剖宫产术后引产成功与失败后的围产期结局
Perinatal outcomes after successful and failed trials of labor after cesarean delivery.
作者信息
El-Sayed Yasser Y, Watkins Melanie M, Fix Megan, Druzin Maurice L, Pullen Kristin M, Caughey Aaron B
机构信息
Department of Obstetrics and Gynecology, Stanford University Medical Center, Stanford, CA, USA.
出版信息
Am J Obstet Gynecol. 2007 Jun;196(6):583.e1-5; discussion 583.e5. doi: 10.1016/j.ajog.2007.03.013.
OBJECTIVE
To compare maternal and neonatal outcomes after successful and failed trials of labor after cesarean in women at term, excluding uterine ruptures, and to examine predictors of successful and failed trials of labor.
STUDY DESIGN
Matched maternal and neonatal data from 1993-1999 in women with singleton term pregnancies with prior cesarean undergoing trial of labor were reviewed. Women with uterine rupture were excluded. Maternal and neonatal outcomes were analyzed for successful and failed trials. Predictors of success and failure were examined.
RESULTS
1284 women and their neonates were available for analysis. 1094 (85.2%) had a vaginal birth and 190 (14.8%) underwent repeat cesarean. Failed trials of labor were associated with higher incidence of choriamnionitis (25.8% vs. 5.5%, P<.001), postpartum hemorrhage (35.8% vs. 15.8%, P<.001), hysterectomy (1% vs. 0%, P=.022), neonatal jaundice (17.4% vs.10.2%, P=.004) and composite major neonatal morbidities (6.3% vs. 2.8%, P=.014).
CONCLUSION
Failed trial of labor in women at term with prior cesarean is associated with increased maternal and neonatal morbidities.
目的
比较足月剖宫产术后引产成功与失败后的母婴结局（不包括子宫破裂），并研究引产成功与失败的预测因素。
研究设计
回顾了1993年至1999年单胎足月妊娠且既往有剖宫产史并接受引产的产妇及新生儿的配对数据。排除子宫破裂的妇女。分析引产成功与失败的母婴结局。研究成功与失败的预测因素。
结果
1284名妇女及其新生儿可供分析。1094例（85.2%）经阴道分娩，190例（14.8%）接受再次剖宫产。引产失败与绒毛膜羊膜炎发生率较高（25.8%对5.5%，P<0.001）、产后出血（35.8%对15.8%，P<0.001）、子宫切除术（1%对0%，P=0.022）、新生儿黄疸（17.4%对10.2%，P=0.004）及新生儿严重复合疾病（6.3%对2.8%，P=0.014）相关。
结论
既往有剖宫产史的足月妇女引产失败与母婴发病率增加有关。
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