Amikam Uri, Hochberg Alyssa, Segal Roy, Abramov Shani, Lavie Anat, Yogev Yariv, Hiersch Liran
Lis Hospital for Women, Sourasky Medical Center, Tel Aviv, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Int J Gynaecol Obstet. 2024 Apr;165(1):237-243. doi: 10.1002/ijgo.15178. Epub 2023 Oct 11.
To determine perinatal outcomes following uterine rupture during a trial of labor after one previous cesarean delivery (CD) at term.
A retrospective single-center study examining perinatal outcomes in women with term singleton pregnancies with one prior CD, who underwent a trial of labor after cesarean (TOLAC) and were diagnosed with uterine rupture, between 2011 and 2022. The primary outcome was a composite maternal outcome, and the secondary outcome was a composite neonatal outcome. Additionally, we compared perinatal outcomes between patients receiving oxytocin during labor with those who did not.
Overall, 6873 women attempted a TOLAC, and 116 were diagnosed with uterine rupture. Among them, 63 (54.3%) met the inclusion criteria, and 18 (28%) had the maternal composite outcome, with no cases of maternal death. Sixteen cases (25.4%) had the composite neonatal outcome, with one case (1.6%) of perinatal death. No differences were noted between women receiving oxytocin and those not receiving oxytocin in the rates of maternal composite (35.7% vs 26.5%, P = 0.502, respectively) or neonatal composite outcomes (21.4% vs 26.5%, P = 0.699).
Uterine rupture during a TOLAC entails increased risk for myriad adverse outcomes for the mother and neonate, though possibly more favorable than previously described. Oxytocin use does not affect these risks.
确定既往足月剖宫产术后阴道试产期间子宫破裂后的围产期结局。
一项回顾性单中心研究，调查2011年至2022年间既往有一次剖宫产史、足月单胎妊娠且接受剖宫产术后阴道试产并被诊断为子宫破裂的妇女的围产期结局。主要结局是综合产妇结局，次要结局是综合新生儿结局。此外，我们比较了分娩期间使用缩宫素的患者与未使用缩宫素的患者的围产期结局。
总体而言，6873名妇女尝试进行剖宫产术后阴道试产，116名被诊断为子宫破裂。其中，63名（54.3%）符合纳入标准，18名（28%）出现综合产妇结局，无产妇死亡病例。16例（25.4%）出现综合新生儿结局，1例（1.6%）围产期死亡。使用缩宫素的妇女与未使用缩宫素的妇女在综合产妇结局发生率（分别为35.7%和26.5%，P = 0.502）或综合新生儿结局发生率（分别为21.4%和26.5%，P = 0.699）方面未发现差异。
剖宫产术后阴道试产期间子宫破裂会增加母亲和新生儿出现多种不良结局的风险，尽管可能比先前描述的更有利。使用缩宫素不会影响这些风险。
