Peled Tzuria, Sela Hen Y, Joseph Jordanna, Martinotti Tal, Grisaru-Granovsky Sorina, Rottenstreich Misgav
Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91031, Israel.
Department of Nursing, Jerusalem College of Technology, Jerusalem 91031, Israel.
J Clin Med. 2022 Jul 22;11(15):4256. doi: 10.3390/jcm11154256.
Objective: Twin trial of labor after a cesarean section (TOLAC) is associated with a lower success rate of vaginal delivery than singleton TOLAC, and a higher rate of adverse outcomes in comparison to an elective repeat cesarean delivery. This study aims to investigate the factors associated with failed TOLAC, among women with twin gestation. Study design: A multicenter retrospective cohort study was undertaken. All women with twin pregnancies attempting a trial of labor after a previous cesarean in two university-affiliated obstetrical centers, between 2005 and 2021 were included. The study population included women with a twin gestation where twin A presented in the vertex position, a single previous low segment transverse section, and those who were eligible for a vaginal delivery. Labor, maternal, and neonatal characteristics were compared. A univariate analysis was undertaken, followed by multivariate analysis (aORs; [95% CI]). Results: A total of 160 women attempting a twin TOLAC were included. Vaginal birth after cesarean was achieved in 86.3% of these cases. Assisted reproductive technology (ART), the lack of oxytocin use for augmentation during labor, the lack of epidural analgesia, and preterm birth before 34, 32, and 28 gestational weeks were all found to be associated with failed TOLAC. In the multivariate analysis, cervical dilation on admission (aOR 0.6 [0.40−0.82], p < 0.01), no use of oxytocin (aOR 5.2 [1.36−19.73], p = 0.02), gestational age at delivery (aOR 0.8 [0.65−1.00], p = 0.047) and lack of epidural analgesia (aOR 4.5 [1.01−20.16], p = 0.049), were all found to be significantly associated with failed TOLAC. Conclusion: In the investigated population of women with twins undergoing TOLAC, the use of epidural analgesia, the use of oxytocin and increased cervical dilation to the delivery room are associated with a higher rate of vaginal delivery, and may reduce the risk of repeat cesarean delivery.
剖宫产术后经阴分娩双胎试验（TOLAC）与单胎TOLAC相比，阴道分娩成功率较低，且与择期再次剖宫产相比，不良结局发生率较高。本研究旨在调查双胎妊娠女性中TOLAC失败的相关因素。研究设计：进行了一项多中心回顾性队列研究。纳入2005年至2021年间在两家大学附属医院产科中心尝试经剖宫产术后经阴分娩的所有双胎妊娠女性。研究人群包括双胎A为头位、既往有一次低位横切口剖宫产且适合经阴道分娩的双胎妊娠女性。比较了分娩、母体和新生儿特征。进行了单因素分析，随后进行多因素分析（调整后比值比；[95%置信区间]）。结果：共纳入160例尝试双胎TOLAC的女性。其中86.3%的病例实现了剖宫产术后阴道分娩。辅助生殖技术（ART）、分娩期间未使用缩宫素加强宫缩、未使用硬膜外镇痛以及孕34、32和28周前早产均与TOLAC失败有关。在多因素分析中，入院时宫颈扩张情况（调整后比值比0.6[0.40−0.82]，p<0.01）、未使用缩宫素（调整后比值比5.2[1.36−19.73]，p = 0.02）、分娩时孕周（调整后比值比0.8[0.65−1.00]，p = 0.047）和未使用硬膜外镇痛（调整后比值比4.5[1.01−20.16]，p = 0.049）均与TOLAC失败显著相关。结论：在所调查的接受TOLAC的双胎妊娠女性人群中，使用硬膜外镇痛、使用缩宫素以及进入产房时宫颈扩张程度增加与较高的阴道分娩率相关，并且可能降低再次剖宫产的风险。
