患者偏好和态度与剖宫产后试产的关联。
The association of patient preferences and attitudes with trial of labor after cesarean.
机构信息
Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA.
Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
出版信息
J Perinatol. 2019 Oct;39(10):1340-1348. doi: 10.1038/s41372-019-0399-5. Epub 2019 Jul 3.
OBJECTIVE
To evaluate the association of patient preferences and attitudes with TOLAC.
STUDY DESIGN
Prospective observational study of TOLAC-eligible women at 26-34 weeks gestation. Preferences (utilities) were elicited using the time trade-off and standard gamble metrics. Logistic regression was used to identify preference- and attitude-based factors associated with TOLAC.
RESULTS
Of the 231 participants, most (n = 197, 85%) preferred vaginal delivery, but only 40% (n = 93) underwent TOLAC. Utilities for uterine rupture outcomes did not differ based on delivery approach. In multivariable analysis, strength of preference for vaginal delivery, value for the experience of labor, and the opinion of the person whom the participant thought of as most important to this decision were associated with TOLAC.
CONCLUSIONS
Future decision support interventions incorporating individualized information regarding the likelihood of vaginal birth and empowering patients to express their preferences and engage their families in the decision-making process may improve decision quality and increase TOLAC rates.
目的
评估患者偏好和态度与 TOLAC 的相关性。
研究设计
对 26-34 周妊娠的 TOLAC 合格女性进行前瞻性观察研究。使用时间权衡和标准博弈测度来引出偏好（效用）。使用逻辑回归来确定与 TOLAC 相关的偏好和态度因素。
结果
在 231 名参与者中，大多数（n=197，85%）更喜欢阴道分娩，但只有 40%（n=93）进行了 TOLAC。分娩方式对子宫破裂结局的效用没有差异。在多变量分析中，阴道分娩的偏好强度、对分娩经历的重视程度以及参与者认为对这个决策最重要的人的意见与 TOLAC 相关。
结论
未来的决策支持干预措施可以结合关于阴道分娩可能性的个体化信息，并赋予患者表达偏好的权力，让他们的家人参与决策过程，这可能会提高决策质量并增加 TOLAC 的比率。
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