有剖宫产和阴道分娩史的妇女试产时子宫破裂的风险。
Risk of uterine rupture in women undergoing trial of labour with a history of both a caesarean section and a vaginal delivery.
机构信息
Department of Gynecology and Obstetrics, Diakonessenhuis Utrecht, Utrecht, Netherlands.
出版信息
Arch Gynecol Obstet. 2011 Nov;284(5):1053-8. doi: 10.1007/s00404-011-2048-x. Epub 2011 Aug 31.
PURPOSE
To determine the risk of uterine rupture for women undergoing trial of labour (TOL) with both a prior caesarean section (CS) and a vaginal delivery.
METHODS
A systematic literature search was performed using keywords for CS and uterine rupture. The results were critically appraised and the data from relevant and valid articles were extracted. Odds ratios were calculated and a pooled estimate was determined using the Mantel-Haenszel method.
RESULTS
Five studies were used for final analysis. Three studies showed a significant risk reduction for women with both a previous CS and a prior vaginal delivery (PVD) compared to women with a previous CS only, and two studies showed a trend towards risk reduction. The absolute risk of uterine rupture with a prior vaginal delivery varied from 0.17 to 0.46%. The overall odds ratio for PVD was 0.39 (95% CI 0.29-0.52, P < 0.00001).
CONCLUSION
Women with a history of both a CS and vaginal delivery are at decreased risk of uterine rupture when undergoing TOL compared with women who have only had a CS.
目的
确定既往剖宫产（CS）和阴道分娩（PVD）后行试产（TOL）的妇女发生子宫破裂的风险。
方法
使用 CS 和子宫破裂的关键词进行系统文献检索。对结果进行批判性评价，并提取相关和有效文章的数据。使用 Mantel-Haenszel 法计算比值比，并确定合并估计值。
结果
最终分析使用了 5 项研究。3 项研究表明，与仅行 CS 的妇女相比，既往 CS 合并 PVD 的妇女发生子宫破裂的风险显著降低，2 项研究显示风险降低的趋势。既往 PVD 发生子宫破裂的绝对风险为 0.17%至 0.46%。PVD 的总体比值比为 0.39（95%CI 0.29-0.52，P<0.00001）。
结论
与仅行 CS 的妇女相比，既往 CS 合并 PVD 后行 TOL 的妇女发生子宫破裂的风险降低。
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