既往因多胎妊娠行剖宫产术后的引产试验。

Trial of labor after one previous cesarean delivery for multifetal gestation.

作者信息

Varner Michael W, Thom Elizabeth, Spong Catherine Y, Landon Mark B, Leveno Kenneth J, Rouse Dwight J, Moawad Atef H, Simhan Hyagriv N, Harper Margaret, Wapner Ronald J, Sorokin Yoram, Miodovnik Menachem, Carpenter Marshall, Peaceman Alan, O'sullivan Mary J, Sibai Baha M, Langer Oded, Thorp John M, Ramin Susan M, Mercer Brian M

机构信息

Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA.

出版信息

Obstet Gynecol. 2007 Oct;110(4):814-9. doi: 10.1097/01.AOG.0000280586.05350.9e.

DOI:10.1097/01.AOG.0000280586.05350.9e

PMID:17906014

Abstract

OBJECTIVE

To estimate success rates and risks with a trial of labor after one previous cesarean delivery for multifetal gestation compared with one previous cesarean delivery for a singleton pregnancy.

METHODS

Patients from the National Institute of Child Health and Human Development Maternal Fetal Medicine Units Network Cesarean Registry with one previous cesarean delivery and a current term singleton pregnancy were identified. Cases had one previous cesarean delivery for a multifetal pregnancy. Controls had one previous cesarean delivery for a singleton pregnancy.

RESULTS

Of cases, 556 of 944 (58.9%) attempted a trial of labor. Of controls, 13,923 of 29,329 (47.5%) attempted a trial of labor. The trial of labor success rate was 85.6% among cases and 73.1% among controls (odds ratio 2.19, 95% confidence interval 1.72-2.78). Compared with trial of labor controls, cases had no statistically increased risk of transfusion, endometritis, intensive care unit admissions, uterine rupture, or perinatal complications. Cases in this analysis with a successful trial of labor were more likely to have previously had a successful vaginal birth after cesarean (37.1% compared with 14.1%, P<.001).

CONCLUSION

Women with one previous cesarean delivery for a multifetal gestation have high trial of labor success rates and low complication rates.

摘要

目的

评估与单胎妊娠前次剖宫产相比，多胎妊娠前次剖宫产术后试产的成功率及风险。

方法

从美国国立儿童健康与人类发展研究所母胎医学单位网络剖宫产登记处中，识别出有前次剖宫产史且当前为足月单胎妊娠的患者。病例组为有前次多胎妊娠剖宫产史的患者。对照组为有前次单胎妊娠剖宫产史的患者。

结果

病例组中，944例中有556例（58.9%）尝试试产。对照组中，29329例中有13923例（47.5%）尝试试产。病例组试产成功率为85.6%，对照组为73.1%（优势比2.19，95%置信区间1.72 - 2.78）。与试产对照组相比，病例组输血、子宫内膜炎、入住重症监护病房、子宫破裂或围产期并发症的风险无统计学意义上的增加。该分析中试产成功的病例组患者既往更有可能有剖宫产术后阴道分娩成功史（37.1% 对比14.1%，P<0.001）。