Kwon Ji Young, Jo Yun Sung, Lee Gui Se Ra, Kim Sa Jin, Shin Jong Chul, Lee Young
Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Korea.
J Matern Fetal Neonatal Med. 2009 Nov;22(11):1057-62. doi: 10.3109/14767050902874089.
To evaluate the effect of labor progress prior to cesarean delivery on the outcome of vaginal birth after cesarean delivery (VBAC).
The medical records of women attempting VBAC between January 2000 and February 2008 were reviewed. All women had only one previous cesarean and underwent spontaneous labor.
Among 1148 enrolled women, 956 (83.3%) achieved a successful VBAC. Birth weight, previous indication for cesarean delivery and oxytocin augmentation were significantly associated with VBAC outcome. By multivariate analysis, a cervical dilatation >or=8 cm at previous cesarean was independently predictive of successful VBAC in women with a previous cesarean for non-recurrent indications (p = 0.046), yielding a VBAC success rate of 93.1%, whereas the extent of cervical dilatation at the previous cesarean did not affect the outcome of subsequent delivery in women with a previous cesarean for recurrent indications.
Women with cesarean for non-recurrent indications who achieved a cervical dilatation >or=8 cm may be the best candidates for VBAC, with the greatest likelihood of a successful VBAC. Labor progress at previous cesarean can serve as a valuable indicator for VBAC outcome in women with a previous cesarean for non-recurrent indications, and therefore should be discussed as part of preconception counseling.
评估剖宫产术前产程进展对剖宫产术后阴道分娩（VBAC）结局的影响。
回顾2000年1月至2008年2月间尝试VBAC的女性的病历。所有女性既往仅接受过一次剖宫产且为自然分娩。
在1148名登记入组的女性中，956名（83.3%）成功实现VBAC。出生体重、既往剖宫产指征及缩宫素加强与VBAC结局显著相关。多因素分析显示，既往剖宫产时宫颈扩张≥8 cm可独立预测既往因非复发性指征行剖宫产的女性VBAC成功（p = 0.046），VBAC成功率为93.1%，而既往剖宫产时宫颈扩张程度对既往因复发性指征行剖宫产的女性后续分娩结局无影响。
既往因非复发性指征行剖宫产且宫颈扩张≥8 cm的女性可能是VBAC的最佳候选者，VBAC成功可能性最大。既往剖宫产时的产程进展可作为既往因非复发性指征行剖宫产女性VBAC结局的重要指标，因此应在孕前咨询中进行讨论。
