Christmann-Schmid Corina, Raio Luigi, Scheibner Katrin, Müller Martin, Surbek Daniel
Department of Gynecology and Obstetrics, University Hospital, Bern, Switzerland.
Universitätsklinik für Frauenheilkunde, Effingerstrasse 102, 3010, Bern, Switzerland.
Arch Gynecol Obstet. 2016 Nov;294(5):905-910. doi: 10.1007/s00404-016-4055-4. Epub 2016 Mar 15.
Caesarean sections (CS) have significantly increased worldwide and a previous CS is nowadays an important and increasingly reported indication to perform a repeat CS. There is a paucity of information in Switzerland on the incidence of repeat CS after previous CS and relationship between the rates of vaginal birth after CS (VBAC). The aim of this study was to analyse the actual trend in VBAC in Switzerland.
We performed a retrospective cohort study to analyse the proportion of VBAC among all pregnant women with previous sections which give birth during two time periods (group 1:1998/1999 vs. group 2:2004/2005) in our tertiary care referral hospital and in the annual statistics of Swiss Women's Hospitals (ASF-Statistics). In addition, the proportion of induction of labour after a previous caesarean and its success was analysed.
In both cohorts studied, we found a significant decrease of vaginal births (p < 0.05) and a significant increase of primary elective repeat caesarean section (p < 0.05) from the first to the second time period, while there was a decrease of secondary repeat caesarean sections. The prevalence of labour induction did not decrease.
Our study shows that vaginal birth after a prior caesarean section has decreased over time in Switzerland. There was no significant change in labour induction during the study period. While this trend might reflect an increasing demand for safety in pregnancy and childbirth, it concomitantly increases maternal risks of further pregnancies, and women need to be appropriately informed about long-term risks.
剖宫产在全球范围内显著增加，既往剖宫产如今已成为进行再次剖宫产的一个重要且报告日益增多的指征。瑞士关于既往剖宫产术后再次剖宫产的发生率以及剖宫产术后阴道分娩（VBAC）率之间关系的信息匮乏。本研究的目的是分析瑞士VBAC的实际趋势。
我们进行了一项回顾性队列研究，以分析在我们的三级医疗转诊医院以及瑞士妇女医院年度统计数据（ASF统计）中，两个时间段（第1组：1998/1999年与第2组：2004/2005年）内所有有既往剖宫产史的孕妇中VBAC的比例。此外，分析了既往剖宫产术后引产的比例及其成功率。
在两个研究队列中，我们发现从第一个时间段到第二个时间段，阴道分娩显著减少（p < 0.05），首次择期再次剖宫产显著增加（p < 0.05），而二次再次剖宫产减少。引产的发生率没有下降。
我们的研究表明，瑞士既往剖宫产术后的阴道分娩随时间推移有所减少。在研究期间引产没有显著变化。虽然这种趋势可能反映了对妊娠和分娩安全性的需求增加，但它同时增加了产妇再次怀孕的风险，并且需要让女性充分了解长期风险。
