既往有剖宫产史的女性中，试产与择期剖宫产的孕产妇死亡率和发病率比较。
Comparison of maternal mortality and morbidity between trial of labor and elective cesarean section among women with previous cesarean delivery.
作者信息
Wen Shi Wu, Rusen I D, Walker Mark, Liston Robert, Kramer Michael S, Baskett Tom, Heaman Maureen, Liu Shiliang
机构信息
Division of Health Surveillance and Epidemiology, Centre for Healthy Human Development, Health Canada, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada.
出版信息
Am J Obstet Gynecol. 2004 Oct;191(4):1263-9. doi: 10.1016/j.ajog.2004.03.022.
OBJECTIVE
This study was undertaken to assess the safety of trial of labor after previous cesarean delivery.
STUDY DESIGN
Retrospective cohort study of 308,755 Canadian women with previous cesarean delivery between 1988 and 2000. Occurrences of in-hospital maternal death, uterine rupture, and other severe maternal morbidity were compared between women with a trial of labor and those with an elective cesarean section.
RESULTS
Rates of uterine rupture (0.65%), transfusion (0.19%), and hysterectomy (0.10%) were significantly higher in the trial-of-labor group. Maternal in-hospital death rate, however, was lower in the trial-of-labor group (1.6 per 100,000) than in the elective cesarean section group (5.6 per 100,000). The association between trial of labor and uterine rupture was stronger in low volume (<500) than in high volume (> or =500 births per year) obstetric units.
CONCLUSION
Trial of labor is associated with increased risk of uterine rupture, but elective cesarean section may increase the risk of maternal death.
目的
本研究旨在评估既往剖宫产术后试产的安全性。
研究设计
对1988年至2000年间308755例有既往剖宫产史的加拿大女性进行回顾性队列研究。比较试产女性和择期剖宫产女性的院内孕产妇死亡、子宫破裂及其他严重孕产妇并发症的发生情况。
结果
试产组子宫破裂率（0.65%）、输血率（0.19%）和子宫切除率（0.10%）显著更高。然而，试产组的院内孕产妇死亡率（每10万例中有1.6例）低于择期剖宫产组（每10万例中有5.6例）。在低容量（<500例）产科单位，试产与子宫破裂之间的关联比高容量（≥500例/年）产科单位更强。
结论
试产与子宫破裂风险增加相关，但择期剖宫产可能增加孕产妇死亡风险。
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