Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel.
Faculty of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Arch Gynecol Obstet. 2022 Aug;306(2):389-396. doi: 10.1007/s00404-021-06312-3. Epub 2021 Oct 28.
Spontaneous labor onset, epidural anesthesia and prior cesarean for non-arrest disorders are strong predictors of successful vaginal birth after cesarean in women delivering a macrosomic fetus.
Lower rates of successful vaginal birth after cesarean in association with increasing birthweight were previously reported. We aimed to determine the factors associated with successful trial of labor after cesarean (TOLAC) among primiparous women with fetal macrosomia.
A retrospective cohort study conducted during 2005-2019 at two university hospitals, including all primiparous women delivering a singleton fetus weighing ≥ 4000 g, after cesarean delivery at their first delivery. A multivariate analysis was performed to evaluate the characteristics associated with TOLAC success (primary outcome).
Of 551 primiparous women who met the inclusion criteria, 50.1% (n = 276) attempted a TOLAC and 174 (63.0%) successfully delivered vaginally. In a multivariate analysis, spontaneous onset of labor (aOR [95% CI] 3.68 (2.05, 6.61), P < 0.001), epidural anesthesia (aOR [95% CI] 2.38 (1.35, 4.20), P = 0.003) and history of cesarean delivery due to non-arrest disorder (aOR [95% CI] 2.25 (1.32, 3.85), P = 0.003) were the only independent factors associated with TOLAC success. Successful TOLAC was achieved in 82.0% (82/100) in the presence of all three favorable factors, 61.3% (65/106) in the presence of two factors and 38.6% (27/70) in the presence of one or less of these three factors (P < 0.001).
Spontaneous onset of labor, epidural anesthesia and prior cesarean delivery due to non-arrest disorders were independently associated with higher vaginal birth after cesarean rate among women with fetal macrosomia, with an overall favorable success rate in the presence of these factors. These findings should be implemented in patient counseling in those contemplating a vaginal birth in this setting.
自发性临产、硬膜外麻醉和因非窒息性疾病行剖宫产术是预测巨大儿产妇行剖宫产术后阴道分娩成功的强有力指标。
先前有报道称，剖宫产术后阴道分娩成功率与胎儿体重增加呈负相关。本研究旨在确定与初产妇巨大儿行剖宫产术后试产（TOLAC）成功相关的因素。
这是一项回顾性队列研究，于 2005 年至 2019 年在两所大学附属医院进行，纳入所有因首次分娩行剖宫产术且分娩的单胎胎儿体重≥4000g 的初产妇。采用多变量分析评估与 TOLAC 成功相关的特征（主要结局）。
在符合纳入标准的 551 名初产妇中，50.1%（n=276）尝试了 TOLAC，174 名（63.0%）成功阴道分娩。多变量分析显示，自发性临产（优势比[95%置信区间]3.68（2.05，6.61），P<0.001）、硬膜外麻醉（优势比[95%置信区间]2.38（1.35，4.20），P=0.003）和因非窒息性疾病行剖宫产术（优势比[95%置信区间]2.25（1.32，3.85），P=0.003）是与 TOLAC 成功相关的唯一独立因素。在存在所有三个有利因素的情况下，82.0%（82/100）成功行 TOLAC，在存在两个因素的情况下，61.3%（65/106）成功行 TOLAC，在存在一个或更少的三个因素的情况下，38.6%（27/70）成功行 TOLAC（P<0.001）。
自发性临产、硬膜外麻醉和因非窒息性疾病行剖宫产术与巨大儿产妇剖宫产术后阴道分娩率升高独立相关，在存在这些因素的情况下，总体阴道分娩成功率较高。这些发现应在那些考虑在这种情况下行阴道分娩的患者咨询中实施。
