Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA 23507, USA.
Am J Obstet Gynecol. 2013 Mar;208(3):229.e1-5. doi: 10.1016/j.ajog.2012.11.042. Epub 2012 Dec 2.
The objective was to determine the rate of neonatal brachial plexus palsy (NBPP) among women with vaginal birth after cesarean delivery (VBAC) and to compare the peripartum characteristics with control subjects.
The Maternal-Fetal Medicine Unit cesarean registry data were used to identify nonanomalous singleton pregnancies with VBAC and NBPP at gestational age of ≥37 weeks (term) and 4 control subjects (matched for gestational age and diabetes mellitus status but without brachial injury). Odds ratio (OR) and 95% confidence intervals (CIs) were calculated.
Among 11,313 VBACs at term, there were 23 women with NBPP (rate of 2.0/1000 women). Newborn infants with NBPP, compared with control infants, were significantly more likely to weigh ≥4000 g (48% vs 10%, respectively; OR, 8.45; 95% CI, 2.58-28.44) and to require admission to the neonatal intensive care unit (30% vs 13%; OR, 12.98; 95% CI, 2.61-72.18).
Women who desire VBAC should be informed about the low rate of NBPP and, if eligible, encouraged to have a trial of labor after cesarean delivery.
旨在确定剖宫产后阴道分娩（VBAC）女性中新生儿臂丛神经麻痹（NBPP）的发生率，并与对照组比较围产期特征。
使用母胎医学单位剖宫产登记数据，确定非畸形单胎妊娠，VBAC 且妊娠年龄≥37 周（足月）和 4 名对照组（匹配妊娠年龄和糖尿病状态，但无臂丛损伤）。计算比值比（OR）和 95%置信区间（CI）。
在 11313 例足月 VBAC 中，有 23 例发生 NBPP（发生率为 2.0/1000 名女性）。与对照组新生儿相比，NBPP 新生儿更有可能体重≥4000g（分别为 48%和 10%；OR，8.45；95%CI，2.58-28.44），且更需要入住新生儿重症监护病房（30%和 13%；OR，12.98；95%CI，2.61-72.18）。
希望 VBAC 的女性应被告知 NBPP 的发生率较低，如果符合条件，应鼓励其进行剖宫产后的试产。
