Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON; Department of Obstetrics and Gynecology, Unity Health- St. Michael's Hospital, Toronto, ON.
Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON.
J Obstet Gynaecol Can. 2022 Jun;44(6):658-663. doi: 10.1016/j.jogc.2021.11.015. Epub 2021 Dec 15.
To understand current attitudes and practice patterns of obstetrical care providers regarding trial of labour after cesarean (TOLAC) and to assess misconceptions regarding eligibility for and risks associated with TOLAC.
A survey was developed based on published literature, validated by a statistician, and piloted with Canadian obstetricians. French and English versions were distributed via the mailing list of the Society of Obstetricians and Gynaecologists of Canada and social media. Practising obstetrical care providers with an office antenatal practice were eligible to participate. Data were analyzed using descriptive statistics and correlational and multiple regression analyses.
A total of 381 people responded, with representation from every Canadian province and territory. Obstetrician-gynaecologists (239, 63%), family physicians (100, 26%), and midwives (42, 11%) responded. Most participants (277, 78%) thought that TOLAC should be actively encouraged. Only 141 (40%) used a decision aid when counselling patients, although most respondents (250, 71%) thought it would be useful. Providers were less comfortable offering oxytocin induction compared with cervical foley or amniotomy (P < 0.001) and offering TOLAC to patients with an unknown uterine scar (P < 0.001). Providers in western Canada reported more comfort offering TOLAC to patients with more than 1 previous cesarean delivery compared with other regions. Two hundred nine participants (62%) reported that they had had at least 1 patient with a uterine rupture, with the minority of cases (13, 6%) resulting in litigation.
This study offers new information on current national practice patterns and provider attitudes regarding TOLAC. These results can be used to guide future educational initiatives to increase TOLAC rates.
了解产科医护人员在剖宫产术后试产（TOLAC）方面的当前态度和实践模式，并评估对 TOLAC 适应证和相关风险的误解。
根据已发表的文献制定了一项调查，该调查由统计学家进行了验证，并在加拿大产科医生中进行了试点。法语和英语版本通过加拿大妇产科医生协会的邮件列表和社交媒体分发。有门诊产前护理实践的产科医护人员有资格参加。使用描述性统计数据以及相关性和多元回归分析来分析数据。
共有 381 人做出回应，来自加拿大每个省和地区。妇产科医生（239 人，63%）、家庭医生（100 人，26%）和助产士（42 人，11%）做出回应。大多数参与者（277 人，78%）认为应积极鼓励 TOLAC。尽管大多数受访者（250 人，71%）认为这将是有用的，但只有 141 人（40%）在为患者提供咨询时使用决策辅助工具。与宫颈 Foley 或羊膜穿刺术相比，提供者在提供催产素诱导方面的舒适度较低（P < 0.001），并且在为未知子宫疤痕的患者提供 TOLAC 方面的舒适度较低（P < 0.001）。与其他地区相比，加拿大西部的提供者报告在为有超过 1 次剖宫产史的患者提供 TOLAC 时更舒适。209 名参与者（62%）报告说他们至少有 1 名患者发生了子宫破裂，其中少数病例（13 例，6%）导致诉讼。
本研究提供了有关当前全国实践模式和提供者对 TOLAC 的态度的新信息。这些结果可用于指导未来的教育计划，以提高 TOLAC 的比率。
