Tripathi Jagruti B, Doshi Haresh U, Kotdawala Parul J
Department of Obstetrics and Gynaecology, BJ Medical College and Civil Hospital, Ahmedabad.
J Indian Med Assoc. 2006 Mar;104(3):113-5.
A study was carried out among 81 women with previous one caesarean section (CS) done for non-recurrent indications to confirm the efficacy and safety of trial of labour (TOL) and to examine the effect of various factors on the mode of delivery. Singleton term pregnancy, vertex presentation and adequate pelvic capacity were the pre-requisites for case selection. Careful monitoring was done during labour and effect of various factors on the outcome was analysed statistically. Success rate of TOL was 73%. A non-recurrent indication for previous CS, such as malpresentation and foetal distress is associated with higher success rate of vaginal birth after caesarean (VBAC) compared to recurrent indications, such as cephalopelvic disproportion (CPD) and failure to progress (FTP). Prior vaginal birth improves the success rate (87%) of VBAC. Factors like premature rupture of membranes, hypertensive disorders of pregnancy, and post-date pregnancy did not affect the outcome adversely. Rate of emergency CS was 44% in women with floating head foetus, 39% in induction/augmentation group and 43% when birth weight of the foetus was > 3000 g. No maternal/perinatal mortality observed. Maternal/perinatal morbidity was low in cases with successful TOL. Uterine rupture occurred in one woman. There are few absolute contra-indications to attempted VBAC. Though the success rate does vary with different pre-existing factors, the clinician may anticipate greater than 50% chance for success in any individual labour.
对81例因非复发性指征行过一次剖宫产的女性进行了一项研究，以证实试产（TOL）的有效性和安全性，并研究各种因素对分娩方式的影响。单胎足月妊娠、头先露和骨盆容量足够是病例选择的前提条件。分娩期间进行了仔细监测，并对各种因素对结局的影响进行了统计学分析。试产成功率为73%。与复发性指征（如头盆不称（CPD）和产程无进展（FTP））相比，前次剖宫产的非复发性指征（如胎位异常和胎儿窘迫）与剖宫产术后阴道分娩（VBAC）的较高成功率相关。既往有阴道分娩史可提高VBAC的成功率（87%）。胎膜早破、妊娠高血压疾病和过期妊娠等因素对结局无不利影响。胎头浮动的女性急诊剖宫产率为44%，引产/加强宫缩组为39%，胎儿出生体重>3000g时为43%。未观察到孕产妇/围产儿死亡。试产成功的病例中孕产妇/围产儿发病率较低。有一名女性发生子宫破裂。尝试VBAC几乎没有绝对禁忌证。尽管成功率会因不同的既往因素而有所不同，但临床医生可以预期任何一次分娩的成功机会都大于50%。
