Pang Man Wah, Law Lai Wah, Leung Tak Yeung, Lai Pui Yee, La Tze Kin
Department of Obstetrics and Gynecology, Prince of Wales Hospital, Hong Kong SAR, China.
Eur J Obstet Gynecol Reprod Biol. 2009 Mar;143(1):24-8. doi: 10.1016/j.ejogrb.2008.10.016. Epub 2009 Jan 10.
Certain sociodemographic characteristics and pregnancy events were shown to pre-dispose women to decline vaginal birth after cesarean section (CS) in the Western population. The study aimed to identify the sociodemographic factors and pregnancy events associated with Chinese women who declined to attempt vaginal birth after CS.
This was a retrospective study of Hong Kong Chinese women who delivered in a public obstetric unit between 2002 and 2006. It was the unit's policy that women should attempt vaginal birth after one previous lower segment CS. During the study period, 1317 healthy Hong Kong Chinese women carrying a singleton pregnancy had had one previous lower segment CS. Of these women, 787 had had no antenatal complications during their index pregnancy. Univariate and multivariate analyses were performed to identify the sociodemographic factors and pregnancy events associated with women who declined vaginal birth after CS.
Thirty-nine percent (39.26%; 95%CI 35.85, 42.67) of women had elective CS because they had declined a vaginal birth. A history of a previous successful vaginal birth was the strongest determinant negatively associated with declining a vaginal birth (OR 0.15; 95%CI 0.06, 0.37). Determinants that were positively associated with declining a vaginal birth were higher family social class (OR 1.61; 95%CI 1.02, 2.55); family income of more than US$ 3850 per month (OR 1.56; 95%CI 1.03, 2.34), and women who attended private antenatal care before their first visit to the public unit (OR 1.47; 95%CI 1.02, 2.12).
Women who experienced a previous successful vaginal birth were positively associated with attempting vaginal birth after CS. Women who declined vaginal birth after CS exhibited certain social characteristics and treatment-seeking behavior. Future studies into the social context of this group of women may help us understand the underlying reasons why they decline vaginal birth.
在西方人群中，某些社会人口学特征和妊娠事件被证明会使女性倾向于拒绝剖宫产术后阴道分娩（CS）。本研究旨在确定与拒绝剖宫产术后尝试阴道分娩的中国女性相关的社会人口学因素和妊娠事件。
这是一项对2002年至2006年间在一家公立产科单位分娩的中国香港女性进行的回顾性研究。该单位的政策是，曾有一次下段剖宫产史的女性应尝试阴道分娩。在研究期间，1317名怀有单胎妊娠的健康中国香港女性曾有一次下段剖宫产史。其中，787名女性在本次妊娠期间无产前并发症。进行单因素和多因素分析以确定与剖宫产术后拒绝阴道分娩的女性相关的社会人口学因素和妊娠事件。
39%（39.26%；95%可信区间35.85，42.67）的女性选择剖宫产是因为她们拒绝阴道分娩。既往有成功阴道分娩史是与拒绝阴道分娩呈负相关的最强决定因素（比值比0.15；95%可信区间0.06，0.37）。与拒绝阴道分娩呈正相关的决定因素包括较高的家庭社会阶层（比值比1.61；95%可信区间1.02，2.55）；每月家庭收入超过3850美元（比值比1.56；95%可信区间1.03，2.34），以及在首次就诊于公立单位之前接受私人产前护理的女性（比值比1.47；95%可信区间1.02，2.12）。
既往有成功阴道分娩经历的女性与剖宫产术后尝试阴道分娩呈正相关。剖宫产术后拒绝阴道分娩的女性表现出某些社会特征和就医行为。对这组女性社会背景的未来研究可能有助于我们理解她们拒绝阴道分娩的潜在原因。
