Department of Obstetrics and Gynecology, Foch Hospital, 92150, Suresnes, France.
Department of Clinical Research and Innovation, Foch Hospital, 92150, Suresnes, France.
BMC Pregnancy Childbirth. 2023 May 26;23(1):388. doi: 10.1186/s12884-023-05688-1.
Lower rates of successful trial of labor after cesarean (TOLAC) in association with fetal macrosomia were previously reported. This study aimed to compare TOLAC to elective caesarean delivery (CD) in women with estimated fetal weight large for gestational age (eLGA) and a prior CD. Primary outcome was to analyse the mode of delivery in case of TOLAC. Secondary outcome was to compare maternal and foetal morbidity.
We conducted a retrospective, descriptive, multicentric, cohort study in five maternity units between January and December 2020. Inclusion criteria were: women with a single prior CD and eLGA or neonatal weight > 90th percentile with singleton pregnancy and gestational age ≥ 37 weeks.
rate of vaginal delivery, maternal and fetal morbidity including: shoulder dystocia, neonatal hospitalization, fetal trauma, neonatal acidosis, uterine rupture, 3 and 4 perineal tears, post-partum hemorrhage, and a need for blood transfusion.
Four hundred forty women met inclusion criteria, including 235 (53.4%) eLGA. 170 (72.3%) had a TOLAC (study group) and 65 (27.7%) an elective CD (control). 117 (68.82%) TOLAC had a vaginal delivery. No significant differences were found between the two groups in the rates of: postpartum haemorrhage, transfusion, Apgar score, neonatal hospitalization, and foetal trauma. Cord lactate was higher in the case of TOLAC (3.2 vs 2.2, p < 0.001). Median fetal weight was 3815 g (3597-4085) vs. 3865 g (3659-4168): p = 0.068 in the study vs. controls group respectively.
TOLAC for eLGA fetuses is legitimate because there is no difference in maternal-fetal morbidity, and the CD rate is acceptable.
先前有报道称，胎儿巨大儿与剖宫产术后试产（TOLAC）成功率降低有关。本研究旨在比较估计胎儿体重过大（eLGA）且既往有剖宫产史的妇女行 TOLAC 与选择性剖宫产（CD）的效果。主要结局为分析 TOLAC 的分娩方式。次要结局为比较母婴发病率。
我们在 2020 年 1 月至 12 月期间在五家产科单位进行了一项回顾性、描述性、多中心队列研究。纳入标准为：单胎既往有剖宫产史且 eLGA 或新生儿体重>第 90 百分位数，单胎妊娠且孕龄≥37 周。
阴道分娩率、母婴发病率，包括肩难产、新生儿住院、胎儿创伤、胎儿酸中毒、子宫破裂、3 度和 4 度会阴裂伤、产后出血和需要输血。
440 名符合纳入标准的妇女，包括 235 名（53.4%）eLGA。170 名（72.3%）行 TOLAC（研究组），65 名（27.7%）行择期 CD（对照组）。117 名（68.82%）TOLAC 行阴道分娩。两组间产后出血、输血、Apgar 评分、新生儿住院和胎儿创伤发生率无显著差异。TOLAC 组脐带血乳酸水平较高（3.2 vs 2.2，p<0.001）。胎儿体重中位数分别为 3815g（3597-4085）和 3865g（3659-4168）：研究组与对照组相比，差异无统计学意义（p=0.068）。
对于 eLGA 胎儿，TOLAC 是合理的，因为母婴发病率无差异，且 CD 率可接受。
