在全球妇女和儿童健康研究网络选定的南亚和拉丁美洲地区，剖宫产术后经阴道分娩与再次剖宫产的产妇及围产期结局比较
Maternal and perinatal outcomes of women with vaginal birth after cesarean section compared to repeat cesarean birth in select South Asian and Latin American settings of the global network for women's and children's health research.
作者信息
Figueroa Lester, Harrison Margo, Mazariegos Manolo, Goudar Shivaprasad, Kavi Avinash, Derman Richard, Patel Archana, Das Prabir, Hibberd Patricia L, Saleem Sarah, Naqvi Farnaz, Goldenberg Robert L, Haque Rashidul, Billah Sk Masum, Petri William A, McClure Elizabeth M, Tan Sylvia, Krebs Nancy F
机构信息
Instituto de Nutrición de Centroamérica y Panamá -INCAP, Calzada Roosevelt 6-25 zona 11, C.A, Guatemala City, Guatemala.
University of Colorado School of Medicine, Denver, CO, USA.
出版信息
Matern Health Neonatol Perinatol. 2023 Nov 1;9(1):13. doi: 10.1186/s40748-023-00169-x.
OBJECTIVE
Our objective was to analyze a prospective population-based registry including five sites in four low- and middle-income countries to observe characteristics associated with vaginal birth after cesarean versus repeat cesarean birth, as well as maternal and newborn outcomes associated with the mode of birth among women with a history of prior cesarean.
HYPOTHESIS
Maternal and perinatal outcomes among vaginal birth after cesarean section will be similar to those among recurrent cesarean birth.
METHODS
A prospective population-based study, including home and facility births among women enrolled from 2017 to 2020, was performed in communities in Guatemala, India (Belagavi and Nagpur), Pakistan, and Bangladesh. Women were enrolled during pregnancy, and delivery outcome data were collected within 42 days after birth.
RESULTS
We analyzed 8267 women with a history of prior cesarean birth; 1389 (16.8%) experienced vaginal birth after cesarean, and 6878 (83.2%) delivered by a repeat cesarean birth. Having a repeat cesarean birth was negatively associated with a need for curettage (ARR 0.12 [0.06, 0.25]) but was positively associated with having a blood transfusion (ARR 3.74 [2.48, 5.63]). Having a repeat cesarean birth was negatively associated with stillbirth (ARR 0.24 [0.15, 0.49]) and, breast-feeding within an hour of birth (ARR 0.39 [0.30, 0.50]), but positively associated with use of antibiotics (ARR 1.51 [1.20, 1.91]).
CONCLUSIONS
In select South Asian and Latin American low- and middle-income sites, women with a history of prior cesarean birth were 5 times more likely to deliver by cesarean birth in the hospital setting. Those who delivered vaginally had less complicated pregnancy and labor courses compared to those who delivered by repeat cesarean birth, but they had an increased risk of stillbirth. More large scale studies are needed in Low Income Country settings to give stronger recommendations.
TRIAL REGISTRATION
NCT01073475, Registered February 21, 2010, https://clinicaltrials.gov/ct2/show/record/NCT01073475 .
目的
我们的目的是分析一项基于人群的前瞻性登记研究，该研究涵盖四个低收入和中等收入国家的五个地点，以观察剖宫产术后阴道分娩与再次剖宫产相关的特征，以及既往有剖宫产史的女性分娩方式相关的母婴结局。
假设
剖宫产术后阴道分娩的母婴围产期结局将与再次剖宫产的结局相似。
方法
在危地马拉、印度（贝拉加维市和那格浦尔市）、巴基斯坦和孟加拉国的社区开展了一项基于人群的前瞻性研究，纳入了2017年至2020年登记的在家分娩和机构分娩的女性。女性在孕期登记入组，并在产后42天内收集分娩结局数据。
结果
我们分析了8267例既往有剖宫产史的女性；其中1389例（16.8%）经历了剖宫产术后阴道分娩，6878例（83.2%）通过再次剖宫产分娩。再次剖宫产与刮宫需求呈负相关（归因风险比0.12 [0.06, 0.25]），但与输血呈正相关（归因风险比3.74 [2.48, 5.63]）。再次剖宫产与死产（归因风险比0.24 [0.15, 0.49]）以及出生后一小时内母乳喂养（归因风险比0.39 [0.30, 0.50]）呈负相关，但与使用抗生素呈正相关（归因风险比1.51 [1.20, 1.91]）。
结论
在选定的南亚和拉丁美洲低收入和中等收入地区，既往有剖宫产史的女性在医院环境中进行剖宫产分娩的可能性高出5倍。与再次剖宫产分娩的女性相比，阴道分娩的女性孕期和产程并发症较少，但死产风险增加。在低收入国家环境中需要开展更多大规模研究，以给出更有力的建议。
试验注册
NCT01073475，2010年2月21日注册，https://clinicaltrials.gov/ct2/show/record/NCT01073475 。
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