Goodall Perpetua T, Ahn Jennifer T, Chapa Jeff B, Hibbard Judith U
Department of Obstetrics and Gynecology, Section of Maternal Fetal Medicine, The University of Chicago, Chicago, Ill, USA.
Am J Obstet Gynecol. 2005 May;192(5):1423-6. doi: 10.1016/j.ajog.2004.12.075.
This study was undertaken to determine whether obesity is a risk factor for failed trial of labor (TOL) in women with previous cesarean delivery (CD).
We performed a review of singleton gestations 36 weeks or greater with previous CD who underwent TOL from January 1998 to June 2002, stratifying by body mass index (BMI, kg/m2): normal (BMI <25), overweight (BMI 25-29.9), obese (BMI 30-39.9), and morbidly obese (BMI >40). Rates for failed TOL were determined, and groups compared.
For 725 patients, failed TOL rates were as follows: 14.1%, 20.4%, 27.7%, and 30.3% for normal, overweight, obese, and morbidly obese groups, respectively (P < .0001). Significant risk factors included: no previous vaginal delivery, labor induction, recurrent CD indication, and fetal macrosomia. However, obesity remained an independent risk factor for failed TOL in the obese and morbidly obese groups with odds ratio of 1.99 (95% CI 1.20-3.30) and 2.22 (1.11-4.44) for these groups (P = .03), respectively.
Obesity is an independent risk factor for failed TOL in patients with previous CD.
本研究旨在确定肥胖是否为既往有剖宫产史的女性试产失败的危险因素。
我们对1998年1月至2002年6月期间既往有剖宫产史且孕周36周及以上的单胎妊娠女性进行了回顾性研究，根据体重指数（BMI，kg/m²）进行分层：正常（BMI<25）、超重（BMI 25-29.9）、肥胖（BMI 30-39.9）和病态肥胖（BMI>40）。确定试产失败率，并对各组进行比较。
725例患者的试产失败率如下：正常、超重、肥胖和病态肥胖组分别为14.1%、20.4%、27.7%和30.3%（P<.0001）。显著的危险因素包括：既往无阴道分娩史、引产、再次剖宫产指征和胎儿巨大。然而，肥胖仍然是肥胖和病态肥胖组试产失败的独立危险因素，这两组的比值比分别为1.99（95%CI 1.20-3.30）和2.22（1.11-4.44）（P=.03）。
肥胖是既往有剖宫产史患者试产失败的独立危险因素。
