Ram Maya, Hiersch Liran, Ashwal Eran, Yogev Yariv, Aviram Amir
Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Arch Gynecol Obstet. 2021 Aug;304(2):329-336. doi: 10.1007/s00404-020-05946-z. Epub 2021 Jan 3.
To compare pregnancy outcomes in grand-multiparous (GMP) women with and without one previous cesarean delivery (CD), and to evaluate the number of previous successful vaginal deliveries after a CD needed to reduce the complication rate of trials of labor after a previous CD.
This is a retrospective cohort study of women with singleton pregnancy at term who had a trial of vaginal delivery between 2007 and 2014 at a tertiary medical center. We compared pregnancy outcomes in GMP women with and without one previous cesarean delivery. The primary outcome was mode of delivery and secondary outcomes were uterine rupture and composite maternal and neonatal morbidity. For the secondary objective, we compared pregnancy outcomes in women in TOLAC, stratified by the number of previous vaginal deliveries.
Overall, 2815 GMP women met the study criteria, of which 310 (11%) had a previous cesarean delivery. The rate of a successful vaginal deliveries (VBAC) was similar, regardless of the presence of a previous cesarean delivery. No other differences in outcomes were found between the groups. In a secondary analysis, it was found that the presence of a single previous VBAC (compared to no previous VBACs) increased the odds of achieving a vaginal delivery in the next trial of labor after cesarean delivery (TOLAC) (aOR 5.66; 95% CI 3.73-8.60), and decreased the risk of maternal or neonatal adverse outcomes (aOR 0.62; 95% CI 0.39-0.97, and aOR 0.49; 95% CI 0.25-0.97, respectively). Multiple prior VBACs (as compared to a single prior VBAC) did not increase the odds of achieving another VBAC.
Grand-multiparous women with and without previous uterine scar have comparable pregnancy outcomes. Additionally, after the first VBAC, additional successful VBACs do not improve the success rate in the next TOLAC.
比较有一次剖宫产史和无剖宫产史的经产妇的妊娠结局，并评估既往剖宫产术后需要有多少次成功的阴道分娩才能降低再次剖宫产术后试产的并发症发生率。
这是一项回顾性队列研究，研究对象为2007年至2014年在一家三级医疗中心进行阴道试产的足月单胎妊娠妇女。我们比较了有一次剖宫产史和无剖宫产史的经产妇的妊娠结局。主要结局是分娩方式，次要结局是子宫破裂以及孕产妇和新生儿综合发病率。对于次要目标，我们比较了剖宫产术后阴道试产（TOLAC）妇女的妊娠结局，并根据既往阴道分娩次数进行分层。
总体而言，2815名经产妇符合研究标准，其中310名（11%）有既往剖宫产史。无论是否有既往剖宫产史，成功阴道分娩（VBAC）的发生率相似。两组之间在其他结局方面未发现差异。在一项次要分析中发现，有一次既往VBAC（与无既往VBAC相比）增加了剖宫产术后下次试产时实现阴道分娩的几率（调整后比值比[aOR] 5.66；95%置信区间[CI] 3.73 - 8.60），并降低了孕产妇或新生儿不良结局的风险（分别为aOR 0.62；95% CI 0.39 - 0.97和aOR 0.49；95% CI 0.25 - 0.97）。多次既往VBAC（与一次既往VBAC相比）并未增加再次实现VBAC的几率。
有和没有既往子宫瘢痕的经产妇妊娠结局相当。此外，在首次VBAC后，额外的成功VBAC并不能提高下次TOLAC的成功率。
