Birgisdottir Brynhildur Tinna, Hardardottir Hildur, Bjarnadottir Ragnhildur I, Thorkelsson Thordur
Laeknabladid. 2008 Sep;94(9):591-7.
To evaluate the frequency of different modes of delivery after one previous cesarean section and those factors which may influence mode of delivery.
During the study period (1.1.2001-31.12.2005) 925 women with a previous cesarean section and a following singleton pregnancy were identified and included. Information regarding mode of delivery, induction of labor, instrumental delivery, the urgency and indications for first and second cesarean section, birth weight and Apgar scores were collected retrospectively.
Trial of labor (TOL) was initiated for 564 women of which 61% were successful while 39% delivered by an emergent cesarean section. In total, 346 women delivered vaginally (37%), 341 women (37%) delivered with an elective cesarean section and 238 (26%) underwent an emergency cesarean section. The VBAC rate increased during the study period, from 35% to 46%. Women who underwent an elective cesarean section due to fetal malpresentation (most often breech) in their first pregnancy were significantly more likely to have a successful VBAC in their second pregnancy (53%) compared with women who had an elective cesarean section for any other indication (21%) (p<0.0001). Uterine rupture occurred in six women (1%) during TOL, five underwent an emergency cesarean section and had healthy infants while there was one intrapartum fetal death. No correlation was found between birth mode and Apgar scores at five minutes. Perinatal mortality rate was 5,4 per thousand. Trial of labor was less likely to succeed if the infant's birth weight was >4000 grams compared with <4000 grams (p<0.01).
The results of this study indicate that VBAC is a safe option for women with a history of one previous cesarean section while in the hospital setting where there are resources for an immediate cesarean section.
Vaginal birth after cesarean section (VBAC), uterine rupture, perinatal mortality rate. Correspondence: Hildur Hardardóttir, hhard@landspitali.is.
评估既往有一次剖宫产史的产妇不同分娩方式的频率以及可能影响分娩方式的因素。
在研究期间（2001年1月1日至2005年12月31日），确定并纳入了925例既往有剖宫产史且此次为单胎妊娠的产妇。回顾性收集了有关分娩方式、引产、器械助产、首次和第二次剖宫产的紧迫性及指征、出生体重和阿氏评分的信息。
564例产妇尝试经阴道分娩（TOL）试验，其中61%成功，39%行急诊剖宫产。总共有346例产妇经阴道分娩（37%），341例产妇（37%）行择期剖宫产，238例（26%）行急诊剖宫产。在研究期间，阴道试产成功率从35%提高到46%。与因其他任何指征行择期剖宫产的产妇（21%）相比，首次妊娠因胎位异常（最常见为臀位）行择期剖宫产且此次尝试经阴道分娩成功的产妇比例更高（53%）（p<0.0001）。6例产妇（1%）在经阴道分娩试验期间发生子宫破裂，5例行急诊剖宫产且新生儿健康，1例发生产时胎儿死亡。未发现分娩方式与5分钟时阿氏评分之间存在相关性。围产儿死亡率为千分之5.4。与出生体重<4000克的婴儿相比，出生体重>4000克的婴儿经阴道分娩试验成功可能性更低（p<0.01）。
本研究结果表明，对于既往有一次剖宫产史且所在医院具备急诊剖宫产资源的产妇，经阴道分娩是一种安全的选择。
剖宫产术后阴道分娩（VBAC）；子宫破裂；围产儿死亡率。通信作者：希尔杜尔·哈达尔多蒂尔，hhard@landspitali.is
