Placek P J, Taffel S M
National Center for Health Statistics, Hyattsville, MD 20782.
Am J Public Health. 1988 May;78(5):512-5. doi: 10.2105/ajph.78.5.512.
The incidence of vaginal birth after cesarean (VBAC) and characteristics of VBAC births are investigated using 1980-85 National Hospital Discharge Survey Data collected by the National Center for Health Statistics. Only 3.4 per cent of mothers with previous cesarean delivery had VBAC in their subsequent 1980 delivery; this increased to 6.6 per cent in 1985. Because VBAC is a relatively infrequent event, 1980-85 data were combined and indicate that in this period 4.9 per cent of mothers with previous cesarean had a vaginal birth in their subsequent delivery. Combined 1980-85 VBAC rates are under 10 per cent for all age, race, marital status, region, hospital size, hospital ownership, and expected source of payment groups. Between 1980 and 1985, over 1.4 million repeat cesareans were performed for mothers having a live birth. Evidence suggests that potentially over 500,000 of these repeat cesareans could have been VBACs (over and above the 74,000 VBACs which occurred). VBAC mothers' mean length of hospital stay is 3.2 days, which compares closely with 3.0 days for other vaginal deliveries, but both contrast sharply with 5.6 days for repeat cesareans and 6.0 days for primary cesareans. Except for the uterine scar from the previous cesarean, VBAC mothers appear to have about the same history and frequency of complications as mothers with other vaginal deliveries. If the 500,000 repeat cesareans had been VBACs, surgical fees and costs for 1.2 million days of hospital stay would have been averted over the 1980-85 period.
利用美国国家卫生统计中心收集的1980 - 1985年全国医院出院调查数据，对剖宫产术后阴道分娩（VBAC）的发生率及VBAC分娩的特征进行了调查。在1980年，既往有剖宫产史的母亲中只有3.4%在随后的分娩中进行了VBAC；到1985年，这一比例增至6.6%。由于VBAC相对不常见，因此将1980 - 1985年的数据合并，结果显示在此期间，既往有剖宫产史的母亲中有4.9%在随后的分娩中进行了阴道分娩。1980 - 1985年所有年龄、种族、婚姻状况、地区、医院规模、医院所有制及预期支付来源组的VBAC率均低于10%。1980年至1985年期间，为有活产的母亲进行了超过140万次再次剖宫产。有证据表明，这些再次剖宫产中可能有超过50万例本可以是VBAC（超过已发生的7.4万例VBAC）。VBAC母亲的平均住院时间为3.2天，与其他阴道分娩的3.0天相近，但两者与再次剖宫产的5.6天及初次剖宫产的6.0天形成鲜明对比。除了既往剖宫产留下的子宫瘢痕外，VBAC母亲的病史和并发症发生频率似乎与其他阴道分娩的母亲大致相同。如果这50万例再次剖宫产是VBAC，那么在1980 - 1985年期间可避免120万天住院的手术费用和成本。
