Abstract:【Objective】 To investigate the indications of having to transform from labor analgesia by means of combined spinal epidural who selected vaginal delivery into cesarean section. 【Methods】 During January 2009 to December 2013

428 cases were collected as research group who were able for vaginal delivery and chosen combined spinal epidural and 430 cases contemporaneously of vaginal delivery at first without labor analgesia also transformed into cesarean section for control group

the indications and factors of cesarean section of two groups were analyzed and compared. 【Results】 The top four indications of two groups for cesarean section successively were: head dystocia

fetal distress

social factors and scarred uterus. For research group

the head dystocia rate was higher than that in control group(P < 0.01)

but cesarean section rates due to fetal distress and social factors were lower than those in control group(P < 0.05 and P < 0.01). As for head dystocia in two groups

the top three factors were: persistent occiput posterior position

persistent occiput transverse position

cephalopelvic disproportion (occipito-anterior position). The top three influence factors of fetal distress in research group successively were the umbilical cord factors

chorioamnionitis

pregnancy combined diseases

while in control group it seemed to be umbilical cord factors

unidentified amniotic fluid turbidity and chorioamnionitis. Besides

neonatal asphyxia rate of research group was lower than that in control group (P < 0.05)

but the oxytocin usage rate was higher than that of control group (P < 0.01). 【Conclusions】 It seemed that combined spinal epidural for labor analgesia could reduce the incidence of fetal distress and neonatal asphyxia

but increase the risk of head dystocia. Strengthening observation and handling labor abnormalities

improving analgesia method may be effective ways to reduce the rate of cesarean section.