剖宫产时机及其对首次阴道分娩时产程和生殖道损伤的影响：一项回顾性队列研究。
Timing of cesarean and its impact on labor duration and genital tract trauma at the first subsequent vaginal birth: a retrospective cohort study.
机构信息
Department of Gynecology and Obstetrics, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic.
Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 80, 304 60, Plzen, Czech Republic.
出版信息
BMC Pregnancy Childbirth. 2019 Jun 20;19(1):207. doi: 10.1186/s12884-019-2359-7.
BACKGROUND
The objectives of this study were to explore the course of labor and the risk of obstetric anal sphincter injury at the first vaginal birth after cesarean section (fVBAC) in comparison to primiparous vaginal birth (PVB) in women without epidural analgesia and to assess if laboring before the previous cesarean affected these outcomes.
METHODS
All fVBACs without epidural analgesia and the subsequent PVBs (controls) between 2012 and 2016 were included in this retrospective cohort study. Data were collected from health records and included maternal demographics, gestational age, and labor details (duration of 1st and 2nd stages, labor induction or augmentation, birthweight, operative vaginal birth, estimated blood loss, extent of childbirth trauma) in both groups as well as cervical dilation at the time of previous cesarean in the fVBAC group. Wilcoxon and Chi-square tests were used for data analyses.
RESULTS
The study comprised 510 women; 255 fVBACs and 255 controls. The majority of fVBACs were after a pre-labor cesarean section - 177 (69.4%). There was a statistically significant difference in the recorded duration of first stage between the fVBACs and controls (289 vs. 347 min respectively, p < .001). Women were less likely to have an intact perineum in the fVBAC group (29.8 vs. 43.1%, p < 0.01), however, there was no statistically significant difference in anal sphincter injury rates between both groups (2.3 vs. 1.9%, p = 0.76). The groups differed in rates of cervical tears requiring suturing (21.2 vs. 12.9%, p = 0.01). On further subgroup analysis, the duration of first stage of labor was shorter in women who previously had a caesarean section late in labor (≥ 8 cm cervical dilatation) compared to a pre-labor cesarean section, however, there were no differences in other outcomes.
CONCLUSION
Compared to primiparous women having a vaginal birth, women having their first vaginal birth after a cesarean section have a shorter 1st stage of labor (particularly if the cesarean was performed in advanced labor), a higher risk of sustaining cervical lacerations and perineal trauma. However, there was no difference in the risk of sustaining obstetric anal sphincter injuries between the study groups.
背景
本研究旨在探讨无硬膜外麻醉的剖宫产后阴道分娩（VBAC）与初次阴道分娩（PVB）的产程及产科肛门括约肌损伤风险，并评估前次剖宫产时的产程是否会影响这些结局。
方法
本回顾性队列研究纳入了 2012 年至 2016 年间所有无硬膜外麻醉的 VBAC 及随后的 PVB（对照组）。从病历中收集了产妇人口统计学、孕周和产程详细信息（1 期和 2 期持续时间、引产或催产、出生体重、经阴道分娩、估计失血量、分娩创伤程度），以及 VBAC 组前次剖宫产时的宫颈扩张情况。采用 Wilcoxon 和 Chi-square 检验进行数据分析。
结果
本研究共纳入 510 名妇女；255 例 VBAC，255 例对照组。大多数 VBAC 是在产前剖宫产之后进行的-177 例（69.4%）。VBAC 组和对照组的第 1 产程记录时间有显著统计学差异（分别为 289 分钟和 347 分钟，p<0.001）。VBAC 组中会阴完整的产妇比例较低（29.8% vs. 43.1%，p<0.01），但两组的肛门括约肌损伤率无统计学差异（2.3% vs. 1.9%，p=0.76）。两组的宫颈撕裂发生率存在差异，需要缝合（21.2% vs. 12.9%，p=0.01）。进一步的亚组分析显示，与产前剖宫产相比，前次剖宫产在产程晚期（≥8cm 宫颈扩张）的产妇第 1 产程时间更短，但其他结局无差异。
结论
与初次阴道分娩的初产妇相比，剖宫产后初次阴道分娩的产妇第 1 产程较短（尤其是前次剖宫产在活跃期进行时），宫颈撕裂和会阴创伤的风险较高。但两组的产科肛门括约肌损伤风险无差异。
Zotero 插件