Office for Research and Clinical Audit, Lindsay Stewart R&D Centre, Royal College of Obstetricians and Gynaecologists, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
BJOG. 2014 Jan;121(2):183-92. doi: 10.1111/1471-0528.12508. Epub 2013 Nov 20.
To investigate the demographic and obstetric factors associated with the uptake and success rate of vaginal birth after caesarean section (VBAC).
Cohort study using data from Hospital Episode Statistics.
English National Health Service.
Women whose first birth resulted in a live singleton delivery by caesarean section between 1 April 2004 and 31 March 2011, and who had a second birth before 31 March 2012.
Logistic regression to estimate adjusted odds ratios (OR).
Attempted and successful VBAC.
Among the 143,970 women in the cohort, 75,086 (52.2%) attempted a VBAC for their second birth. Younger women, those of non-white ethnicity and those living in a more deprived area had higher rates of attempted VBAC. Overall, 47,602 women (63.4%) who attempted a VBAC had a successful vaginal birth. Younger women and women of white ethnicity had higher success rates. Black women had a particularly low success rate (OR, 0.54; 95% confidence interval [CI], 0.50-0.57). Women who had an emergency caesarean section in their first birth also had a lower VBAC success rate, particularly those with a history of failed induction of labour (OR, 0.59; 95% CI, 0.53-0.67).
In this national cohort, just over one-half of women with a primary caesarean section who were eligible for a trial of labour attempted a VBAC for their second birth. Of these, almost two-thirds successfully achieved a vaginal delivery.
探讨与剖宫产后阴道分娩（VBAC）的接受度和成功率相关的人口统计学和产科因素。
使用来自医院病例统计数据的队列研究。
英国国家医疗服务体系。
2004 年 4 月 1 日至 2011 年 3 月 31 日期间首次分娩为剖宫产活单胎分娩的妇女，且在 2012 年 3 月 31 日前再次分娩。
采用逻辑回归估计调整后的优势比（OR）。
尝试和成功 VBAC。
在队列中的 143970 名妇女中，75086 名（52.2%）为第二次分娩尝试 VBAC。年轻女性、非白种人女性和生活在贫困地区的女性尝试 VBAC 的比例较高。总体而言，尝试 VBAC 的 47602 名妇女（63.4%）阴道分娩成功。年轻女性和白种人女性的成功率较高。黑人女性的成功率特别低（OR，0.54；95%置信区间 [CI]，0.50-0.57）。在第一次分娩中进行紧急剖宫产的女性 VBAC 成功率也较低，尤其是那些有引产失败史的女性（OR，0.59；95%CI，0.53-0.67）。
在这个全国性队列中，超过一半有初次剖宫产且有试产资格的女性为第二次分娩尝试 VBAC。其中，近三分之二成功实现了阴道分娩。
