Dinsmoor Mara J, Brock Ellen L
Department of Obstetrics and Gynecology, Medical College of Virginia Physicians and Hospitals of the Virginia Commonwealth University Health System, Richmond, Virginia, USA.
Obstet Gynecol. 2004 Feb;103(2):282-6. doi: 10.1097/01.AOG.0000110544.42128.7a.
To apply published scoring systems retrospectively to patients who had undergone a trial of labor after cesarean delivery to estimate whether there was a score at which a trial of labor should be discouraged.
Patients with 1 previous cesarean delivery who then delivered between January 1, 1998, and December 31, 1998, were studied. An investigator blinded to outcome assigned scores using 3 different scoring systems. Student t test, chi(2), analysis of variance, and receiver operating curve analysis were performed. P <.05 was significant.
Seventy-six percent (117/153) of trial of labor patients had a vaginal birth after cesarean delivery. Successful vaginal birth after cesarean delivery patients had significantly different mean scores using all 3 scoring systems, but none of the systems accurately predicted failed trial of labor resulting in cesarean delivery. Unfavorable scores were associated with high rates of major complications.
An unfavorable score predicting a high rate of complications and more failed trials of labor may help in counseling patients considering trial of labor. A better system to predict the success or failure of trial of labor is needed.
III
对接受过剖宫产术后试产的患者回顾性应用已发表的评分系统，以评估是否存在一个应不鼓励试产的评分。
研究1998年1月1日至1998年12月31日期间有过1次剖宫产史且随后分娩的患者。一名对结局不知情的研究者使用3种不同的评分系统进行评分。进行了Student t检验、卡方检验、方差分析和受试者工作特征曲线分析。P <.05具有显著性。
76%（117/153）的试产患者剖宫产术后经阴道分娩。剖宫产术后成功经阴道分娩的患者使用所有3种评分系统的平均得分均有显著差异，但没有一个系统能准确预测试产失败导致剖宫产。不良评分与高比例的严重并发症相关。
预测高并发症发生率和更多试产失败的不良评分可能有助于为考虑试产的患者提供咨询。需要一个更好的系统来预测试产的成功或失败。
III
