Zweifler John, Garza Alvaro, Hughes Susan, Stanich Matthew A, Hierholzer Anne, Lau Monica
Department of Family and Community Medicine, University of California, San Francisco, Fresno, Calif 93701, USA.
Ann Fam Med. 2006 May-Jun;4(3):228-34. doi: 10.1370/afm.544.
In 1999 the American College of Obstetricians and Gynecologists (ACOG) adopted more-restrictive guidelines for vaginal birth after cesarean delivery (VBAC). This study assesses trends in VBAC in California and compares neonatal and maternal mortality rates among women attempting VBAC delivery or undergoing repeat cesarean delivery before and after this guideline revision.
The 1996 through 2002 California Birth Statistical Master Files were used to identify 386,232 California residents who previously gave birth by cesarean delivery and had a singleton birth planned in a California hospital.
Attempted VBAC deliveries decreased significantly from 24% before to 13.5% after guideline revision (P <.001). Neonatal mortality rates per 1,000 live births for attempted VBAC deliveries were not different from repeat cesarean delivery rates among neonates weighing > or =1,500 g in either the study periods 1996 to 1999 or 2000 to 2002. Neonatal mortality rates for attempted VBAC deliveries were higher for repeat cesarean deliveries among neonates weighing <1,500 g in the same periods (attempted VBAC: 1996-1999, 253.2; 95% Poisson confidence interval [CI], 197.7-308.6; 2000-2002, 336.8; CI, 254.3-419.4; repeat cesarean delivery: 1996-1999, 59.1; CI, 48.3-69.9; 2000-2002, 60.5, CI, 48.4-72.5). Maternal death rates per 100,000 live births for attempted VBAC deliveries were similar for both periods (1996-1999, 2.0; CI, 0.1-11.0; 2000-2002, 8.5; CI, 1.0-30.6).
Neonatal and maternal mortality rates did not improve despite increasing rates of repeat cesarean delivery during the years after the ACOG 1999 VBAC guideline revision. Women with infants weighing > or =1,500 g encountered similar neonatal and maternal mortality rates with VBAC or repeat cesarean delivery.
1999年，美国妇产科医师学会（ACOG）对剖宫产术后阴道分娩（VBAC）采用了更为严格的指南。本研究评估了加利福尼亚州VBAC的趋势，并比较了在该指南修订前后尝试VBAC分娩或接受再次剖宫产的女性的新生儿和孕产妇死亡率。
使用1996年至2002年加利福尼亚州出生统计主文件，识别出386,232名曾在加利福尼亚州医院剖宫产分娩且计划单胎分娩的加利福尼亚居民。
尝试VBAC分娩的比例从指南修订前的24%显著降至修订后的13.5%（P<.001）。在1996年至1999年或2000年至2002年的研究期间，体重≥1500g的新生儿中，尝试VBAC分娩的每1000例活产新生儿死亡率与再次剖宫产分娩的死亡率没有差异。在同一时期，体重<1500g的新生儿中，尝试VBAC分娩的再次剖宫产分娩的新生儿死亡率更高（尝试VBAC：1996 - 1999年，253.2；95%泊松置信区间[CI]，197.7 - 308.6；2000 - 2002年，336.8；CI，254.3 - 419.4；再次剖宫产分娩：1996 - 1999年，59.1；CI，48.3 - 69.9；2000 - 2002年，60.5，CI，48.4 - 72.5）。两个时期尝试VBAC分娩的每10万例活产孕产妇死亡率相似（1996 - 1999年，2.0；CI，0.1 - 11.0；2000 - 2002年，8.5；CI，1.0 - 30.6）。
在ACOG 1999年VBAC指南修订后的几年里，尽管再次剖宫产率上升，但新生儿和孕产妇死亡率并未改善。体重≥1500g婴儿的女性，VBAC或再次剖宫产的新生儿和孕产妇死亡率相似。
