Harrison Margo S, Liyew Tewodros, Kirub Ephrem, Teshome Biruk, Jimenez-Zambrano Andrea, Muldrow Margaret, Yarinbab Teklemariam
University of Colorado School of Medicine, Colorado, USA.
Mizan-Tepi University Teaching Hospital, Aman, Bench Maji Zone, Ethiopia.
J Womens Health Dev. 2021 Mar;4(1):001-9. doi: 10.26502/fjwhd.2644-28840055. Epub 2021 Jan 8.
The objective of this study was to observe mode of delivery among women with a history of prior cesarean birth.
After collecting data on a convenience sample of 1,000 women giving birth at 28 weeks gestation or greater at Mizan-Tepi University Teaching Hospital, we reduced the sample to only include women with a history of prior cesarean birth. We wanted to observe mode of delivery among this cohort and determine if any characteristics were associated with elective repeat cesarean birth, as compared to vaginal birth after cesarean.
Of 1,000 women in our convenience sample, data on history of prior cesarean birth was missing on 2 women (0.2%). Of the remaining women, 49 (4.9%) reported a history of prior cesarean; 44 (89.8%) reported one prior cesarean and 5 (10.2%) women had two prior cesarean births. Repeat cesarean birth occurred in 65.1% (n = 29/44) of women with one prior cesarean and in 80.0% (n = 4/5) of women with two prior surgeries. Among the total cohort of women with a history of prior cesarean birth, of those who experienced repeat cesarean birth (n = 33), 27.3% (n = 9) occurred pre-labor, 69.7% (n = 23) occurred intrapartum after the onset of spontaneous labor, and 3.0% (n = 1) occurred intrapartum during the course of an induced or augmented labor. Labor onset and cervical exam on admission were statistically significantly different in bivariate comparisons of women who successfully achieved vaginal birth after cesarean as compared to those who gave birth by repeat cesarean birth, and postpartum maternal antibiotics were more common after repeat cesarean birth, p < 0.05. In a multivariable model of factors associated with successful vaginal birth after cesarean, the likelihood of successful vaginal birth was increased 15% for each increasing centimeter of dilation on a woman's admission cervical exam (RR 1.15, p= 0.004).
Almost one-third of women in our observational cohort attempted trial of labor after cesarean; those that were successful were more likely to have been more cervically dilated on their admission exam. No sociodemographic or obstetrical characteristics were more likely among women who underwent pre-labor repeat cesarean birth as compared to intrapartum cesarean birth.
本研究的目的是观察有剖宫产史女性的分娩方式。
在收集了米赞 - 泰皮大学教学医院1000名妊娠28周及以上分娩女性的便利样本数据后，我们将样本缩小至仅包括有剖宫产史的女性。我们希望观察该队列中的分娩方式，并确定与择期再次剖宫产相比，剖宫产术后阴道分娩是否有任何特征与之相关。
在我们的便利样本中的1000名女性中，有2名女性（0.2%）缺失既往剖宫产史的数据。在其余女性中，49名（4.9%）报告有既往剖宫产史；44名（89.8%）报告有一次既往剖宫产史，5名（10.2%）女性有两次既往剖宫产史。有一次既往剖宫产史的女性中，65.1%（n = 29/44）进行了再次剖宫产，有两次既往手术史的女性中，80.0%（n = 4/5）进行了再次剖宫产。在有既往剖宫产史的女性总队列中，在经历再次剖宫产的女性（n = 33）中，27.3%（n = 9）在临产前进行，69.7%（n = 23）在自然发动分娩后产时进行，3.0%（n = 1）在引产或加强宫缩的产时进行。与通过再次剖宫产分娩的女性相比，剖宫产术后成功实现阴道分娩的女性在双变量比较中，入院时的临产发动和宫颈检查在统计学上有显著差异，再次剖宫产术后产后母体使用抗生素更为常见，p < 0.05。在剖宫产术后成功阴道分娩相关因素的多变量模型中，女性入院宫颈检查时每增加1厘米的扩张，成功阴道分娩的可能性增加15%（RR 1.15，p = 0.004）。
在我们的观察队列中，近三分之一有剖宫产史的女性尝试了剖宫产术后阴道试产；成功的女性在入院检查时宫颈扩张更可能更大。与产时剖宫产相比，临产前进行再次剖宫产的女性中，没有更可能出现的社会人口统计学或产科特征。
