Li Wai-Hou, Yang Ming-Jie, Wang Peng-Hui, Juang Chi-Mou, Chang Yi-Wen, Wang Hsing-I, Chen Chih-Yao, Yen Ming-Shyen
Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan.
Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang-Ming University, School of Medicine, Taipei, Taiwan.
Taiwan J Obstet Gynecol. 2016 Jun;55(3):394-8. doi: 10.1016/j.tjog.2016.04.016.
Because of the increased risk of uterine rupture and other morbidities, instances of trial of labor after cesarean (TOLAC) have decreased in number each year. Nevertheless, under careful assessment and advanced medical care, TOLAC is still a safe option for delivery. The objective of this study is to find the factors that impact the success rate for TOLAC and to compare the results with Taiwan national registry data.
A longitudinal cohort study that includes a total of 254 cases of women receiving TOLAC in a tertiary medical center over a period of 10 years.
A total of 254 participants who underwent TOLAC, which accounts for 1.67% of total labor instances (254/15,166), were enrolled for analysis. The success rate of TOLAC was found to be 80.70% (205/254), including 146 (57.5%) normal deliveries, 45 (17.7%) vacuum-assisted deliveries, and 14 (5.5%) forceps-assisted deliveries. The conversion rate to cesarean section was 19.3%. There were no uterine rupture cases in our study, and there were only two suspected cases, which turned out to have no actual rupture. When analyzing the factors affecting the results of TOLAC, we found that a successfully spontaneously delivered baby had a lower birth weight than the failed TOLAC cases that were converted to cesarean delivery (mean, 2989 g vs. 3379 g; p < 0.001). Among the patients who were converted to cesarean section, the most common reason was dysfunctional labor (79.6%), followed by fetal distress (14.3%).
Under intensive care and observation, TOLAC section may still be a feasible choice. Nevertheless, the body weight of the baby has been shown to be a factor that can influence the success rate.
由于子宫破裂及其他并发症风险增加，剖宫产术后试产（TOLAC）的病例数逐年减少。然而，在仔细评估和先进医疗护理下，TOLAC仍是一种安全的分娩选择。本研究的目的是找出影响TOLAC成功率的因素，并将结果与台湾国家登记数据进行比较。
一项纵向队列研究，共纳入10年间在一家三级医疗中心接受TOLAC的254例女性病例。
共有254名接受TOLAC的参与者被纳入分析，占总分娩病例的1.67%（254/15166）。TOLAC的成功率为80.70%（205/254），其中146例（57.5%）顺产，45例（17.7%）真空辅助分娩，14例（5.5%）产钳辅助分娩。剖宫产转化率为19.3%。本研究中无子宫破裂病例，仅有2例疑似病例，最终证实无实际破裂。在分析影响TOLAC结果的因素时，我们发现成功自然分娩的婴儿出生体重低于转为剖宫产的失败TOLAC病例（平均体重，2989克对3379克；p<0.001）。在转为剖宫产的患者中，最常见的原因是产程异常（79.6%），其次是胎儿窘迫（14.3%）。
在重症监护和观察下，TOLAC仍可能是一种可行的选择。然而，婴儿体重已被证明是影响成功率的一个因素。
