Fobelets Maaike, Beeckman Katrien, Buyl Ronald, Daly Déirdre, Sinclair Marlene, Healy Patricia, Grylka-Baeschlin Susanne, Nicoletti Jane, Gross Mechthild M, Morano Sandra, Putman Koen
Department of Public Health, Interuniversity Centre for Health Economics Research (I-CHER), Vrije Universiteit Brussel, Brussels, Belgium.
Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.
Birth. 2018 Jun;45(2):137-147. doi: 10.1111/birt.12324. Epub 2017 Dec 5.
How a woman gives birth can affect her health-related quality of life (HRQoL). This study explored HRQoL at 3 months postpartum in women with a history of one previous cesarean in three European countries.
A prospective longitudinal survey, embedded within a cluster randomized trial in three countries, exploring women's postnatal HRQoL up to 3 months postpartum. The Short-Form Six-Dimensions (SF-6D) was used to measure HRQoL, and multivariate analyses were used to examine the relationship with mode of birth.
Complete data were available from 880 women. Women with a spontaneous vaginal birth had the highest HRQoL scores, whereas women with an emergency repeat cesarean (P = .01) had the lowest. Postnatal readmission of the mother (P = .03), having public health insurance (P = .04), and a low antenatal HRQoL score (P < .01) contributes to poorer HRQoL scores. More specifically, women with a spontaneous vaginal birth had significantly higher HRQoL scores on the vitality dimension compared with women with an emergency repeat cesarean (P = .04).
In women with low-risk factors, repeat cesareans result in a poorer HRQoL compared with vaginal birth. When there are no contraindications for vaginal birth, women with a history of one previous cesarean should be encouraged to give birth vaginally rather than have an elective repeat cesarean.
女性的分娩方式会影响其健康相关生活质量（HRQoL）。本研究探讨了欧洲三个国家中曾有一次剖宫产史的女性产后3个月时的健康相关生活质量。
一项前瞻性纵向调查，纳入了三个国家的一项整群随机试验，旨在探究女性产后3个月内的产后健康相关生活质量。采用简式六维健康调查量表（SF-6D）来测量健康相关生活质量，并使用多变量分析来检验与分娩方式的关系。
共有880名女性提供了完整数据。自然阴道分娩的女性健康相关生活质量得分最高，而急诊再次剖宫产的女性得分最低（P = 0.01）。母亲产后再次入院（P = 0.03）、拥有公共医疗保险（P = 0.04）以及产前健康相关生活质量得分较低（P < 0.01）均导致健康相关生活质量得分较低。更具体地说，与急诊再次剖宫产的女性相比，自然阴道分娩的女性在活力维度上的健康相关生活质量得分显著更高（P = 0.04）。
在低风险因素的女性中，与阴道分娩相比，再次剖宫产会导致较差的健康相关生活质量。当无阴道分娩禁忌证时，应鼓励有过一次剖宫产史的女性阴道分娩而非选择性再次剖宫产。
