Qu Z Q, Yang M H, Du M Y, Ma C, Tao Y P, Chen Z, Liang K, Ma R M
Department of Obstetrics and Gynecology, the First Affiliated Hospital of Kunming Medical University, Kunming 650032, China.
Zhonghua Fu Chan Ke Za Zhi. 2017 Aug 25;52(8):521-525. doi: 10.3760/cma.j.issn.0529-567X.2017.08.004.
To explore the perinatal outcome of vaginal birth after cesarean (VBAC) in women with advanced age. Totally 2 587 women delivered after one or two prior cesarean sections (gestational age≥28 weeks) in the First Affiliated Hospital of Kunming Medical University from July 2013 to February 2017. 909 trial of labor after cesarean(TOLAC) cases of singleton pregnancy with one prior cesarean section were studied retrospectively. According to the age, of the 909 TOLAC cases, 237 were the advanced age group, and 672 cases were the low age group. The maternal and neonatal outcomes between the two groups were compared. The percentage of TOLAC in women with advanced age was 32.4% (237/731), and VBAC rate was 88.2% (209/237). The percentage of TOLAC in younger women was 36.2% (672/1 856), and VBAC rate was 82.4% (554/672). The difference of the TOLAC rate between the two groups was not significant (>0.05), and the VBAC rate of the advanced age group was higher than the low age group (<0.05). In the comparison of the two groups, the proportion of bachelor degree or above(55.7%,132/237), the prepregnancy BMI (22.4±3.0) kg/m(2), pregnant interval time (68.5±38.3) months, the proportion of gestational hypertension (8.4%,20/237), the proportion of gestational diabetes(34.6%,82/237) and the rate of the neonatal ICU admission (18.1%,43/237) in the advanced age group were higher than those of the low age group (<0.05), respectively. And there were no significant differences in the rate of postpartum hemorrhage, the rate of postpartum hemorrhage≥1 500 ml, the rate of postpartum transfusion, puerperal morbidity, neonatal birth weight, neonatal 5 min Apgar score<7 score, umbilical artery blood pH<7.0, neonatal tracheal intubation and respiratory distress syndrome (all >0.05). In all TOLAC cases, the rate of uterine rupture was 0.11%(1/909) and there was no maternal and neonatal death. VBAC is a safe and feasible way of delivery for singleton pregnancy after one prior cesarean section in women with advanced age.
探讨高龄产妇剖宫产术后阴道分娩(VBAC)的围产期结局。2013年7月至2017年2月,昆明医科大学第一附属医院共有2587例产妇在既往剖宫产一至两次后分娩(孕周≥28周)。回顾性研究909例既往有一次剖宫产史的单胎妊娠剖宫产术后试产(TOLAC)病例。根据年龄,909例TOLAC病例中,高龄组237例,低龄组672例。比较两组的母婴结局。高龄产妇TOLAC的比例为32.4%(237/731),VBAC率为88.2%(209/237)。低龄产妇TOLAC的比例为36.2%(672/1856),VBAC率为82.4%(554/672)。两组TOLAC率差异无统计学意义(>0.05),高龄组VBAC率高于低龄组(<0.05)。两组比较,高龄组本科及以上学历比例(55.