青少年剖宫产术后试产——一项多中心研究
Trial of Labor After Cesarean in Adolescents - A Multicenter Study.
作者信息
Levin Gabriel, Meyer Raanan, Mor Nizan, Yagel Simcha, David Mankuta, Yinon Yoav, Rottenstreich Amihai
机构信息
Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel.
出版信息
J Pediatr Adolesc Gynecol. 2020 Aug;33(4):398-402. doi: 10.1016/j.jpag.2020.02.006. Epub 2020 Feb 19.
STUDY OBJECTIVE
Data regarding trial of labor after cesarean delivery (TOLAC) among young women are limited. The aim of this study was to assess the TOLAC success rate and its related factors among adolescent women who had never delivered vaginally.
DESIGN
A multicenter retrospective cohort study of all adolescent women aged ≤21 years with a history of 1 previous cesarean delivery, who delivered in 2 tertiary medical centers during 2007-2019. Women were allocated to 2 groups: 1) women who underwent TOLAC, and 2) women who had a repeat cesarean delivery with no trial of labor. Maternal and neonatal outcomes were compared between the two groups. In addition, perinatal outcomes were compared between women with successful and unsuccessful TOLAC.
RESULTS
The study cohort included 167 women who had a previous caesarean delivery; 117 underwent TOLAC and 50 underwent a repeat cesarean delivery with no trial of labor. Neonatal birthweight (median 2937 vs 3170 g, P = .03) and gestational age at delivery (median 38 weeks vs 39, P = .009) were lower in the repeat cesarean group as compared to those undergoing TOLAC. Overall, 97 of 117 participants (83%) had a successful TOLAC. Failed TOLAC was associated low birthweight as compared to successful TOLAC (5 [25%] vs 7 [7%], odds ratio [OR] 4.3, 95% confidence interval [CI] 1.2-15.3, P = .02), and birthweight difference between current and previous deliveries was higher in the failed TOLAC group (median 315 vs 197 g, P = .04). Rates of neonatal Apgar score at 1 minute < 7 and of neonatal intensive care unit admission were higher in the TOLAC failure group (4 [20%] vs 5 [5%], OR 4.6, 95% CI 1.1-19.0, P = .03, and 4 [20%] vs 4 [4%], OR 5.8, 95% CI 1.3-25.6, P = .02), respectively). In a multivariable logistic regression analysis, only low birthweight was independently associated with TOLAC failure (adjusted OR 9.9, 95% CI 2.1-45.4, P = .003). Two cases of uterine rupture occurred in the no trial of labor group, whereas none were encountered in participants undergoing TOLAC.
CONCLUSIONS
TOLAC in adolescent women who had never delivered vaginally is associated with a relatively high success rate.
研究目的
关于剖宫产术后阴道试产（TOLAC）在年轻女性中的数据有限。本研究的目的是评估从未经阴道分娩的青春期女性的TOLAC成功率及其相关因素。
设计
一项多中心回顾性队列研究，纳入2007年至2019年期间在两家三级医疗中心分娩的所有年龄≤21岁且有1次剖宫产史的青春期女性。将女性分为两组：1）接受TOLAC的女性，2）直接行再次剖宫产且未进行阴道试产的女性。比较两组的母婴结局。此外，比较TOLAC成功和失败的女性的围产期结局。
结果
研究队列包括167例有剖宫产史的女性；117例接受TOLAC，50例直接行再次剖宫产且未进行阴道试产。与接受TOLAC的女性相比，再次剖宫产组的新生儿出生体重（中位数2937 vs 3170 g，P = 0.03）和分娩时的孕周（中位数38周 vs 39周，P = 0.009）较低。总体而言，117名参与者中有97名（83%）TOLAC成功。与TOLAC成功相比，TOLAC失败与低出生体重相关（5例[25%] vs 7例[7%]，优势比[OR] 4.3，95%置信区间[CI] 1.2 - 15.3，P = 0.02），且TOLAC失败组当前与上次分娩的出生体重差异更大（中位数315 vs 197 g，P = 0.04）。TOLAC失败组1分钟时新生儿阿氏评分<7分和新生儿重症监护病房入住率更高（4例[20%] vs 5例[5%]，OR 4.6, 95% CI 1.1 - 19.0，P = 0.03，以及4例[20%] vs 4例[4%]，OR 5.8, 95% CI 1.3 - 25.6，P = 0.02）。在多变量逻辑回归分析中，只有低出生体重与TOLAC失败独立相关（调整后的OR 9.9, 95% CI 2.1 - 45.4，P = 0.003）。未进行阴道试产组发生2例子宫破裂，而接受TOLAC的参与者中未发生子宫破裂。
结论
从未经阴道分娩的青春期女性进行TOLAC成功率相对较高。
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