Yang Yue-Zhou, Ye Xu-Ping, Sun Xiao-Xi
Shanghai Jiai Genetics and IVF Institute Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China.
Clin Invest Med. 2017 Jun 26;40(3):E135-E145. doi: 10.25011/cim.v40i3.28393.
The purpose of this study was to perform a meta-analysis comparing the rates of uterine rupture, and other maternal and neonatal complications, between women who undergo a trial of labour (TOL) after a prior Cesarean delivery and those to undergo elective repeat Cesarean delivery (ERCD).
Medline, Cochrane, EMBASE and Google Scholar were searched until May 6, 2015 using the keywords/phrases: trial of labour, Cesarean section, elective, repeat, pregnancy and vaginal birth. Randomized controlled trials (RCTs), two-arm prospective studies, one-arm studies and retrospective studies were included. The primary outcome was uterine rupture.
Sixteen studies were included in the meta-analysis. TOL after prior Cesarean delivery was associated with higher odds of uterine rupture as compared with ERCD (Peto odds ratio [OR] = 4.685, 95% confidence interval [CI]: 3.077 to 7.133, p < 0.001). TOL was associated with a higher rate of endometritis, a lower rate of hysterectomy, and a lower rate of respiratory problems in newborns. There were no differences between the groups with respect to neonatal intensive care unit admissions, postpartum hemorrhage, thromboembolic disease, sepsis and neonatal mortality.
TOL may be associated with a higher risk of uterine rupture and endometritis, but lower risk of hysterectomy and neonatal respiratory problems than ERCD.
本研究旨在进行一项荟萃分析，比较既往剖宫产术后进行引产试验（TOL）的女性与接受择期再次剖宫产（ERCD）的女性之间子宫破裂率以及其他孕产妇和新生儿并发症的发生率。
检索了Medline、Cochrane、EMBASE和谷歌学术，检索截止至2015年5月6日，使用的关键词/短语为：引产试验、剖宫产、择期、再次、妊娠和阴道分娩。纳入了随机对照试验（RCT）、双臂前瞻性研究、单臂研究和回顾性研究。主要结局是子宫破裂。
荟萃分析纳入了16项研究。与ERCD相比，既往剖宫产术后进行TOL与子宫破裂几率更高相关（Peto比值比[OR]=4.685，95%置信区间[CI]：3.077至7.133，p<0.001）。TOL与子宫内膜炎发生率较高、子宫切除率较低以及新生儿呼吸问题发生率较低相关。两组在新生儿重症监护病房入院率、产后出血、血栓栓塞性疾病、败血症和新生儿死亡率方面无差异。
与ERCD相比，TOL可能与子宫破裂和子宫内膜炎风险较高相关，但子宫切除和新生儿呼吸问题风险较低。
