Nakamura Kohei, Hayashi Shusaku, Sasahara Jun, Okamoto Yoko, Ishii Keisuke, Mitsuda Nobuaki
Department of Obstetrics and Gynecology, Shimane University Faculty of Medicine, Shimane, Japan.
Department of Maternal-Fetal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
Birth. 2017 Dec;44(4):363-368. doi: 10.1111/birt.12293. Epub 2017 May 2.
This study aimed to describe the perinatal outcomes of women opting for vaginal birth after cesarean delivery (VBAC) managed without induction or augmentation of labor.
This was a retrospective cohort study of candidates for VBAC at a tertiary center in Japan from April 2003 to March 2012. Women with singleton gestations and one prior low-transverse cesarean delivery who intended VBAC at 36 weeks of gestation were identified as candidates for VBAC and included in the study. Participants were managed without induction or augmentation of labor. Maternal characteristics and perinatal outcomes were obtained from medical records. Factors associated with successful VBAC were analyzed with a multivariable logistic regression model.
Of 333 candidates for VBAC, 242 (72.7%) had vaginal birth, 49 (14.7%) had repeat cesarean delivery with spontaneous labor, and 42 (12.6%) had repeat cesarean delivery without spontaneous labor. The rate of uterine rupture was 0.3% (1/333). Prior vaginal delivery and nonrecurring indications for prior cesarean delivery were associated with successful VBAC.
Management of candidates for VBAC without induction or augmentation of labor resulted in a high VBAC rate and favorable perinatal outcomes. Such restrictive VBAC policies may be an acceptable alternative to standard management or abandonment of VBAC.
本研究旨在描述在未进行引产或加强产程的情况下选择剖宫产术后阴道分娩（VBAC）的女性的围产期结局。
这是一项对2003年4月至2012年3月期间日本一家三级医疗中心的VBAC候选者进行的回顾性队列研究。单胎妊娠且既往有一次低位横切口剖宫产史、在妊娠36周时打算进行VBAC的女性被确定为VBAC候选者并纳入研究。参与者在未进行引产或加强产程的情况下接受管理。从医疗记录中获取产妇特征和围产期结局。使用多变量逻辑回归模型分析与成功VBAC相关的因素。
在333名VBAC候选者中，242名（72.7%）经阴道分娩，49名（14.7%）在自然发动分娩后再次剖宫产，42名（12.6%）在未自然发动分娩的情况下再次剖宫产。子宫破裂率为0.3%（1/333）。既往阴道分娩和既往剖宫产的非复发性指征与成功VBAC相关。
对VBAC候选者在未进行引产或加强产程的情况下进行管理，导致VBAC率较高且围产期结局良好。这种限制性的VBAC政策可能是标准管理或放弃VBAC的一种可接受的替代方案。
