Cahill Alison G, Stamilio David M, Odibo Anthony O, Peipert Jeffrey F, Ratcliffe Sarah J, Stevens Erika J, Sammel Mary D, Macones George A
Department of Obstetrics and Gynecology, Washington University, St. Louis, MO, USA.
Am J Obstet Gynecol. 2006 Oct;195(4):1143-7. doi: 10.1016/j.ajog.2006.06.045. Epub 2006 Jul 17.
This study was undertaken to determine whether vaginal birth after cesarean (VBAC) or elective repeat cesarean delivery is safer overall for a woman with a prior vaginal delivery.
This retrospective cohort study of pregnant women from 1996 to 2000 who had a prior cesarean delivery, was conducted in 17 centers. Trained nurses extracted historical and maternal outcome data on subjects by using standardized tools. This planned secondary analysis examined the subcohort that had also previously undergone a vaginal delivery, comparing those who underwent a VBAC trial with those who elected to have a repeat cesarean delivery. Outcomes included uterine rupture, bladder injury, fever, transfusion and a composite (uterine rupture, bladder injury, and artery laceration). We performed bivariate and multivariable analyses.
Of 6619 patients with a prior cesarean delivery who had also had a prior vaginal delivery, 5041 patients attempted a VBAC delivery and 1578 had an elective cesarean delivery. Although there was no significant difference in uterine rupture or bladder injury between the two groups, women who underwent a VBAC attempt were less likely to experience the composite adverse maternal outcome, have a fever, or require a transfusion.
Among VBAC candidates who have had a prior vaginal delivery, those who attempt a VBAC trial have decreased risk for overall major maternal morbidities, as well as maternal fever and transfusion requirement compared with women who elect repeat cesarean delivery. Physicians should make this more favorable benefit-risk ratio explicit when counseling this patient subpopulation on a trial of labor.
本研究旨在确定对于有过阴道分娩史的女性，剖宫产术后阴道分娩（VBAC）或择期再次剖宫产总体上哪种更安全。
这项对1996年至2000年有过剖宫产史的孕妇进行的回顾性队列研究在17个中心开展。经过培训的护士使用标准化工具提取研究对象的病史和产妇结局数据。这项计划中的二次分析考察了之前也有过阴道分娩经历的亚组人群，将尝试VBAC的人群与选择再次剖宫产的人群进行比较。结局包括子宫破裂、膀胱损伤、发热、输血以及一个综合指标（子宫破裂、膀胱损伤和动脉撕裂）。我们进行了双变量和多变量分析。
在6619例有过剖宫产史且之前也有过阴道分娩经历的患者中，5041例尝试VBAC分娩，1578例接受择期剖宫产。虽然两组在子宫破裂或膀胱损伤方面无显著差异，但尝试VBAC的女性发生综合不良产妇结局、发热或需要输血的可能性较小。
在有过阴道分娩史的VBAC候选者中，与选择再次剖宫产的女性相比，尝试VBAC的女性发生总体主要产妇并发症、产妇发热和输血需求的风险降低。在为这一亚组患者提供试产咨询时，医生应明确说明这种更有利的效益风险比。
