Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Chicago, Chicago, Illinois, USA.
Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA.
BJOG. 2022 Jul;129(8):1319-1324. doi: 10.1111/1471-0528.17056. Epub 2021 Dec 27.
To characterise neonatal morbidity following preterm trial of labour (TOL) in comparison with elective repeat caesarean section (eRCS) specifically among patients without a previous vaginal delivery who may have a lower success rate of vaginal birth after caesarean.
This is a secondary analysis of a multicentre prospective database.
SETTING/POPULATION: Maternal and Fetal Medicine Unit Cesarean Section Registry.
Singleton pregnancies in women without a previous vaginal delivery who delivered at 24 weeks to 36 weeks gestation.
Neonatal outcomes were compared between those with a TOL and those undergoing eRCS. Logistic regression was used to control for confounders, including gestational age at delivery.
Composite neonatal morbidity.
A total of 1906 patients were included, 985 with TOL and 921 with no TOL. The TOL success rate was 63.1%. The rate of uterine rupture was low, at 0.10% in the TOL group and 0.11% in the eRCS group (p = 0.32). After adjustment, neonates born to women undergoing a TOL had no statistically significant difference in outcomes including composite neonatal outcome (adjusted odds ratio 0.86, 95% CI 0.68-1.09), neonatal intensive care unit admission, respiratory distress syndrome, necrotising enterocolitis, hypoxic ischaemic encephalopathy, seizures, transient tachypnoea of the newborn, compared with patients who underwent eRCS, with the exception of decreased risk of proven/suspected sepsis (adjusted odds ratio 0.68, 95% CI 0.52-0.87) CONCLUSION: A TOL in preterm patients without a previous vaginal delivery was not found to have a statistically significant association with increased neonatal morbidity.
与选择性剖宫产（eRCS）相比，明确在既往无阴道分娩史的患者中，尤其是在既往剖宫产分娩后阴道分娩成功率较低的患者中，试产分娩早产儿的新生儿发病率特征。
这是一项多中心前瞻性数据库的二次分析。
设置/人群：妇产医学单位剖宫产登记处。
既往无阴道分娩史的单胎妊娠妇女，分娩孕周为 24 至 36 周。
比较试产分娩和 eRCS 分娩的新生儿结局。采用逻辑回归来控制混杂因素，包括分娩时的孕龄。
复合新生儿发病率。
共纳入 1906 例患者，其中 985 例接受试产分娩，921 例未接受试产分娩。试产分娩成功率为 63.1%。子宫破裂发生率较低，试产分娩组为 0.10%，eRCS 组为 0.11%（p=0.32）。调整后，与 eRCS 组相比，接受试产分娩的产妇所分娩的新生儿在复合新生儿结局（调整后的优势比 0.86，95%可信区间 0.68-1.09）、新生儿重症监护病房入住、呼吸窘迫综合征、坏死性小肠结肠炎、缺氧缺血性脑病、癫痫、新生儿暂时性呼吸急促等方面的结局差异无统计学意义，除确诊/疑似败血症的风险降低（调整后的优势比 0.68，95%可信区间 0.52-0.87）外。
在既往无阴道分娩史的早产患者中，试产分娩与新生儿发病率增加无统计学显著相关性。
