Beucher G, Dolley P, Lévy-Thissier S, Florian A, Dreyfus M
Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen cedex 9, France.
J Gynecol Obstet Biol Reprod (Paris). 2012 Dec;41(8):708-26. doi: 10.1016/j.jgyn.2012.09.028. Epub 2012 Nov 14.
To assess maternal outcomes during trial of labor (TOL) and elective repeat caesarean delivery (ERCD) in women with a previous caesarean delivery.
French and English publications were searched using PubMed and Cochrane Library.
Maternal mortality remains a very rare event regardless of the planned mode of delivery (EL2). It is potentially reduced after a TOL but the presence of biases in many studies does not allow any conclusion (EL3). Maternal morbidity is mainly due to the failure of the TOL and to the risk of unplanned caesarean delivery during labor (EL2). The risk of complete uterine rupture significantly increases with TOL versus ERCD but it remains low at about 0.2 to 0.8% for women with one scar on the uterus (EL2). The occurrence of a post-surgical wound, mostly from the bladder, is rare (less than 0.5%) regardless of the planned mode of delivery (EL2). Facing the risk of hemorrhage requiring hysterectomy or blood transfusion, data are heterogeneous because of the nature of the populations studied. These risks do not seem to vary with the mode of delivery (EL3). The risk of post-partum venous thrombo-embolic complications and infections (endometritis and maternal fever) appears to be similar in both TOL and ERCD (EL3). The risk of infection is primarily related to the additional presence of obesity (EL2). While maternal morbidity progressively increases with the number of iterative caesarean sections, maternal morbidity in TOL after a previous caesarean delivery decreases with the number of successful TOL (EL2).
In patients with a previous caesarean delivery, the risks of maternal complications are rare and similar between TOL and ERCD. There is an increased risk of complete uterine rupture in case of TOL. Nevertheless TOL has a favorable benefit/risk balance in most cases and its success reduces the risk of short and long-term maternal complications (EL3).
评估有剖宫产史的女性在试产（TOL）和择期再次剖宫产（ERCD）期间的母儿结局。
通过PubMed和Cochrane图书馆检索法语和英语出版物。
无论计划的分娩方式如何，孕产妇死亡仍然是非常罕见的事件（证据水平2）。试产后孕产妇死亡风险可能降低，但许多研究存在偏倚，无法得出任何结论（证据水平3）。孕产妇发病主要归因于试产失败以及分娩期间非计划剖宫产的风险（证据水平2）。与择期再次剖宫产相比，试产时子宫完全破裂的风险显著增加，但对于子宫有一处瘢痕的女性，该风险仍较低，约为0.2%至0.8%（证据水平2）。无论计划的分娩方式如何，手术伤口（主要来自膀胱）的发生率都很低（低于0.5%）（证据水平2）。由于研究人群的性质，面对需要子宫切除或输血的出血风险，数据存在异质性。这些风险似乎不因分娩方式而异（证据水平3）。试产和择期再次剖宫产时产后静脉血栓栓塞并发症和感染（子宫内膜炎和产妇发热）的风险似乎相似（证据水平3）。感染风险主要与肥胖的额外存在有关（证据水平2）。虽然孕产妇发病随着剖宫产次数的增加而逐渐增加，但有剖宫产史的女性试产时的孕产妇发病随着试产成功次数的增加而降低（证据水平2）。
有剖宫产史的患者中，孕产妇并发症的风险罕见，试产和择期再次剖宫产相似。试产时子宫完全破裂的风险增加。然而，在大多数情况下，试产具有良好的效益/风险平衡，其成功可降低孕产妇短期和长期并发症的风险（证据水平3）。
