Rottenstreich Misgav, Futeran Shahar Chen, Rotem Reut, Sela Hen Y, Rottenstreich Amihai, Samueloff Arnon, Shen Ori, Reichman Orna
Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel.
Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel.
Eur J Obstet Gynecol Reprod Biol. 2020 Sep;252:344-348. doi: 10.1016/j.ejogrb.2020.06.060. Epub 2020 Jun 29.
Parturients in second delivery undergoing vaginal birth after cesarean (VBAC) are divided to those who had their cesarean delivery (CD) while in labor as opposed to those who had an elective CD. We aimed to study if the stage of labor that was present during the primary CD is associated with the duration of subsequent spontaneous VBAC.
A retrospective study (2006-2014). Multiparas in second delivery with a history of a CD (P2-VBAC) were sub-grouped based on stage of labor at which the CD was performed in the first delivery; elective, latent, first or second stage of labor, Duration of labor was compared between P2-VBAC (as one group and further as the sub-groups) to primiparas (P1), multiparas in second (P2) and third (P3) vaginal delivery (VD). A Cox regression analysis was performed including maternal age, preterm-delivery, regional anesthesia, oxytocin augmentation, birthweight and neonatal gender.
A total of 58,028 parturients were included in the study. Mean duration of labor was significantly longer in parturients with a first VD (P1 and P2-VBAC) compared to repeat VD (P2 and P3), 6.0 versus 2.5 h, respectively, (P < 0.001). Analyzing duration of labor by the sub-groups of P2-VBAC revealed that spontaneous VD following a second-stage CD was associated with shorter duration of labor when compared with spontaneous VD following elective, latent and active first stage CD 4.2 versus 6.3, 7.0, 6.9 h respectively, p<0.001.
Second stage CD shortens duration of the following VBAC compared to those who underwent cesarean in earlier stages of labor.
剖宫产术后经阴道分娩（VBAC）的经产妇被分为剖宫产（CD）时处于产程中的产妇和择期剖宫产的产妇。我们旨在研究首次剖宫产时所处的产程阶段是否与后续自然VBAC的持续时间相关。
一项回顾性研究（2006 - 2014年）。将有剖宫产史的经产妇（P2 - VBAC）根据首次分娩时剖宫产的产程阶段进行亚组划分；择期、潜伏期、第一产程或第二产程。将P2 - VBAC（作为一组并进一步分为亚组）与初产妇（P1）、经产妇第二次（P2）和第三次（P3）阴道分娩（VD）的产妇进行产程持续时间比较。进行Cox回归分析，包括产妇年龄、早产、区域麻醉、缩宫素加强宫缩、出生体重和新生儿性别。
该研究共纳入58028名产妇。首次阴道分娩的产妇（P1和P2 - VBAC）的平均产程明显长于再次阴道分娩的产妇（P2和P3），分别为6.0小时和2.5小时，（P < 0.001）。按P2 - VBAC亚组分析产程持续时间发现，与择期、潜伏期和活跃期第一产程剖宫产术后的自然阴道分娩相比，第二产程剖宫产术后的自然阴道分娩产程持续时间较短，分别为4.2小时与6.3小时、7.0小时、6.9小时，p < 0.001。
与在产程早期进行剖宫产的产妇相比，第二产程剖宫产可缩短后续VBAC的持续时间。
