Duff P, Southmayd K, Read J A
Division of Maternal-Fetal Medicine, Madigan Army Medical Center, Tacoma, Washington.
Obstet Gynecol. 1988 Mar;71(3 Pt 1):380-4.
The purpose of this prospective investigation was to evaluate the outcome of trial of labor in women with a history of a single low transverse cesarean section for dystocia in comparison with the outcome in women with a history of cesarean delivery for a reason other than dystocia. During the study period, 89 of 131 patients (68%) with a history of dystocia had a successful trial of labor, compared with 78 of 96 women (81%) who had cesarean delivery for a reason other than dystocia (P less than .025). Within the former group, 79% of women who originally had surgery while still in the latent phase of labor had a successful trial of labor, compared with 61% (.05 less than P less than .10) of patients who had an arrest of dilation in the active phase of labor and 65% (not significant) of those who had an arrest of descent. The only serious complication among study patients was a single instance of uterine scar dehiscence (0.5%). We conclude that approximately two-thirds of patients with a previous cesarean delivery for dystocia will have a successful trial of labor. Of these women, those individuals whose initial operation was performed in the latent phase of labor appear to have the best prognosis for subsequent vaginal delivery.
这项前瞻性研究的目的是评估因难产行单次低位横切口剖宫产术的女性试产的结局，并与因难产以外的原因行剖宫产术的女性的结局进行比较。在研究期间，131例有难产史的患者中有89例（68%）试产成功，相比之下，96例因难产以外的原因行剖宫产术的女性中有78例（81%）试产成功（P<0.025）。在前一组中，最初在产程潜伏期手术的女性中有79%试产成功，相比之下，活跃期宫颈扩张停滞的患者中有61%（0.05<P<0.10）试产成功，胎头下降停滞的患者中有65%（无显著性差异）试产成功。研究患者中唯一的严重并发症是1例子宫瘢痕裂开（0.5%）。我们得出结论，既往因难产行剖宫产术的患者中约三分之二试产会成功。在这些女性中，最初在产程潜伏期进行手术的个体后续经阴道分娩的预后似乎最佳。
