predictive models for vaginal delivery of recurrent pregnancy after cesarean section [J]. Chinese Modern Doctor, 2021,59 (25):184-188.\\u003c/li\\u003e\\n\\u003cli\\u003eObstetrics Group of the Obstetrics and Gynecology Branch of the Chinese Medical Association Expert consensus on vaginal delivery management for re pregnancy after cesarean section (2016) [J]. Chinese Journal of Obstetrics and Gynecology, 2016, 51 (8):561-564.\\u003c/li\\u003e\\n\\u003cli\\u003eAmerican College of Obstetricians and Gynecologists.Vaginal Birth After Cesarean Delivery[J].Obstetrics and Gynecology,2019,133(2):e110-127.\\u003c/li\\u003e\\n\\u003cli\\u003eYu Xing,Xuan Chen.Research progress on vaginal trial for re- pregnancy after cesarean section [J].International Journal of Obstetrics and Gynecology, 2021, 48 (1): 99-104.\\u003c/li\\u003e\\n\\u003cli\\u003eSociety of Gynecologic 0ncology，American College of 0bstetricians and Gynecologists and the Society for Maternal-Fetal Medicine,Cahill AG，et a1.Placenta accreta spectrum[J].American journal of obstetrics and gynecology，2018,219(6): B2-B16．\\u003c/li\\u003e\\n\\u003cli\\u003eTian Mou,Yan Wang,Guoli Liu, etc. Clinical application of 7 predictive models for vaginal delivery after cesarean section in China [J]. Journal of Peking University (Medical Edition), 2016, 48 (5): 795-800.\\u003c/li\\u003e\\n\\u003cli\\u003eCuizhu Sun,Xia Sun,Jia Wei,etc. Predictive analysis of factors related to vaginal delivery after cesarean section [J]. Chinese Journal of Family Planning and Obstetrics and Gynecology, 2022, 14 (4): 52-57.\\u003c/li\\u003e\\n\\u003cli\\u003eXing Xie,Beihua Kong,and Tao Duan are editors in chief. Obstetrics and Gynecology 9th edition Beijing: People\\u0026apos;s Health Publishing House,2018:163-165.\\u003c/li\\u003e\\n\\u003cli\\u003eEditor in Chief Xiaocheng Nie.Diagnosis and Treatment Techniques for Scared Uterine Pregnancy [M]. First Edition Chengdu: Sichuan University Press, 2023: 64-75.\\u003c/li\\u003e\\n\\u003cli\\u003eSabol B，Denman MA，Guise JM．Vaginal birth after cesarean:an effective method to reduce cesarean [J]．Clinical Obstetrics and Gynecology,2015，58(2):309-319．\\u003c/li\\u003e\\n\\u003cli\\u003eWeijian Zeng,Wei Gu,Yiling Ke,etc. Exploration of Predictive Factors for Successful Vaginal Trial Delivery after Cesarean Section [J]. Chinese Journal of Obstetrics and Gynecology, 2019, 20 (3): 196-198.\\u003c/li\\u003e\\n\\u003cli\\u003eHaumonte JB,Raylet M,Christophe M，et al.French validation and adaptation of the Grobman nomogram for prediction of vaginal birth after cesarean delivery [J].Journal of Gynecology Obstetrics and Human Reproduction,2018,47（3）:127-131.\\u003c/li\\u003e\\n\\u003cli\\u003eYan Long,Li Lin.Measures and value of preventing uterine cavity infection in patients undergoing artificial rupture induced abortion [J].Journal of Practical Obstetrics and Gynecology,2016,32 (3):170-172.\\u003c/li\\u003e\\n\\u003cli\\u003eMeiling Zeng,Libi Liang,Hailan Guan.Clinical application of guided instruments in full-term vaginal delivery with scarred uterus re pregnancy [J].Jilin Medical Journal,2017,38 (4):643-645.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":false,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":true,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"After cesarean section, Second pregnancy, Vaginal trial, Population sociology\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-5843109/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-5843109/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eObjective\\u003c/strong\\u003e To explore the demographic and sociological factors influencing the outcome of trial of labor after cesarean (TOLAC) during subsequent pregnancy, aimed at improving the success rate of TOLAC.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMethods\\u003c/strong\\u003e Adopting a prospective nested case-control study.Follow up on the vaginal trial outcomes of 562 pregnant women with scar uterus who met the inclusion criteria.132 cases of scarred uterus transferred to cesarean section were included in the study group and 430 scarred uterus cases of successful vaginal delivery were included in the control group.Compare the differences between the two groups in demographic sociology and obstetric conditions and further conduct correlation analysis on indicators with statistical differences between groups.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults\\u003c/strong\\u003e Single factor comparison between groups showed statistical differences between the two groups in terms of education level, vaginal delivery history over 28 weeks, natural labor, cervical score, and intraspinal delivery analgesia (P\\u0026lt;0.05).There was no statistically significant difference in age and ethnicity(P\\u0026gt;0.05).Multivariate logistic regression analysis showed a negative correlation between educational level and vaginal trial delivery failure in scarred uterus pregnancy (OR=0.692, P\\u0026lt;0.05),The negative correlation was discovered between known confounding factors (≥ 28 weeks of vaginal delivery history, natural labor, cervical score, intraspinal delivery analgesia) and TOLAC failure(P\\u0026lt;0.05) . There was no interaction between educational level and the various known confounding factors included (OR=1, P\\u0026gt;0.05)\\u003cstrong\\u003e.\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusion\\u003c/strong\\u003e Educational level is an independent factor affecting the outcome of TOLAC, and there is a negative correlation between educational level and TOLAC failure.Therefore,it is necessary to strengthen scientific education, psychological guidance, and psychological support for pregnant women with scarred uterus who have lower educational level in order to improve the success rate of TOLAC.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Study on demographic and sociological factors influencing the outcome of vaginal trial of labor for subsequent pregnancies after cesarean section\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-01-23 07:16:02\",\"doi\":\"10.21203/rs.3.rs-5843109/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"23c55a8a-0b9c-4e9a-84de-05ac333ee219\",\"owner\":[],\"postedDate\":\"January 23rd, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[{\"id\":43250954,\"name\":\"Health sciences/Diseases\"},{\"id\":43250955,\"name\":\"Health sciences/Health care\"},{\"id\":43250956,\"name\":\"Health sciences/Health occupations\"},{\"id\":43250957,\"name\":\"Health sciences/Medical research\"},{\"id\":43250958,\"name\":\"Health sciences/Risk factors\"}],\"tags\":[],\"updatedAt\":\"2025-06-16T05:08:49+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-01-23 07:16:02\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-5843109\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-5843109\",\"identity\":\"rs-5843109\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}