Hassan Aisha
Department of Gynaecology. Ayub Teaching Hospital, Abbottabad.
J Ayub Med Coll Abbottabad. 2005 Jan-Mar;17(1):57-61.
The caesarean section rate has increased to an alarming extent in the last three decades the world over and fear of rupture of uterus in subsequent pregnancy and labour has led to a high rate of repeat caesarean sections. The objective of this study was to determine the final outcome of a trial of scar and Vaginal Birth After Caesarean Section (VBAC) and develop guidelines to reduce the rate of unnecessary repeat caesarean section.
This study was carried out in Obstetric and Gynecology Unit 'A' of Ayub Teaching Hospital Abbottabad from 01.11.2002 to 31.10.2004. A total of 2652 patients were delivered during this period out of which 297 patients had history of one previous caesarean section. A total of 53 patients had an elective repeat caesarean section and rest of 244 was subjected to a trial of scar.
Out of 244 patients selected for trial of scar, 165 (67.2%) had a successful uncomplicated vaginal delivery, 7 (3.2%) were delivered by forceps, 11 (5.2%) with vacuum extractor and 61 (24.4%) required a repeat emergency caesarean section. 83% of the patients had a spontaneous onset of labour and 17% needed induction of labour with prostaglandin E2 pesseries and augmentation of the labour with oxytocin. However repeat caesarean section rate was high in the later group. 71.2% of the babies were born with Apgar score > 8 and 24.6% had an Apgar score between 6-8. There were 3 cases of scar dehiscence and one case of ruptured uterus and one baby was lost due to this complication. No serious maternal complication occurred.
More than 75% of the patients with previous one caesarean section for non-recurrent cause can be successfully delivered vaginally. Antenatal booking and follow up, careful case selection for trial of scar and close observations during labour will achieve successful maternal and perinatal outcome. VBAC also saves any future caesarean sections, as currently previous two caesarean sections is an indication for elective caesarean section.
在过去三十年里，全球剖宫产率已上升到令人担忧的程度，对后续妊娠和分娩时子宫破裂的恐惧导致了重复剖宫产的高比率。本研究的目的是确定剖宫产术后瘢痕子宫试产及阴道分娩（VBAC）的最终结果，并制定指南以降低不必要的重复剖宫产率。
本研究于2002年11月1日至2004年10月31日在阿伯塔巴德阿尤布教学医院妇产科A区进行。在此期间共分娩2652例患者，其中297例有一次剖宫产史。共有53例患者进行了择期重复剖宫产，其余244例接受了瘢痕子宫试产。
在244例接受瘢痕子宫试产的患者中，165例（67.2%）成功进行了无并发症的阴道分娩，7例（3.2%）通过产钳助产，11例（5.2%）使用真空吸引器助产，61例（24.4%）需要再次紧急剖宫产。83%的患者自然发动分娩，17%需要使用前列腺素E2栓引产并用缩宫素加强宫缩。然而，后一组的重复剖宫产率较高。71.2%的婴儿出生时阿氏评分>8分，24.6%的婴儿阿氏评分在6 - 8分之间。有3例瘢痕裂开，1例子宫破裂，1例婴儿因该并发症死亡。未发生严重的母体并发症。
超过75%因非复发性原因曾行一次剖宫产的患者可以成功进行阴道分娩。产前登记和随访、仔细选择瘢痕子宫试产病例以及分娩期间密切观察将实现成功的母婴和围产期结局。VBAC还可避免未来的剖宫产，因为目前有两次剖宫产史是择期剖宫产的指征。
