Blackwell S C, Hassan S S, Wolfe H M, Michaelson J, Berry S M, Sorokin Y
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hutzel Hospital, 4707 St. Antoine Boulevard, Detroit, MI 48201, USA.
J Reprod Med. 2000 Dec;45(12):987-90.
To compare the delivery outcomes in term diabetic patients without a prior cesarean delivery to those attempting vaginal birth after cesarean (VBAC).
A retrospective chart review study was performed of singleton pregnancies complicated by class A-2-R diabetes who delivered at > or = 37 weeks from 1991 to 1997. Exclusion criteria were prior classical or low vertical cesarean, more than one prior cesarean delivery, fetal structural defects or any contraindications to labor. Outcome measures were compared for patients without prior cesarean (group 1) to those with a VBAC attempt (group 2).
One hundred fifty-nine patients, 127 patients without a prior cesarean delivery and 32 patients with a VBAC attempt, met all the study criteria. The cesarean delivery rate was 26.3% (34/127) in group 1 and 56.3% (18/32) in group 2 (VBAC success rate, 43.7%). There were no cases of uterine rupture. There were no differences in the frequency of endometritis rates or neonatal intensive care unit admission, whether vaginal or cesarean delivery occurred.
VBAC success rates appeared to be lower for diabetic gravidas as compared to those for nondiabetic women reported in the literature. Although maternal and neonatal complication rates were low, further studies are necessary to determine the safety of VBAC in this population.
比较未行剖宫产的足月糖尿病患者与剖宫产术后试产（VBAC）患者的分娩结局。
对1991年至1997年期间分娩孕周≥37周、单胎妊娠合并A-2-R级糖尿病的患者进行回顾性病历审查研究。排除标准为既往有古典式或低位纵切口剖宫产史、既往剖宫产次数超过一次、胎儿结构缺陷或任何分娩禁忌证。对未行剖宫产的患者（第1组）和试产VBAC的患者（第2组）的结局指标进行比较。
159例患者符合所有研究标准，其中127例未行剖宫产，32例试产VBAC。第1组剖宫产率为26.3%（34/127），第2组为56.3%（18/32）（VBAC成功率为43.7%）。无子宫破裂病例。无论采用阴道分娩还是剖宫产，子宫内膜炎发生率或新生儿重症监护病房收治率均无差异。
与文献报道的非糖尿病孕妇相比，糖尿病孕妇的VBAC成功率似乎较低。尽管母婴并发症发生率较低，但仍需进一步研究以确定该人群VBAC的安全性。
