Charitou Anastasia, Charos Dimitrios, Vamenou Iliana, Vivilaki Victoria G
Department of Midwifery, University of West Attica, Athens, Greece.
Eur J Midwifery. 2019 Apr 17;3:8. doi: 10.18332/ejm/108297. eCollection 2019.
Rising rates of caesarean section (CS) is an issue of particular concern. Recently, there has been research supporting Vaginal Births After Caesarean (VBAC), which is controversial. In Greece, over half of births in the country are by CS, placing Greece among countries with the highest CS rates. The aim of this study was to investigate the prevalence and the factors associated with VBACs and to compare the maternal/neonatal outcomes with a 'non-caesarean' control group.
The data were evaluated and retrospectively gathered on archived singleton births, from medical records of a midwifery-led team, between May 2006 and May 2013. The target group of the study included mothers with a previous CS, who had a second birth. The sample consisted of 71 VBAC women and 583 who had normal spontaneous vaginal delivery (NSVD) as the 'non-caesarean' control group.
The duration of labour was longer for the VBACs compared with first-time mothers who gave birth naturally (for duration 481-720 min, 27% vs 10.3%, respectively), episiotomy was more common for VBAC (20.7% vs 7.9%), and epidural analgesia was more often for VBAC (68.4% vs 10%). The percentage of 1-min Apgar score in the range 0-7 in the VBAC group was 5%, and there was no significant difference in women who had NSVD (3.6%). The Apgar score in the 5th minute was always above 8 for both groups.
Severe maternal and neonatal complications are infrequent, and therefore the necessity arises for further continuous studies to ascertain the safety of VBAC.
剖宫产率上升是一个特别令人担忧的问题。最近，有研究支持剖宫产后阴道分娩（VBAC），但这一方法存在争议。在希腊，该国超过一半的分娩是通过剖宫产进行的，这使希腊成为剖宫产率最高的国家之一。本研究的目的是调查VBAC的发生率及其相关因素，并将母婴结局与“非剖宫产”对照组进行比较。
对2006年5月至2013年5月间由助产士主导的团队的医疗记录中存档的单胎分娩数据进行评估和回顾性收集。该研究的目标群体包括有过剖宫产史且再次分娩的母亲。样本包括71名VBAC妇女和583名自然顺产（NSVD）的妇女作为“非剖宫产”对照组。
与自然分娩的初产妇相比，VBAC产妇的产程更长（产程在481 - 720分钟时，分别为27%和10.3%），VBAC产妇更常进行会阴切开术（20.7%对7.9%），且更常使用硬膜外镇痛（68.4%对10%）。VBAC组1分钟阿氏评分在0 - 7分的比例为5%，NSVD妇女中这一比例无显著差异（3.6%）。两组在第5分钟时的阿氏评分均始终高于8分。
严重的母婴并发症并不常见，因此有必要进一步持续研究以确定VBAC的安全性。
