剖宫产后阴道分娩趋势：钟摆往哪个方向摆动？

Vaginal Birth After Cesarean Trends: Which Way Is the Pendulum Swinging?

机构信息

Department of Obstetrics and Gynecology, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, L466, Portland, OR 97239-3098, USA.

出版信息

Obstet Gynecol Clin North Am. 2017 Dec;44(4):655-666. doi: 10.1016/j.ogc.2017.08.006.

DOI:10.1016/j.ogc.2017.08.006

PMID:29078947

Abstract

The cesarean delivery rate has plateaued at 32%; concurrently, after peaking in the mid-1990s, trial of labor after cesarean (TOLAC) rates have declined. Less than 25% of women with a prior cesarean delivery attempt a future TOLAC. This decreasing trend in TOLAC is caused by inadequate resource availability, malpractice concerns, and lack of knowledge in patients and providers regarding the perceived risks and benefits. This article outlines the factors influencing recent vaginal birth after cesarean trends in addition to reviewing the maternal and neonatal outcomes associated with TOLAC, specifically in high-risk populations.

摘要

剖宫产率已趋于平稳，维持在 32%；与此同时，自 20 世纪 90 年代中期达到峰值后，剖宫产后试产（TOLAC）的比例有所下降。仅有不到 25%的有过剖宫产史的女性会尝试再次 TOLAC。TOLAC 比例下降的原因包括资源不足、医疗纠纷顾虑以及患者和医务人员对相关风险和获益的认知不足。本文除了综述 TOLAC 相关的母婴结局，还重点分析了影响近期剖宫产后阴道分娩趋势的因素，特别是高危人群。