Koigi-Kamau R, Leting P K, Kiarie J N
Department of Obstetrics and Gynaecology, College of Health Science, University of Nairobi, P.O. Box 19676, Nairobi, Kenya.
East Afr Med J. 2005 Dec;82(12):631-6. doi: 10.4314/eamj.v82i12.9368.
To determine perceptions, preferences and practices of vaginal birth after Caesarean.
Cross-sectional descriptive study.
Private clinics of obstetricians in five major towns of Kenya.
Obstetricians in private practice.
Practice and experiences in trial of labour (TOL); need for, and application of, selection criteria in TOL; perceptions on outcomes of TOL and patient preference; perception on trends of vaginal birth after Caesarean (VBAC) and need for policy on TOL.
Nearly all respondents (98.4%) believed in the need for, and application of, selection criteria for allowing TOL. However, only 23% believed in routine screening with radiological pelvimetry, while 63.2% believed in routine foetal weight estimation. All obstetricians (100%) have ever managed TOL in private practice, and 74% had managed at least one case in the last six months. Despite lack of tangible selection criteria, 83.1% think that most women prefer TOL while 95.1% discourage it if perceived as inappropriate. Failure rate of TOL was perceived to be more than 50% by 35.2% of the respondents. A majority of the respondents (about 75%) would prefer TOL on themselves or their spouses. Those who perceived that there was a falling trend of VBAC were 58%, citing increased demand by mothers (45.7%), obstetricians' convenience (40.0%) and fear of litigation (26.8%) as the reasons for this observation. A fluid policy of "TOL whenever it is deemed as appropriate" was preferred by 88.7%.
The perception of obstetricians is that desire for VBAC predominates over elective repeat Caesarean. However, consensus on appropriate selection criteria is lacking, which leaves the obstetrician in a management dilemma. Hence, there is need to study outcomes of both ERC and TOL in order to come out with objective policy guidelines on management of one previous Caesarean in pregnancy.
确定剖宫产术后阴道分娩的认知、偏好和实践情况。
横断面描述性研究。
肯尼亚五个主要城镇的私人产科诊所。
私人执业的产科医生。
试产（TOL）的实践与经验；TOL中选择标准的必要性及应用情况；对TOL结局和患者偏好的认知；对剖宫产术后阴道分娩（VBAC）趋势的认知以及对TOL政策的需求。
几乎所有受访者（98.4%）都认为需要并应用TOL的选择标准。然而，只有23%的人认为需要常规进行放射学骨盆测量筛查，而63.2%的人认为需要常规估计胎儿体重。所有产科医生（100%）都曾在私人执业中处理过TOL，74%的人在过去六个月中至少处理过一例。尽管缺乏明确的选择标准，但83.1%的人认为大多数女性更喜欢TOL，而95.1%的人认为如果被认为不合适则不鼓励TOL。35.2%的受访者认为TOL的失败率超过50%。大多数受访者（约75%）希望自己或配偶接受TOL。58%的人认为VBAC呈下降趋势，他们指出母亲需求增加（45.7%）、产科医生便利（40.0%）和害怕诉讼（26.8%）是观察到这一现象的原因。88.7%的人更喜欢“在认为合适时随时进行TOL”这一灵活政策。
产科医生的认知是，对VBAC的渴望超过了选择性再次剖宫产。然而，在合适的选择标准上缺乏共识，这使产科医生陷入管理困境。因此，有必要研究选择性再次剖宫产和TOL的结局，以便制定关于孕期有过一次剖宫产的管理的客观政策指南。
