Krispin Eyal, Hiersch Liran, Wilk Goldsher Yulia, Wiznitzer Arnon, Yogev Yariv, Ashwal Eran
a Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva , Israel.
b Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel.
J Matern Fetal Neonatal Med. 2018 Apr;31(8):1066-1072. doi: 10.1080/14767058.2017.1306513. Epub 2017 Mar 27.
To estimate the effect of prior successful vaginal birth after cesarean (VBAC) on the rate of uterine rupture and delivery outcome in women undergoing labor after cesarean.
A retrospective cohort study of all women attempting labor after cesarean delivery in a university-affiliated tertiary-hospital (2007-2014) was conducted. Study group included women attempting vaginal delivery with a history of cesarean delivery and at least one prior VBAC. Control group included women attempting first vaginal delivery following cesarean delivery. Primary outcome was defined as the rate of uterine rupture. Secondary outcomes were delivery and maternal outcomes.
Of 62,463 deliveries during the study period, 3256 met inclusion criteria. One thousand two hundred and eleven women had VBAC prior to the index labor and 2045 underwent their first labor after cesarean. Women in the study group had a significantly lower rate of uterine rupture 9 (0.7%) in respect to control 33 (1.6%), p = .036, and had a higher rate of successful vaginal birth (96 vs. 84.9%, p < .001). In multivariate analysis, previous VBAC was associated with decreased risk of uterine rupture (OR = 0.46, 95% CI 0.21-0.97, p = .04).
In women attempting labor after cesarean, prior VBAC appears to be associated with lower rate of uterine rupture and higher rate of successful vaginal birth.
评估既往剖宫产术后成功经阴道分娩（VBAC）对剖宫产术后再次分娩妇女子宫破裂率及分娩结局的影响。
对一所大学附属三级医院（2007年至2014年）所有剖宫产术后尝试再次分娩的妇女进行回顾性队列研究。研究组包括有剖宫产史且至少有一次既往VBAC经历并尝试经阴道分娩的妇女。对照组包括剖宫产术后首次尝试经阴道分娩的妇女。主要结局定义为子宫破裂率。次要结局为分娩及母体结局。
在研究期间的62463例分娩中，3256例符合纳入标准。1211名妇女在本次分娩前有VBAC经历，2045名妇女为剖宫产术后首次分娩。研究组妇女的子宫破裂率显著低于对照组，分别为9例（0.7%）和33例（1.6%），p = 0.036，且经阴道成功分娩率更高（96%对84.9%，p < 0.001）。多因素分析显示，既往VBAC与子宫破裂风险降低相关（OR = 0.46，95%CI 0.21 - 0.97，p = 0.04）。
在剖宫产术后尝试再次分娩的妇女中，既往VBAC似乎与较低的子宫破裂率和较高的经阴道成功分娩率相关。
