Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel.
The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Arch Gynecol Obstet. 2018 Aug;298(2):273-277. doi: 10.1007/s00404-018-4801-x. Epub 2018 May 24.
To evaluate whether cesarean delivery (CD) indication, labor status, and other primary CD characteristics affect the risk for uterine rupture in subsequent deliveries.
A case-control study of women attempting trial of labor after cesarean (TOLAC) in a single, tertiary, university-affiliated medical center (2007-2016). Deliveries complicated by uterine rupture were matched to successful vaginal birth after cesarean (VBAC) deliveries in a 1:3 ratio. Indication, labor status and post-partum complications (postpartum hemorrhage and postpartum infection) at primary CD were compared between study and control group.
During study period, there were 75,682 deliveries, of them, 3937 (5.2%) were TOLAC. Study group included 53 cases of uterine rupture at TOLAC and 159 women with successful VBAC. Women in study group had significantly lower rates of previous VBAC (15.1 vs. 28.9%, p = 0.047). Rate of postpartum complications at primary CD was significantly higher in women with TOLAC complicated by uterine rupture (7.5 vs. 1.9%, respectively, p = 0.042). Utilizing the multivariate logistic regression analysis, postpartum complications remained an independent risk factor for uterine rupture in the following TOLAC (aOR 4.07, 95% CI 1.14-14.58, p = 0.031).
Postpartum hemorrhage and infection, in primary CD, seem to be associated with increased risk for uterine rupture during subsequent TOLAC.
评估剖宫产（CD）指征、分娩状态和其他主要 CD 特征是否会影响后续分娩中子宫破裂的风险。
对单中心三级大学附属医院的尝试剖宫产分娩后试产（TOLAC）妇女进行病例对照研究（2007-2016 年）。将伴有子宫破裂的分娩与成功的剖宫产阴道分娩（VBAC）按 1:3 比例配对。比较研究组和对照组在原发性 CD 时的指征、分娩状态和产后并发症（产后出血和产后感染）。
在研究期间，共有 75682 例分娩，其中 3937 例（5.2%）为 TOLAC。研究组包括 53 例 TOLAC 时子宫破裂和 159 例成功 VBAC 的妇女。研究组既往 VBAC 率明显较低（15.1% vs. 28.9%，p=0.047）。原发性 CD 产后并发症发生率在 TOLAC 并发子宫破裂的妇女中明显较高（分别为 7.5%和 1.9%，p=0.042）。利用多变量逻辑回归分析，产后并发症仍然是后续 TOLAC 中子宫破裂的独立危险因素（aOR 4.07，95%CI 1.14-14.58，p=0.031）。
原发性 CD 中的产后出血和感染似乎与后续 TOLAC 中子宫破裂的风险增加相关。
