Guise Jeanne-Marie, Berlin Michelle, McDonagh Marian, Osterweil Patricia, Chan Benjamin, Helfand Mark
Department of Obstetrics and Gynecology, Evidence-based Practice Center, Oregon Health & Science University, UHN-50, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA.
Obstet Gynecol. 2004 Mar;103(3):420-9. doi: 10.1097/01.AOG.0000116259.41678.f1.
To evaluate the benefits and harms of vaginal birth after cesarean compared with repeat cesarean delivery.
The computerized databases MEDLINE, EMBASE, HealthSTAR, Cochrane CENTRAL, and National Centre for Reviews and Dissemination Database of Abstracts of Reviews of Effectiveness, along with reference lists and national experts, were used to conduct this review.
All studies that reported data for maternal or infant outcomes in women with prior cesarean delivery were eligible. Methodological quality was evaluated for each study with the criteria of the United States Preventive Services Task Force and the National Health Service Centre for Reviews and Dissemination. Twenty of 6,828 potentially relevant articles (55,506 patients) were included in the analysis.
TABULATION, INTEGRATION, AND RESULTS: Two authors independently abstracted information on study design, sample size, participant characteristics, and maternal and fetal health outcomes by using a standardized protocol. Rates of vaginal delivery in women undergoing a trial of labor ranged from 60% to 82%. There was no significant difference in maternal deaths or hysterectomy between trial of labor and repeat cesarean. Uterine rupture was more common in the trial-of-labor group, but rates of asymptomatic uterine dehiscence did not differ. Studies conflicted on the effect of induction of labor on these outcomes. Data regarding infant outcomes were poor.
Safety in childbirth for women with prior cesarean is a major public health concern. Methodological deficiencies in the literature evaluating the relative safety of vaginal birth after cesarean compared with repeat cesarean delivery are striking. The identification of high-risk and low-risk groups of women and settings for morbidity remains a key research priority.
评估剖宫产术后经阴道分娩与再次剖宫产相比的益处和危害。
使用计算机化数据库MEDLINE、EMBASE、HealthSTAR、Cochrane CENTRAL以及国家卫生服务中心有效性综述摘要数据库，并结合参考文献列表和国家专家进行本综述。
所有报告既往剖宫产妇女母婴结局数据的研究均符合条件。根据美国预防服务工作组和国家卫生服务中心综述与传播中心的标准对每项研究的方法学质量进行评估。分析纳入了6828篇潜在相关文章中的20篇（55506名患者）。
制表、整合与结果：两位作者使用标准化方案独立提取关于研究设计、样本量、参与者特征以及母婴健康结局的信息。进行试产的妇女阴道分娩率在60%至82%之间。试产组和再次剖宫产组在孕产妇死亡或子宫切除方面无显著差异。子宫破裂在试产组中更常见，但无症状子宫裂开的发生率无差异。关于引产对这些结局的影响，研究结果存在冲突。关于婴儿结局的数据较差。
既往剖宫产妇女的分娩安全是一个主要的公共卫生问题。在评估剖宫产术后经阴道分娩与再次剖宫产相对安全性的文献中，方法学缺陷十分显著。识别高风险和低风险妇女群体以及发病情况的相关因素仍然是关键的研究重点。
