From the Department of Obstetrics and Gynaecology, Faculty of Medicine, Hôpital Sainte-Justine, Université de Montréal, Montréal, Québec, Canada; and Department of Obstetrics and Gynaecology, Faculty of Medicine, Centre de recherche du Centre hospitalier universitaire de Québec, Université Laval, Québec, Québec, Canada.
Obstet Gynecol. 2010 Feb;115(2 Pt 1):338-343. doi: 10.1097/AOG.0b013e3181c915da.
To estimate the association between neonatal birth weight and adverse obstetric outcomes in women attempting vaginal birth after cesarean.
We reviewed the medical records of all women undergoing a trial of labor after a prior low transverse cesarean delivery in our institution between 1987 and 2004. Patients were categorized according to birth weight (less than 3,500 g [group 1, reference], 3,500-3,999 g [group 2], and 4,000 g or more [group 3]) and prior vaginal delivery. The rates of failed trial of labor, uterine rupture, shoulder dystocia, and third- and fourth-degree perineal laceration were compared among groups. Multivariable logistic regressions were performed to adjust for potential confounding factors.
Of 2,586 women, 1,519 (59%), 798 (31%), and 269 (10%) were included in groups 1, 2, and 3, respectively. Birth weight was directly correlated to the rate of failed trial of labor (19%, 28%, and 38% for groups 1, 2, and 3, respectively; P<.01), uterine rupture (0.9%, 1.8%, and 2.6%; P<.05), shoulder dystocia (0.3%, 1.6%, and 7.8%; P<.01), and third- and fourth-degree perineal laceration (5%, 7%, and 12%; P<.01). After adjustment for confounding variables, birth weight of 4,000 g or more remained associated with uterine rupture (odds ratio [OR] 2.62, 95% confidence interval [CI] 1.001-6.85), failed trial of labor (OR 2.47, 95% CI 1.82-3.34), shoulder dystocia (OR 25.13, 95% CI 9.31-67.86), and third- and fourth-degree perineal laceration (OR 2.64, 95% CI 1.66-4.19).
Birth weight and specifically macrosomia are linked with failed trial of labor, uterine rupture, shoulder dystocia, and third- and fourth-degree perineal laceration in women who underwent prior cesarean delivery. Estimated fetal weight should be included in the decision-making process for all women contemplating a trial of labor after cesarean delivery.
II.
评估剖宫产后阴道试产中新生儿体重与不良产科结局的关系。
我们回顾了 1987 年至 2004 年期间我院所有尝试经阴道分娩的既往行子宫下段剖宫产术的患者的病历。根据体重（小于 3500g[第 1 组，参考]、3500-3999g[第 2 组]和 4000g 或以上[第 3 组]）和既往阴道分娩情况对患者进行分类。比较各组间试产失败、子宫破裂、肩难产和三度及四度会阴裂伤的发生率。采用多变量逻辑回归调整潜在混杂因素。
在 2586 名妇女中，分别有 1519 名（59%）、798 名（31%）和 269 名（10%）妇女归入第 1 组、第 2 组和第 3 组。体重与试产失败的发生率直接相关（第 1、2 和 3 组分别为 19%、28%和 38%；P<.01）、子宫破裂（0.9%、1.8%和 2.6%；P<.05）、肩难产（0.3%、1.6%和 7.8%；P<.01）和三度及四度会阴裂伤（5%、7%和 12%；P<.01）。在调整混杂因素后，体重 4000g 或以上与子宫破裂（比值比[OR]2.62，95%置信区间[CI]1.001-6.85）、试产失败（OR 2.47，95% CI 1.82-3.34）、肩难产（OR 25.13，95% CI 9.31-67.86）和三度及四度会阴裂伤（OR 2.64，95% CI 1.66-4.19）相关。
在既往行剖宫产的妇女中，体重和巨大儿与试产失败、子宫破裂、肩难产和三度及四度会阴裂伤有关。对于考虑行剖宫产术后阴道试产的所有妇女，均应考虑估计胎儿体重。
II 级。
