Carauleanu Alexandru, Tanasa Ingrid Andrada, Nemescu Dragos, Socolov Demetra
Department of Obstetrics and Gynecology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.
Exp Ther Med. 2021 Oct;22(4):1111. doi: 10.3892/etm.2021.10545. Epub 2021 Aug 3.
The increasing number of patients who desire to experience vaginal birth after cesarean (VBAC) and the optimized protocols for trial of labor after cesarean (TOLAC) has led to a shift of old obstetrical paradigms. The VBAC trend is accompanied with numerous challenges for healthcare professionals, from establishing suitability of each pregnant patient profile for TOLAC to active labor management, and ethical or legal issues, which occasionally are not included in specific guidelines. That is why an individualized risk assessment and management can serve obstetricians as a useful tool for improving outcomes of patients, satisfaction, and also for avoiding legal or moral liabilities. The risk management concept aims to reduce foreseen risks and to emulate strategies for prediction and prevention of unwanted events. In obstetrics, and particularly for the VBAC topic, this concept is relatively new and undefined, and thus its features are disparate between guideline recommendations and clinical studies. This narrative review intends to offer a new and organic perspective over clinical aspects of TOLAC and VBAC risk management.
希望尝试剖宫产术后阴道分娩（VBAC）的患者数量不断增加，以及剖宫产术后试产（TOLAC）的优化方案，导致了旧有产科模式的转变。VBAC趋势给医护人员带来了诸多挑战，从确定每位孕妇的TOLAC适用性到活跃期分娩管理，以及伦理或法律问题，而这些问题在特定指南中有时并未涵盖。这就是为什么个体化风险评估和管理对产科医生而言是改善患者结局、提高满意度以及避免法律或道德责任的有用工具。风险管理概念旨在降低可预见风险，并模拟预测和预防不良事件的策略。在产科领域，尤其是对于VBAC主题，这一概念相对较新且尚未明确界定，因此其特点在指南建议和临床研究之间存在差异。本叙述性综述旨在就TOLAC和VBAC风险管理的临床方面提供一个全新的有机视角。
