Abdelazim Ibrahim A, Elbiaa Assem A M, Al-Kadi Mohamed, Yehia Amr H, Sami Nusair Bassam M, Faza Mohannad Abu
Department of Obstetrics and Gynecology, Ain Shams University Faculty of Medicine, Cairo, Egypt ; Department of Obstetrics and Gynecology, Ahmadi Hospital, Kuwait Oil Company (KOC), Ahmadi, Kuwait.
Department of Obstetrics and Gynecology, Ain Shams University Faculty of Medicine, Cairo, Egypt ; Department of Obstetrics and Gynecology, Sabah Maternity Hospital, Kuwait.
J Turk Ger Gynecol Assoc. 2014 Dec 1;15(4):245-9. doi: 10.5152/jtgga.2014.14104. eCollection 2014.
To detect the maternal and obstetrical factors associated with successful trial of vaginal birth among women with a previous cesarean delivery.
A total of 122 women who were eligible for a trial of labor after cesarean section (TOLAC) according to departmental protocol were included in this comparative prospective study. After informed consent, the women included in this study were subjected to a thorough history to detect maternal and obstetric characteristics and a standard examination to estimate fetal weight, engagement of the fetal head, intra-partum features of fetal membranes, and cervical dilatation. After delivery, data on duration of labor, labor augmentation, mode of delivery, birth outcome, and neonatal intensive care (NICU) admission were recorded and analyzed.
Trial of labor after cesarean section was successful in 72.13% and was unsuccessful in 27.87%. Body mass index (BMI) was significantly lower in the successful TOLAC group compared to the unsuccessful group (23.8±0.03 versus 26.2±0.02 kg/m(2)), and the number of women with BMI >25 kg/m(2) was significantly high in the unsuccessful group; also, mean gestational age was significantly lower in the successful TOLAC group compared to the unsuccessful group (37.5±0.04 versus 38.5±0.03 weeks), and the number of women admitted in labor with gestation ≥40 weeks was significantly high in the unsuccessful group. The number of women admitted with >2/5 of fetal head palpable abdominally and fetal head station ≥-2 was significantly high in the unsuccessful TOLAC group.
In carefully selected cases, TOLAC is safe and often successful. Presence of BMI >25 kg/m(2), gestation ≥40 weeks, and vertex station ≥-2 were risk factors for unsuccessful TOLAC.
检测与既往剖宫产史女性成功经阴道分娩相关的母体及产科因素。
本比较性前瞻性研究纳入了122名根据科室方案符合剖宫产术后阴道试产（TOLAC）条件的女性。在获得知情同意后，对本研究纳入的女性进行全面病史采集以检测母体和产科特征，并进行标准检查以估计胎儿体重、胎头入盆情况、胎膜产时特征及宫颈扩张情况。分娩后，记录并分析产程时长、产程加速、分娩方式、出生结局及新生儿重症监护（NICU）入院情况等数据。
剖宫产术后阴道试产成功率为72.13%，失败率为27.87%。成功的TOLAC组的体重指数（BMI）显著低于失败组（23.8±0.03 vs 26.2±0.02kg/m²），且BMI>25kg/m²的女性在失败组中的数量显著更高；此外，成功的TOLAC组的平均孕周显著低于失败组（37.5±0.04 vs 38.5±0.03周），且孕周≥40周时临产入院的女性在失败组中的数量显著更高。在失败的TOLAC组中，腹部可触及>2/5胎头且胎头位置≥-2的女性数量显著更高。
在精心挑选的病例中，TOLAC是安全的且通常会成功。BMI>25kg/m²、孕周≥40周及胎头位置≥-2是TOLAC失败的危险因素。
