既往阴道分娩对后续试产期间子宫破裂风险的影响。

Effect of previous vaginal delivery on the risk of uterine rupture during a subsequent trial of labor.

作者信息

Zelop C M, Shipp T D, Repke J T, Cohen A, Lieberman E

机构信息

Department of Obstetrics and Gynecology, Lenox Hill Hospital, New York, NY 10021-1988, USA.

出版信息

Am J Obstet Gynecol. 2000 Nov;183(5):1184-6. doi: 10.1067/mob.2000.109048.

DOI:10.1067/mob.2000.109048

PMID:11084564

Abstract

OBJECTIVE

We examined the effect of prior vaginal delivery on the risk of uterine rupture in pregnant women undergoing a trial of labor after prior cesarean delivery.

STUDY DESIGN

The medical records of all pregnant women with a history of cesarean delivery who attempted a trial of labor during a 12-year period at a single center were reviewed. For the current analysis, the study population was limited to term pregnancies. The effect of previous vaginal delivery on the risk of uterine rupture during a subsequent trial of labor was evaluated. Separate analyses were performed for women with a single previous cesarean delivery and for those with >1 prior cesarean delivery. For each of these subgroups, the rate of uterine rupture among women who had > or =1 prior vaginal delivery was compared with the rate among women with no prior vaginal delivery. Logistic regression analysis was used to examine the associations with control for confounding factors.

RESULTS

Of 3783 women with 1 prior scar, 1021 (27.0%) also had > or =1 prior vaginal delivery. During a subsequent trial of labor, the rate of uterine rupture was 1.1% among pregnant women without prior vaginal delivery and 0.2% among pregnant women with prior vaginal delivery (P =.01). Logistic regression analysis controlling for duration of labor, induction, birth weight, maternal age, year of birth, epidural analgesia, and oxytocin augmentation indicated that, among women with a single scar, those with a prior vaginal delivery had a risk of uterine rupture that was one fifth that of women without a previous vaginal delivery (odds ratio, 0.2; 95% confidence interval, 0.04-0.8). In the group of 143 pregnant women with >1 previous cesarean delivery, women with a prior vaginal delivery had a somewhat lower risk of uterine rupture (3.9% vs 2.5%; adjusted odds ratio, 0.6; 95% confidence interval, 0.01-6.7). This difference was not statistically significant.

CONCLUSION

Among women with 1 prior cesarean delivery undergoing a subsequent trial of labor, those with a prior vaginal delivery were at substantially lower risk of uterine rupture than women without a previous vaginal delivery.

摘要

目的

我们研究了既往阴道分娩对剖宫产术后经阴道试产的孕妇子宫破裂风险的影响。

研究设计

回顾了在单一中心12年间所有有剖宫产史且尝试经阴道试产的孕妇的病历。对于当前分析，研究人群限于足月妊娠。评估既往阴道分娩对后续经阴道试产期间子宫破裂风险的影响。对既往有一次剖宫产的妇女和既往有多次剖宫产的妇女分别进行分析。对于这些亚组中的每一组，将既往有≥1次阴道分娩的妇女的子宫破裂率与无既往阴道分娩的妇女的子宫破裂率进行比较。采用逻辑回归分析来检验与混杂因素控制相关的关联。

结果

在3783例有1处既往瘢痕的妇女中，1021例（27.0%）也有≥1次既往阴道分娩。在随后的经阴道试产期间，无既往阴道分娩的孕妇子宫破裂率为1.1%，有既往阴道分娩的孕妇子宫破裂率为0.2%（P = 0.01）。对产程、引产、出生体重、产妇年龄、出生年份、硬膜外镇痛和缩宫素加强等因素进行控制的逻辑回归分析表明，在有单一瘢痕的妇女中，既往有阴道分娩的妇女子宫破裂风险是无既往阴道分娩妇女的五分之一（比值比，0.2；95%置信区间，0.04 - 0.8）。在143例既往有多次剖宫产的孕妇组中，既往有阴道分娩的妇女子宫破裂风险略低（3.9%对2.5%；调整后的比值比，0.6；95%置信区间，0.01 - 6.7）。这种差异无统计学意义。