Kalok Aida, Zabil Shahril A, Jamil Muhammad Abdul, Lim Pei Shan, Shafiee Mohamad Nasir, Kampan Nirmala, Shah Shamsul Azhar, Mohamed Ismail Nor Azlin
a Department of Obstetrics and Gynaecology , Universiti Kebangsaan Malaysia Medical Centre (UKMMC) , Kuala Lumpur , Malaysia.
b Department of Community Health, Faculty of Medicine , Universiti Kebangsaan Malaysia Medical Centre (UKMMC) , Kuala Lumpur , Malaysia.
J Obstet Gynaecol. 2018 Apr;38(3):339-343. doi: 10.1080/01443615.2017.1355896. Epub 2017 Oct 10.
This was a prospective observational study to determine the predictive factors for a successful vaginal birth after caesarean section (VBAC) and to develop a relevant antenatal scoring system. Patients with one previous caesarean section were included in this study. All data including maternal demographics, obstetric history, pregnancy progress and outcomes were collected and analysed. A total of 142 out of the 186 women (76.3%) had successful VBAC. History of previous vaginal delivery and non-recurrent indications for previous caesarean section were the significant predictive factors for a successful VBAC. Five variables for our scoring tool were selected. By using a proposed mean score of 4 out of 7, the scoring system had a sensitivity of 81.0%, specificity of 52.3% and a positive predictive value of 84.6%. VBAC antenatal scoring system was potentially a useful predictive tool in antenatal counselling. Impact statement What is already known on this subject: Planned vaginal birth after caesarean section (VBAC) is an important strategy to limit the overall caesarean section rate, which is related to maternal morbidities. However, trial of vaginal delivery does involve potential complications including scar dehiscence, postpartum haemorrhage and emergency hysterectomy. What the results of this study add: Clinical predictors of a successful VBAC include non-recurrent indications for the previous caesarean section, previous vaginal delivery, spontaneous onset of labour and birthweight less than 4kg. There were multiple screening tools developed to predict the likelihood of successful VBAC. These scoring systems involved various variables such as age, ethnicity, Bishop's score and previous caesarean indication. We had prospectively developed an antenatal scoring system based on five variables. Our result showed that patient with a score of four and above will have around 85% chance of successful VBAC. What the implications are of these findings for clinical practice and/or further research: We have also found that, estimated foetal weight based on ultrasound scan is a potential predictor for successful VBAC. This simple scoring method will be useful in-patient counselling regarding mode of delivery after one previous caesarean section. A multicentre study involving large cohort of patients is ideal to validate our scoring system.
这是一项前瞻性观察性研究，旨在确定剖宫产术后经阴道分娩成功（VBAC）的预测因素，并建立相关的产前评分系统。本研究纳入了有一次剖宫产史的患者。收集并分析了所有数据，包括产妇人口统计学资料、产科病史、妊娠进展及结局。186名女性中有142名（76.3%）经阴道分娩成功。既往阴道分娩史和既往剖宫产的非复发性指征是经阴道分娩成功的重要预测因素。我们选择了评分工具的五个变量。使用提议的7分中得4分的平均分，该评分系统的敏感性为81.0%，特异性为52.3%，阳性预测值为84.6%。VBAC产前评分系统在产前咨询中可能是一种有用的预测工具。影响声明关于该主题已知的信息：计划性剖宫产术后经阴道分娩（VBAC）是限制总体剖宫产率的一项重要策略，而剖宫产率与产妇发病率相关。然而，阴道分娩试验确实存在潜在并发症，包括瘢痕裂开、产后出血和急诊子宫切除术。本研究结果补充的内容：经阴道分娩成功的临床预测因素包括既往剖宫产的非复发性指征、既往阴道分娩、自然临产及出生体重小于4kg。已经开发了多种筛查工具来预测经阴道分娩成功的可能性。这些评分系统涉及各种变量，如年龄、种族、 Bishop评分和既往剖宫产指征。我们前瞻性地基于五个变量开发了一种产前评分系统。我们的结果表明，得分在4分及以上的患者经阴道分娩成功的几率约为85%。这些发现对临床实践和/或进一步研究的意义：我们还发现，基于超声扫描估计的胎儿体重是经阴道分娩成功的一个潜在预测因素。这种简单的评分方法在为有一次剖宫产史的患者提供分娩方式咨询时将很有用。涉及大量患者队列的多中心研究是验证我们评分系统的理想选择。
