Sabol Bethany, Denman Mary Anna, Guise Jeanne-Marie
Departments of *Obstetrics and Gynecology †Emergency Medicine ‡Medical Informatics and Clinical Epidemiology §Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Oregon.
Clin Obstet Gynecol. 2015 Jun;58(2):309-19. doi: 10.1097/GRF.0000000000000101.
Cesarean deliveries represent almost one third of US births. Given that repeat cesarean is the most common single indication for cesarean, trial of labor after cesarean (TOLAC) with subsequent vaginal birth after cesarean (VBAC) is an important mechanism to reduce the overall cesarean rate. The 2010 National Institutes of Health Conference found that one of the biggest barriers to VBAC is the lack of patient access to TOLAC. Many women who currently deliver by repeat cesarean would be candidates for a TOLAC. This manuscript will summarize the evidence on VBAC to help clinicians identify candidates, provide evidence-based counseling, and guide management of TOLAC.
剖宫产分娩几乎占美国分娩总数的三分之一。鉴于再次剖宫产是剖宫产最常见的单一指征，剖宫产术后试产（TOLAC）并随后实现剖宫产术后阴道分娩（VBAC）是降低总体剖宫产率的一项重要机制。2010年美国国立卫生研究院会议发现，VBAC面临的最大障碍之一是患者无法获得TOLAC。目前通过再次剖宫产分娩的许多女性都适合进行TOLAC。本文将总结关于VBAC的证据，以帮助临床医生识别适合的患者、提供循证咨询并指导TOLAC的管理。
