剖宫产术后阴道分娩与首次阴道分娩的产科肛门括约肌损伤风险指标比较。
Risk indicators for obstetrical anal sphincter injury in vaginal birth after caesarean section compared to first vaginal delivery.
机构信息
Department of Obstetrics and Gynaecology, Amphia Hospital Breda, The Netherlands.
Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands; Amsterdam Public Health, Amsterdam, The Netherlands; Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands.
出版信息
Eur J Obstet Gynecol Reprod Biol. 2023 Sep;288:198-203. doi: 10.1016/j.ejogrb.2023.07.019. Epub 2023 Jul 29.
OBJECTIVES
Comparison of the rate of obstetric anal sphincter injury (OASI) between women having their first vaginal birth after caesarean section (CS) and true nulliparous women with a vaginal delivery. Assessment of risk indicators for OASI in women with vaginal birth after one CS (VBAC).
STUDY DESIGN
28 535 women with their first VBAC and a cohort of 275 439 nulliparous women with a vaginal delivery of a liveborn infant in a cephalic position from the Dutch perinatal registry were analyzed. We compared the OASI rate with univariate and multivariate analysis. In women with VBAC possible risk indicators for OASI were assessed using univariate and multivariate logistic regression analysis.
RESULTS
The rate of OASI was 5.2% in women with vaginal birth after CS and 4.0% in women with a first vaginal delivery. The adjusted OR (aOR) for vaginal birth after an elective CS was higher (aOR 1.34, 95% CI 1.23-1.47) compared to vaginal birth after an emergency CS (aOR 1.16, 95% CI 1.08-1.25). In women with vaginal birth after emergency CS, the aOR for the indication non-progressive labor was 1.18 (95% CI 1.08-1.29), whereas CS for suspected fetal distress was not significantly associated with obstetric anal sphincter injury in VBAC. In the 28 535 women with a VBAC, mediolateral episiotomy (MLE), birth weight < 3000 g and maternal age < 25 years were associated with a significantly lower rate of OASI. A gestational age of 42 weeks, birth weight ≥ 3500 g, operative vaginal delivery and duration of the 2nd stage of labour of ≥ 60 min were associated with a significantly higher rate of OASI.
CONCLUSIONS
Women with a VBAC have a higher rate of OASI in comparison with women with a first vaginal delivery, with the exception of women with a vaginal birth after an emergency CS for suspected fetal distress. Factors associated with a significantly lower rate for OASI were MLE, maternal age < 25 and birth weight < 3000 g. A gestational age of 42 weeks, birth weight between 3500 and 4000 g and ≥ 4000 g, operative vaginal delivery and duration of the 2nd stage of delivery longer dan 60 min were associated with a significantly higher rate of OASI.
目的
比较剖宫产后首次阴道分娩（VBAC）产妇与初产妇阴道分娩的产科肛门括约肌损伤（OASI）发生率。评估 VBAC 中一次剖宫产（CS）后阴道分娩（VBAC）妇女发生 OASI 的风险指标。
研究设计
对荷兰围产期登记处的 28535 名首次 VBAC 产妇和 275439 名初产妇阴道分娩头位活产儿的队列进行分析。我们采用单变量和多变量分析比较 OASI 发生率。在 VBAC 产妇中，采用单变量和多变量逻辑回归分析评估 OASI 的可能风险指标。
结果
CS 后阴道分娩 OASI 发生率为 5.2%，初产妇阴道分娩 OASI 发生率为 4.0%。选择性 CS 后阴道分娩的调整比值比（aOR）高于紧急 CS 后阴道分娩（aOR 1.34，95%CI 1.23-1.47）。在紧急 CS 后阴道分娩的产妇中，非进展性产程的 aOR 为 1.18（95%CI 1.08-1.29），而因胎儿窘迫行 CS 与 VBAC 中的产科肛门括约肌损伤无显著相关性。在 28535 名 VBAC 产妇中，会阴正中切开术（MLE）、出生体重<3000g 和产妇年龄<25 岁与 OASI 发生率显著降低相关。42 周妊娠、出生体重≥3500g、阴道助产和第二产程≥60min 与 OASI 发生率显著升高相关。
结论
与初产妇阴道分娩相比，VBAC 产妇 OASI 发生率更高，除外因疑似胎儿窘迫行紧急 CS 后的产妇。与 OASI 发生率显著降低相关的因素为 MLE、产妇年龄<25 岁和出生体重<3000g。42 周妊娠、出生体重 3500-4000g 及≥4000g、阴道助产和第二产程>60min 与 OASI 发生率显著升高相关。
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