Gupta Pratiksha, Jahan Ishrat, Jograjiya Gelabhai R
Department of Gynaecology and Obstetrics, Post Graduate Institute Of Medical Sciences and Research Employees State Insurance, Basaidarapur, New Delhi, India.
Niger Med J. 2014 May;55(3):260-5. doi: 10.4103/0300-1652.132067.
To analyse the mode of delivery in trial of labour (TOL), incidence of successful vaginal deliveries and indications of repeat caesarean section (CS).
Prospective selective study. Study population consisted of 367 pregnant women with previous one lower segment caesarean section (LSCS) in reproductive age group. These were grouped in to three groups, Group 1 (n = 239): Women, who were elected for repeat CS without a TOL. Group 2 (n = 76): Women, who were given TOL and delivered vaginally. Group 3 (n = 52): Women, who were given a TOL but due to failed trial, had to be taken for emergency repeat section. The maternal and foetal outcome was studied in all the groups.
The data was entered in the Microsoft excel worksheet, values expressed as mean ± SD. Chi-square test was done to compare the categorical variables among the groups. ANOVA (one-way analysis of variance) was done to compare the baseline characteristics of patients and time to delivery among the groups.
Out of 128 women who were given TOL, 76 (59.37%) vaginal birth after caesarean (VBAC) occurred, out of which 40 (52.63%) had spontaneous vaginal deliveries without augmentation of labour and 36 (47.36%) subjects had augmentation of labour with artificial rupture of membranes (ARMs) and oxytocin. A total of 52 women (40.62%) underwent emergency LSCS.
Proper selection and counselling about clinically significant risks, women can be given TOL with careful monitoring and taken for emergency LSCS on minimal indication is the best answer to management of previous one CS in labour.
分析试产（TOL）中的分娩方式、剖宫产术后阴道分娩成功的发生率及再次剖宫产的指征。
前瞻性选择性研究。研究对象为367名育龄期曾行一次子宫下段剖宫产（LSCS）的孕妇。这些孕妇被分为三组，第一组（n = 239）：未进行试产而直接选择再次剖宫产的女性。第二组（n = 76）：接受试产并经阴道分娩的女性。第三组（n = 52）：接受试产但因试产失败而不得不接受急诊再次剖宫产的女性。对所有组的母婴结局进行研究。
数据录入Microsoft Excel工作表，数值以均数±标准差表示。采用卡方检验比较各组间的分类变量。采用方差分析（单向方差分析）比较患者的基线特征及各组间的分娩时间。
在128名接受试产的女性中，有76例（59.37%）成功进行了剖宫产术后阴道分娩（VBAC），其中40例（52.63%）为未使用催产素的自然阴道分娩，36例（47.36%）为使用人工破膜（ARMs）及催产素催产的阴道分娩。共有52名女性（40.62%）接受了急诊子宫下段剖宫产。
对有临床显著风险的患者进行恰当选择和咨询，在密切监测下对女性进行试产，并在最低指征下进行急诊子宫下段剖宫产，是处理前次剖宫产产妇分娩问题的最佳方法。
