Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Gynecol Obstet Hum Reprod. 2022 Dec;51(10):102494. doi: 10.1016/j.jogoh.2022.102494. Epub 2022 Oct 26.
Although ultrasonographic estimation of fetal weight ≥90th percentile is not associated with a greater risk for uterine rupture, trial of labor after cesarean delivery (TOLAC) is considered relatively contraindicated for macrosomic fetuses. Hence, when an estimated fetal weight of 4000 g is detected, TOLAC is usually avoided.Our aim was to evaluate the obstetrical outcome and safety of TOLAC in women with estimated large for gestational age fetuses (eLGA) (≥90th percentile).
Our retrospective cohort study encompassed all pregnant women with an estimated fetal weight ≥90th percentile for gestational age, admitted to a single tertiary care center between January 2012-July 2017 for TOLAC.
1949 women met the inclusion criteria; 78 (4%) eLGA and 1871 (96%) controls. Fifty-five (70.5%) women in the study group had experienced a successful vaginal delivery compared to 1506 (80.5%) of the controls (p = 0.03). The rate of obstetrical complications, including scar dehiscence, uterine rupture, a 3rd/4th degree perineal tear or shoulder dystocia were comparable. The rate of post-partum hemorrhage (PPH) increased in the study group compared to the controls (7.7 % vs.1.7%; p = 0.001).
TOLAC for eLGA fetuses can be considered safe, however, lower successful rates of vaginal births after a cesarean delivery and an increased PPH rate, may be expected.
尽管超声估计胎儿体重≥第 90 百分位与子宫破裂风险增加无关，但对于巨大胎儿，剖宫产术后试产（TOLAC）被认为相对禁忌。因此，当检测到估计胎儿体重为 4000 克时，通常避免 TOLAC。我们的目的是评估估计胎儿体重过大（eLGA）（≥第 90 百分位）孕妇 TOLAC 的产科结局和安全性。
我们的回顾性队列研究包括 2012 年 1 月至 2017 年 7 月期间在一家三级保健中心因 TOLAC 入院的所有估计胎儿体重≥胎龄第 90 百分位的孕妇。
1949 名符合纳入标准的妇女中，78 名（4%）为 eLGA，1871 名（96%）为对照组。研究组中有 55 名（70.5%）女性成功阴道分娩，而对照组中有 1506 名（80.5%）（p=0.03）。包括瘢痕破裂、子宫破裂、三度/四度会阴撕裂或肩难产在内的产科并发症发生率相似。与对照组相比，研究组产后出血（PPH）的发生率增加（7.7% vs. 1.7%；p=0.001）。
对于 eLGA 胎儿，TOLAC 可被认为是安全的，然而，剖宫产术后阴道分娩的成功率较低和 PPH 发生率增加可能是预料之中的。
