Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai Hospital, USA.
Division of Maternal-Fetal Medicine, Icahn School of Medicine at Mount Sinai Hospital, USA; Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai Hospital, USA.
Sex Reprod Healthc. 2024 Sep;41:101011. doi: 10.1016/j.srhc.2024.101011. Epub 2024 Jul 31.
Given the call to reduce rates of non-medically indicated cesarean deliveries (CDs) by encouraging trials of labor after cesarean (TOLAC), this study looks at social characteristics of patients choosing a TOLAC versus a scheduled repeat cesarean delivery (SRCD) to determine disparities regarding delivery method choice.
This was a retrospective cohort study of patients with a history of one CD between April 29, 2015-April 29, 2020. Patients were divided based on type of delivery chosen at admission. Chi-squared tests examined proportional differences between groups and logistic regression models examined odd ratios of choosing TOLAC versus SRCD according to socially dependent categories including race/ethnicity, health insurance, pre-pregnancy body mass index, and Social Vulnerability Index (SVI).
1,983 patients were included. Multivariable logistic regression models revealed that patients with a high SVI (reference: low/medium SVI) (AOR 2.0, CI: 1.5, 2.5), self-identified as Black/ African American (AOR: 2.4, CI: 1.6, 3.6) or Hispanic/Latina (AOR: 2.0, CI: 1.4, 2.8) (reference: White), had public insurance (reference: private insurance) (AOR: 3.7, CI: 2.8, 5.0), and who had an obese BMI (reference: non-obese BMI) were more likely to opt for a TOLAC rather than SRCD.
These findings demonstrate differences in delivery method preferences. Specifically, more disadvantaged patients are more likely to choose TOLAC, suggesting that social and economic factors may play a role in delivery preferences. These findings have implications for improving individualized counselling and engaging in shared decision-making around mode of delivery.
鉴于鼓励剖宫产后试产（TOLAC）以降低无医学指征剖宫产率的呼声，本研究着眼于选择 TOLAC 与计划性再次剖宫产（SRCD）的患者的社会特征，以确定分娩方式选择方面的差异。
这是一项回顾性队列研究，纳入了 2015 年 4 月 29 日至 2020 年 4 月 29 日期间有一次剖宫产史的患者。根据入院时选择的分娩方式将患者分为两组。卡方检验用于检验组间比例差异，逻辑回归模型用于根据包括种族/族裔、医疗保险、孕前体重指数和社会脆弱性指数（SVI）等社会相关类别，检验选择 TOLAC 与 SRCD 的比值比。
共纳入 1983 名患者。多变量逻辑回归模型显示，SVI 较高的患者（参考：低/中 SVI）（AOR 2.0，95%CI：1.5，2.5）、自认为是非裔/非裔美国人（AOR：2.4，95%CI：1.6，3.6）或西班牙裔/拉丁裔（AOR：2.0，95%CI：1.4，2.8）（参考：白人）、拥有公共保险（参考：私人保险）（AOR：3.7，95%CI：2.8，5.0）和肥胖 BMI（参考：非肥胖 BMI）的患者更倾向于选择 TOLAC 而不是 SRCD。
这些发现表明了分娩方式偏好的差异。具体而言，处于不利地位的患者更有可能选择 TOLAC，这表明社会和经济因素可能在分娩偏好中起作用。这些发现对改善个体化咨询和围绕分娩方式进行共同决策具有重要意义。
