在埃塞俄比亚西北部的三级医院中，有过一次横向剖宫产史的妇女再次剖宫产试产成功的预测因素：一项多中心研究。
Predictors of successful trial of labor after cesarean section (TOLAC) in women with one prior transverse cesarean section at Tertiary Hospitals in northwest Ethiopia: a multicenter study.
机构信息
Department of Midwifery, Debremarkos Referral Hospital, Debremarkos, Ethiopia.
Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
出版信息
BMC Pregnancy Childbirth. 2024 Apr 5;24(1):240. doi: 10.1186/s12884-024-06432-z.
BACKGROUND
Trials of labor after cesarean section is the preferred strategy to decrease the cesarean delivery rate and reducing complications associated with multiple cesarean sections. The success rate of trials of labor after cesarean section and associated factors have not been well documented in Ethiopia. Hence, this study was aimed to determine the success rate and factors associated with the trial of labor after one cesarean section in five Comprehensive Specialized Hospitals located in northwest Ethiopia.
METHODS
An institutional-based cross-sectional study was conducted among 437 women who came for the trial of labor from December 1, 2021, to March 30, 2022. All women who fulfilled the eligibility criteria were included to this study. Data was collected using structured and pre-tested questionnaire. Then, the data was entered into Epi Data 4.6 software and exported to SPSS version 26 for analysis. To identify the variables influencing the outcome variable, bivariable and multivariable logistic regression analyses were conducted. The model's fitness was checked using the Hosmer-Lemeshow goodness of fit test, and an adjusted odds ratio with a 95% confidence interval was used to declare the predictors that are significantly associated with TOLAC.
RESULTS
The success rate of the trial of labor after one cesarean section was 56.3% (95% CI, 51.3%, 61.2%). Maternal age ≥ 35 years (AOR: 3.3, 95% CI 1.2, 9.3), the fetal station at admission ≤ zero (AOR: 5. 6, 95% CI 3.3, 9.5), vaginal delivery before cesarean section (AOR: 1.9, 95% CI 1.2, 3.2), and successful vaginal birth after cesarean delivery (AOR 2.2, 95% CI 1.2, 4.1) were found to have a significant association with the success rate of trial of labor after cesarean section.
CONCLUSIONS
In this study, the success rate of the trial of labor after a cesarean section was low as compared to the ACOG guideline and other studies in different countries. Therefore, the clinicians ought to offer counsel during antenatal and intrapartum period, encourage the women to make informed decision on the mode of delivery, and the practitioners need to follow fetal and maternal conditions strictly to minimize adverse birth outcomes.
背景
剖宫产术后试产是降低剖宫产率和减少多次剖宫产相关并发症的首选策略。剖宫产术后试产的成功率及其相关因素在埃塞俄比亚尚未得到很好的记录。因此，本研究旨在确定位于埃塞俄比亚西北部的五家综合专科医院中，与一次剖宫产术后试产相关的成功率及其相关因素。
方法
这是一项基于机构的横断面研究，研究对象为 2021 年 12 月 1 日至 2022 年 3 月 30 日期间来院进行剖宫产术后试产的 437 名妇女。所有符合入选标准的妇女均纳入本研究。使用结构化和预测试问卷收集数据。然后，将数据录入 EpiData 4.6 软件，并导出到 SPSS 版本 26 进行分析。为了确定影响因变量的变量，进行了单变量和多变量逻辑回归分析。使用 Hosmer-Lemeshow 拟合优度检验检查模型的拟合度，使用调整后的优势比（95%置信区间）来确定与 TOLAC 显著相关的预测因子。
结果
一次剖宫产术后试产的成功率为 56.3%（95%CI，51.3%，61.2%）。产妇年龄≥35 岁（AOR：3.3，95%CI 1.2，9.3）、入院时胎方位≤0 （AOR：5.6，95%CI 3.3，9.5）、剖宫产前阴道分娩（AOR：1.9，95%CI 1.2，3.2）和剖宫产术后成功阴道分娩（AOR 2.2，95%CI 1.2，4.1）与剖宫产术后试产成功率显著相关。
结论
与 ACOG 指南和其他国家的研究相比，本研究中剖宫产术后试产的成功率较低。因此，临床医生应该在产前和产时提供咨询，鼓励妇女就分娩方式做出知情决策，并且从业者需要严格监测胎儿和产妇的情况，以最大限度地减少不良分娩结局。
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