Mercer Brian M, Gilbert Sharon, Landon Mark B, Spong Catherine Y, Leveno Kenneth J, Rouse Dwight J, Varner Michael W, 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
Department of Obstetrics and Gynecology at Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio 44109-1989, USA.
Obstet Gynecol. 2008 Feb;111(2 Pt 1):285-91. doi: 10.1097/AOG.0b013e31816102b9.
To estimate the success rates and risks of an attempted vaginal birth after cesarean delivery (VBAC) according to the number of prior successful VBACs.
From a prospective multicenter registry collected at 19 clinical centers from 1999 to 2002, we selected women with one or more prior low transverse cesarean deliveries who attempted a VBAC in the current pregnancy. Outcomes were compared according to the number of prior VBAC attempts subsequent to the last cesarean delivery.
Among 13,532 women meeting eligibility criteria, VBAC success increased with increasing number of prior VBACs: 63.3%, 87.6%, 90.9%, 90.6%, and 91.6% for those with 0, 1, 2, 3, and 4 or more prior VBACs, respectively (P<.001). The rate of uterine rupture decreased after the first successful VBAC and did not increase thereafter: 0.87%, 0.45%, 0.38%, 0.54%, 0.52% (P=.03). The risk of uterine dehiscence and other peripartum complications also declined statistically after the first successful VBAC. No increase in neonatal morbidities was seen with increasing VBAC number thereafter.
Women with prior successful VBAC attempts are at low risk for maternal and neonatal complications during subsequent VBAC attempts. An increasing number of prior VBACs is associated with a greater probability of VBAC success, as well as a lower risk of uterine rupture and perinatal complications in the current pregnancy.
II.
根据既往剖宫产术后经阴道分娩（VBAC）成功的次数，评估VBAC的成功率和风险。
从1999年至2002年在19个临床中心收集的前瞻性多中心登记资料中，我们选取了有一次或多次既往低位横切口剖宫产史且本次妊娠尝试VBAC的女性。根据上次剖宫产术后既往VBAC尝试的次数比较结局。
在13532名符合入选标准的女性中，VBAC成功率随既往VBAC次数的增加而升高：既往VBAC次数为0、1、2、3、4次或更多次的女性，其成功率分别为63.3%、87.6%、90.9%、90.6%和91.6%（P<0.001）。首次VBAC成功后子宫破裂率下降，此后未再升高：分别为0.87%、0.45%、0.38%、0.54%、0.52%（P=0.03）。首次VBAC成功后，子宫裂开及其他围产期并发症的风险在统计学上也有所下降。此后随着VBAC次数增加，未见新生儿发病率升高。
既往有VBAC成功经历的女性在后续VBAC尝试中发生母儿并发症的风险较低。既往VBAC次数增加与VBAC成功的可能性增大以及本次妊娠子宫破裂和围产期并发症风险降低相关。
II级。
