Olagbuji B, Ezeanochie M, Okonofua F
Department of Obstetrics and Gynecology, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria.
J Obstet Gynaecol. 2010;30(6):582-5. doi: 10.3109/01443615.2010.486085.
Achieving a successful vaginal birth after a previous caesarean section (VBAC) is an important strategy in reducing the rising rate of caesarean section and its associated morbidities. Records of 188 women attempting trial of vaginal delivery after a previous lower segment caesarean section were reviewed to predict factors favouring successful vaginal delivery. Of the 188 women, 64 had recurrent indications for caesarean section, while 124 had non-recurrent indications. The group with recurrent indications for previous caesarean section had less vaginal delivery and more repeat caesarean sections as compared with the group with non-recurrent indications (21.9% and 78.1% vs 46.8% and 53.2%, respectively, p = 0.01). Cephalopelvic disproportion was more frequent in the group with recurrent indications (65.6% vs 27.4%, p < 0.0001). Significant predictors of successful VBAC in this cohort of women were non-recurrent indications for the previous caesarean section (p < 0.001, odds ratio (95% CI) 0.32 (0.2-0.6)) and a previous vaginal delivery (p < 0.0001, odds ratio (95% CI) 3.90 (2.1-7.4)). A previous vaginal delivery and a non-recurrent indication for the previous caesarean section are important predictors of VBAC in this cohort of women.
实现前次剖宫产术后成功的阴道分娩（VBAC）是降低剖宫产率及其相关发病率不断上升的一项重要策略。回顾了188例曾行下段剖宫产术后尝试阴道分娩的妇女的记录，以预测有利于成功阴道分娩的因素。在这188例妇女中，64例有剖宫产的复发指征，而124例有非复发指征。与非复发指征组相比，有剖宫产复发指征的组阴道分娩较少，再次剖宫产较多（分别为21.9%和78.1%对46.8%和53.2%，p = 0.01）。复发指征组头盆不称更为常见（65.6%对27.4%，p < 0.0001）。在这组妇女中，成功VBAC的显著预测因素是前次剖宫产的非复发指征（p < 0.001，比值比（95%CI）0.32（0.2 - 0.6））和既往阴道分娩史（p < 0.0001，比值比（95%CI）3.90（2.1 - 7.4））。既往阴道分娩史和前次剖宫产的非复发指征是这组妇女VBAC的重要预测因素。
