怀特对行试产的产妇糖尿病及剖宫产术后阴道分娩结局的分类。
White's classification of maternal diabetes and vaginal birth after cesarean delivery success in women undergoing a trial of labor.
机构信息
From the Departments of Obstetrics and Gynecology University of Texas Health Science Center at Houston, Houston, Texas; The Ohio State University, Columbus, Ohio; University of Alabama at Birmingham, Birmingham Alabama; University of Texas Southwestern Medical Center, Dallas, Texas; University of Utah, Salt Lake City, Utah; University of Pittsburgh, Pittsburgh, Pennsylvania; Thomas Jefferson University, Philadelphia, Pennsylvania; Wayne State University, Detroit, Michigan; University of Cincinnati, Cincinnati, Ohio; Columbia University, New York, New York; Brown University, Providence, Rhode Island; Northwestern University, Chicago, Illinois; University of Miami, Miami, Florida; University of Tennessee, Memphis, Tennessee; University of Texas Health Science Center at San Antonio, San Antonio, Texas; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Case Western Reserve University Cleveland, Ohio, The George Washington University Biostatistics Center, Washington, DC, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
出版信息
Obstet Gynecol. 2010 Jan;115(1):60-64. doi: 10.1097/AOG.0b013e3181c534ca.
OBJECTIVE
To estimate the rate of vaginal birth after cesarean delivery (VBAC) success in diabetic women based on White's Classification.
METHODS
This is a secondary analysis of an observational study conducted at 19 medical centers of women attempting VBAC. Diabetic women with singleton gestations, one prior cesarean delivery, and cephalic presentation who underwent a trial of labor were included. Vaginal birth after cesarean delivery success rates and maternal and neonatal complications were compared based on White's Classification.
RESULTS
Of 11,856 women who underwent trial of labor, 624 met all study criteria (class A1, 356; A2, 169; B, 70; C, 21; D/R/F, 8). Vaginal birth after cesarean delivery success in each group was: A1, 68.5% (95% confidence interval [CI] 63.4-73.3%); A2, 55% (95% CI 47.2-62.7%); B, 70% (95% CI 57.9-80.4%); C, 47.6% (95% CI 25.7-70.2%); and D/F/R, 12.5% (95% CI 0.3-52.7%). Maternal and neonatal complications were rare and not found to be different among groups.
CONCLUSION
Our study provides estimates for VBAC success based on White's classification and indicates a relatively low rate of perinatal complications after VBAC attempt for diabetic women.
LEVEL OF EVIDENCE
III.
目的
根据 White 分类法，估计糖尿病女性行剖宫产术后阴道分娩（VBAC）成功的比率。
方法
这是一项在 19 家医疗中心进行的观察性研究的二次分析，研究对象为尝试 VBAC 的女性。纳入标准为：单胎妊娠、既往剖宫产且头位、行试产的糖尿病女性。根据 White 分类法，比较 VBAC 成功率和母婴并发症。
结果
在 11856 例行试产的女性中，有 624 名符合所有研究标准（A1 类 356 例，A2 类 169 例，B 类 70 例，C 类 21 例，D/R/F 类 8 例）。各组的 VBAC 成功率分别为：A1 类 68.5%（95%置信区间 63.4%-73.3%）；A2 类 55%（95%置信区间 47.2%-62.7%）；B 类 70%（95%置信区间 57.9%-80.4%）；C 类 47.6%（95%置信区间 25.7%-70.2%）；D/F/R 类 12.5%（95%置信区间 0.3%-52.7%）。母婴并发症罕见，且各组间无差异。
结论
本研究根据 White 分类法提供了 VBAC 成功率的估计值，并表明糖尿病女性行 VBAC 尝试后的围产期并发症发生率相对较低。
证据水平
III 级。
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