Balachandran Lekshmi, Vaswani Pooja R, Mogotlane Ramakone
Clinical Associate Professor, Department of Obstetrics and Gynaecology, Amritha institute of Medical Sciences , Kochi, Kerala, India .
Specialist, Department of Obstetrics and Gynaecology, Madinat Zayed Hospital , Abudhabi, UAE .
J Clin Diagn Res. 2014 Feb;8(2):99-102. doi: 10.7860/JCDR/2014/7774.4019. Epub 2014 Feb 3.
The purpose of this study was to determine the outcome of pregnancy in women with previous one cesarean section in relation to vaginal delivery and maternal and perinatal complications. It also aimed at identifying the factors, which can influence the outcome of trial of scar (TOS).
A retrospective analysis of medical records of 151 women with previous one cesarean section who delivered at the Mafraq Hospital, Abu Dhabi between January-August 2011was carried out. Those women with previous classical cesarean section and those with extreme prematurity were excluded. The collected data were analyzed using SPSS software version 20. Continuous and categorical data were presented in the form of mean, standard deviation and percentage, while proportions were analyzed using the chi-square test. A p-value ≤0.05 was considered statistically significant.
Of the 151 women, 115 were candidates for TOS. Of them, 96 (83.47%) had vaginal birth after cesarean (VBAC) and 19 (16.5%) had a repeat cesarean section. There were four cases of primary postpartum hemorrhage (PPH) and two cases of scar dehiscence in the study group. No significant perinatal morbidity was observed. VBAC rate was significantly more in women who had prior vaginal deliveries, especially in those with previous VBAC.
In carefully selected cases, trial of labour (TOL) after a prior cesarean is safe and often successful. A prior vaginal delivery, particularly, a prior VBAC are associated with a higher rate of successful TOL.
本研究的目的是确定既往有一次剖宫产史的女性妊娠结局与阴道分娩及母婴和围产期并发症的关系。它还旨在确定可影响瘢痕子宫试产（TOS）结局的因素。
对2011年1月至8月在阿布扎比马弗拉克医院分娩的151例既往有一次剖宫产史的女性病历进行回顾性分析。排除既往有古典式剖宫产史和极早产的女性。使用SPSS 20版软件对收集的数据进行分析。连续数据和分类数据以均值、标准差和百分比的形式呈现，比例采用卡方检验分析。p值≤0.05被认为具有统计学意义。
151例女性中，115例为瘢痕子宫试产候选人。其中，96例（83.47%）剖宫产术后阴道分娩（VBAC），19例（16.5%）再次剖宫产。研究组有4例原发性产后出血（PPH）和2例瘢痕裂开。未观察到明显的围产期发病率。既往有阴道分娩史的女性，尤其是既往有VBAC史的女性，VBAC率明显更高。
在精心挑选的病例中，既往剖宫产术后试产（TOL）是安全的，且通常成功。既往阴道分娩，尤其是既往VBAC，与更高的TOL成功率相关。
