Bujold Emmanuel, Blackwell Sean C, Gauthier Robert J
Department of Obstetrics and Gynecology, Hôpital Ste-Justine, Université de Montréal, Montreal, Quebec, Canada. ubujold\@med.wayne.edu
Obstet Gynecol. 2004 Jan;103(1):18-23. doi: 10.1097/01.AOG.0000109148.23082.C1.
To estimate whether the rate of uterine rupture in patients with a previous cesarean delivery is related to labor induction and/or cervical ripening using transcervical Foley catheter.
Charts of all patients who had a trial of labor after a previous cesarean delivery in our institution between 1988 and 2002 were reviewed. The rates of successful vaginal birth after cesarean delivery and uterine rupture in patients with spontaneous labor (control group) were compared with those of patients who underwent a labor induction by means of amniotomy with or without oxytocin and patients who underwent a labor induction/cervical ripening using a transcervical Foley catheter. Logistic regression analysis was performed to adjust for confounding variables.
Of 2479 patients, 1807 had a spontaneous labor, 417 had labor induced by amniotomy with or without oxytocin, and 255 had labor induced by using transcervical Foley catheter. The rate of successful vaginal birth after cesarean delivery was significantly different among the groups (78.0% versus 77.9% versus 55.7%, P <.001), but not the rate of uterine rupture (1.1% versus 1.2% versus 1.6%, P =.81). After adjusting for confounding variables, the odds ratio (OR) for successful vaginal birth after cesarean delivery was 0.68 (95% confidence interval [CI] 0.41, 1.15), and the OR for uterine rupture was 0.47 (95% CI 0.06, 3.59) in patients who underwent an induction of labor using a transcervical Foley catheter when compared with patients with spontaneous labor.
Labor induction using a transcervical Foley catheter was not associated with an increased risk of uterine rupture.
评估既往有剖宫产史患者的子宫破裂发生率是否与使用经宫颈Foley导管引产和/或促宫颈成熟有关。
回顾了1988年至2002年间在本机构有既往剖宫产史且进行试产的所有患者的病历。将自然分娩患者（对照组）剖宫产术后成功阴道分娩率和子宫破裂率与行羊膜腔穿刺引产（使用或不使用缩宫素）患者以及使用经宫颈Foley导管引产/促宫颈成熟患者的相应比率进行比较。进行逻辑回归分析以校正混杂变量。
2479例患者中，1807例自然分娩，417例行羊膜腔穿刺引产（使用或不使用缩宫素），255例行经宫颈Foley导管引产。各组间剖宫产术后成功阴道分娩率有显著差异（78.0%对77.9%对55.7%，P<.001），但子宫破裂率无差异（1.1%对1.2%对1.6%，P=.81）。校正混杂变量后，与自然分娩患者相比，使用经宫颈Foley导管引产患者剖宫产术后成功阴道分娩的优势比（OR）为0.68（95%置信区间[CI]0.41，1.15），子宫破裂的OR为0.47（95%CI0.06，3.59）。
使用经宫颈Foley导管引产与子宫破裂风险增加无关。
