Goldman G, Pineault R, Bilodeau H, Blais R
Département de médecine sociale et préventive, Faculté de médecine, Université de Montréal.
CMAJ. 1990 Nov 15;143(10):1017-24.
Repeat cesarean section is a major factor contributing to the rising cesarean section rate. Although vaginal birth after a previous cesarean section (VBAC) is advocated in most cases, it has not yet been adopted as widespread policy. In a case-control study we compared 400 women in Quebec who underwent VBAC with 1600 women who had a repeat cesarean section from 1985 to 1987 in an attempt to identify factors that favour vaginal delivery. Using both simple and multiple logistic regression analyses we examined the effect of independent variables linked to the patients (two variables), the attending physicians (seven) and the hospitals (two) on the dependent variable (type of birth) with the use of odds ratios. We found that the physician characteristics related to type of practice and the degree of hospital specialization were significant factors in predicting the type of delivery. Women who gave birth vaginally were more likely than those who had a repeat cesarean section to be attended by a physician with a specialized practice and to give birth in a hospital providing an intermediate or high level of care. This suggests that VBAC is still perceived as a high-risk option and is managed by only a minority of specialized obstetricians.
再次剖宫产是导致剖宫产率上升的一个主要因素。尽管大多数情况下提倡剖宫产后经阴道分娩（VBAC），但它尚未成为广泛采用的政策。在一项病例对照研究中，我们比较了魁北克省1985年至1987年间接受VBAC的400名女性与1600名接受再次剖宫产的女性，试图确定有利于阴道分娩的因素。我们使用简单和多元逻辑回归分析，通过比值比研究了与患者（两个变量）、主治医生（七个）和医院（两个）相关的自变量对因变量（分娩方式）的影响。我们发现，与执业类型和医院专业化程度相关的医生特征是预测分娩方式的重要因素。与接受再次剖宫产的女性相比，经阴道分娩的女性更有可能由具有专业执业资格的医生接生，并在提供中级或高级护理水平的医院分娩。这表明VBAC仍被视为高风险选择，仅由少数专业产科医生进行管理。
