National Perinatal Epidemiology Centre, Department of Obstetrics and Gynecology, University of College, Cork, Cork, Ireland.
Semin Perinatol. 2010 Aug;34(4):249-57. doi: 10.1053/j.semperi.2010.03.004.
An estimated 40% of the 1.3 million cesarean deliveries performed each year in the United States are repeat procedures. The appropriate clinical management approach for women with previous cesarean delivery remains challenging because options are limited. The risks and benefits of clinical management choices in the woman's health need to be quantified. Thus, we discuss the available published scientific data on (1) the short-term maternal outcomes of trial of labor after cesarean and elective repeat cesarean delivery, (2) the differences between outcomes for both, (3) the important factors that influence these outcomes, and (4) successful vs. unsuccessful vaginal birth after cesarean. For women with a previous cesarean delivery, a successful trial of labor offers several distinct, consistently reproducible advantages compared with elective repeat cesarean delivery, including fewer hysterectomies, fewer thromboembolic events, lower blood transfusion rates, and shorter hospital stay. However, when trial of labor after cesarean fails, emergency cesarean is associated with increased uterine rupture, hysterectomy, operative injury, blood transfusion, endometritis, and longer hospital stay. Care of women with a history of previous cesarean delivery involves a confluence of interactions between medical and nonmedical factors; however, the most important determinants of the short-term outcomes among these women are likely individualized counseling, accurate clinical diagnoses, and careful management during a trial of labor. We recommend a randomized controlled trial among women undergoing a TOLAC and a longitudinal cohort study among women with previous cesarean to evaluate adverse outcomes, with focused attention on both mother and the infant.
在美国，每年进行的 130 万例剖宫产中，估计有 40%是重复手术。对于有剖宫产史的女性，适当的临床管理方法仍然具有挑战性，因为选择有限。需要对女性健康管理选择的风险和益处进行量化。因此，我们讨论了关于（1）剖宫产术后试产和选择性重复剖宫产的短期母婴结局，（2）两者之间的差异，（3）影响这些结局的重要因素，以及（4）剖宫产术后阴道分娩成功与失败的可用已发表科学数据。对于有剖宫产史的女性，与选择性重复剖宫产相比，剖宫产术后试产有几个明显的、一致可重复的优势，包括更少的子宫切除术、更少的血栓栓塞事件、更低的输血率和更短的住院时间。然而，当剖宫产术后试产失败时，紧急剖宫产与子宫破裂、子宫切除术、手术损伤、输血、子宫内膜炎和住院时间延长有关。有剖宫产史的女性的护理涉及医疗和非医疗因素的相互作用；然而，这些女性短期结局的最重要决定因素可能是个体化咨询、准确的临床诊断和试产期间的仔细管理。我们建议对接受 TOLAC 的女性进行随机对照试验，并对有剖宫产史的女性进行纵向队列研究，以评估不良结局，并特别关注母亲和婴儿。
