Division of Health Care Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Road, Hyattsville, MD 20782, USA.
Matern Child Health J. 2013 Sep;17(7):1309-14. doi: 10.1007/s10995-012-1132-6.
This study compares rates of trial of labor after Cesarean delivery (TOLAC) and rates of successful TOLAC between 1990 and 2009. Serial cross-sectional analyses were performed using the National Hospital Discharge Survey data to compare rates of TOLAC and TOLAC success between 1990 and 2009. Joinpoint regression was used to assess trends over time, and logistic regression with marginal effects was used to examine the unadjusted and adjusted significance and magnitude of trends. The rate of TOLAC reached a high of 51.8 % (95 % CI 47.8-55.8 %) in 1995 and a low of 15.9 % (95 % CI 13.8-18.0 %) in 2006, declined, on average, 4.2 (95 % CI -4.8 to -3.9) percentage points per year between 1996 and 2005. Rates increased significantly from 1990 to 1996 and 2005 to 2009. TOLAC success was at its highest rate in 2000, 69.8 % (95 % CI 65.2-74.3 %) and its lowest in 2008, 38.5 % (95 % CI 28.1-48.8 %). The rate of TOLAC success increased significantly between 1990 and 2000, but declined thereafter an average of 3.4 % points per year (95 % CI -4.3 to -2.5). The rate of TOLAC in the US decreased between 1996 and 2005 and the rate of successful TOLAC has declined from 2000 to 2009.
这项研究比较了 1990 年至 2009 年期间剖宫产后试产（TOLAC）的比率和成功 TOLAC 的比率。使用国家医院出院调查数据进行了一系列横断面分析，以比较 1990 年至 2009 年期间 TOLAC 和 TOLAC 成功率的比率。采用 Joinpoint 回归评估随时间的趋势，采用具有边缘效应的逻辑回归检查未调整和调整趋势的显著性和幅度。TOLAC 的比率在 1995 年达到了 51.8%（95%置信区间为 47.8-55.8%）的峰值，在 2006 年达到了 15.9%（95%置信区间为 13.8-18.0%）的低谷，在 1996 年至 2005 年期间平均每年下降 4.2（95%置信区间为-4.8 至-3.9）个百分点。比率从 1990 年到 1996 年以及从 2005 年到 2009 年显著增加。TOLAC 成功率在 2000 年达到最高，为 69.8%（95%置信区间为 65.2-74.3%），在 2008 年达到最低，为 38.5%（95%置信区间为 28.1-48.8%）。1990 年至 2000 年期间 TOLAC 成功率显著增加，但此后每年平均下降 3.4 个百分点（95%置信区间为-4.3 至-2.5）。1996 年至 2005 年期间，美国 TOLAC 的比率下降，而从 2000 年到 2009 年，成功 TOLAC 的比率下降。
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