Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, MO, USA.
Am J Obstet Gynecol. 2012 Jan;206(1):51.e1-5. doi: 10.1016/j.ajog.2011.09.022. Epub 2011 Sep 24.
We sought to estimate the risk of uterine rupture associated with labor induction in women attempting trial of labor after cesarean (TOLAC) accounting for length of labor.
This was a nested case-control study of women attempting TOLAC within a multicenter retrospective cohort study of women with a prior cesarean. Time-to-event analyses were performed with time zero defined as the first cervical exam of 4 cm. Subjects experienced the event (uterine rupture) or were censored (delivered).
In all, 111 cases of uterine rupture were compared to 607 controls. When accounting for length of labor, the risk of uterine rupture in induced labor was similar to the risk in spontaneous-onset labor (hazard ratio, 1.52; 95% confidence interval, 0.97-2.36). An initial unfavorable cervical exam was associated with an increased risk of uterine rupture compared to spontaneous (hazard ratio, 4.09; 95% confidence interval, 1.82-9.17).
After accounting for labor duration, induction is not associated with an increased risk of uterine rupture in women undergoing TOLAC.
本研究旨在评估考虑产程时长的情况下，行剖宫产术后试产（TOLAC）的产妇行引产分娩与子宫破裂风险的相关性。
本研究是一项多中心回顾性队列研究中 TOLAC 产妇的巢式病例对照研究，研究对象为既往有剖宫产史的产妇。以首次宫颈检查 4cm 时为时间零，进行时间依赖性分析。以发生事件（子宫破裂）或删失（分娩）为结局。
共比较了 111 例子宫破裂病例和 607 例对照。考虑产程时长后，引产分娩的子宫破裂风险与自然临产相似（风险比，1.52；95%置信区间，0.97-2.36）。与自然临产相比，初始宫颈检查不理想与子宫破裂风险增加相关（风险比，4.09；95%置信区间，1.82-9.17）。
在考虑产程持续时间后，TOLAC 产妇行引产分娩与子宫破裂风险增加无关。
