Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, 12 Bayit Street, 91031, Jerusalem, Israel.
Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel.
Arch Gynecol Obstet. 2024 Nov;310(5):2469-2476. doi: 10.1007/s00404-024-07742-5. Epub 2024 Sep 21.
This study aimed to assess maternal and neonatal outcomes in patients with polyhydramnios attempting trial of labor after cesarean (TOLAC) compared to those undergoing planned repeat cesarean delivery (PRCD).
A multi-center retrospective cohort study was conducted and included women with term singleton viable pregnancies following a single low-segment transverse cesarean delivery (CD) with a polyhydramnios diagnosis (maximal vertical pocket > 8 cm and/or Amniotic Fluid Index > 24 cm) within 14 days before birth who delivered between the years 2017 and 2021. Maternal and neonatal outcomes were compared between those attempting TOLAC and those opting for PRCD. The primary outcome was composite adverse maternal. Univariate analysis was followed by multivariate analysis to control for potential confounders.
Out of 358 included births with a previous CD, 208 (58.1%) attempted TOLAC, while 150 had PRCD (41.9%). The successful vaginal birth after cesarean (VBAC) rate was 82.2%, and no cases of uterine rupture, hysterectomy, or maternal intensive care unit admission occurred in either group. After controlling for potential confounders, no independent association between TOLAC and composite adverse maternal (adjusted odds ratio [aOR] 0.62, 95% confidence interval [CI] 0.32-1.20, p = 0.16) and neonatal (aOR 0.89, 95% CI 0.51-1.53, p = 0.67) adverse outcomes was demonstrated.
In patients with a term diagnosed polyhydramnios, TOLAC appears to be a reasonable alternative associated with favorable outcomes. Larger prospective studies are needed to refine management strategies and enhance maternal and neonatal outcomes in this context.
本研究旨在评估与计划性再次剖宫产（PRCD）相比，在剖宫产术后尝试经阴道分娩（TOLAC）的羊水过多患者的母婴结局。
进行了一项多中心回顾性队列研究，纳入了 2017 年至 2021 年期间分娩的、足月单胎活产、既往有低位子宫下段剖宫产史且在分娩前 14 天内诊断为羊水过多（最大垂直囊腔>8cm 和/或羊水指数>24cm）的患者。比较了尝试 TOLAC 与选择 PRCD 的患者的母婴结局。主要结局为复合不良母体结局。首先进行单因素分析，然后进行多因素分析以控制潜在混杂因素。
在 358 例既往有剖宫产史的分娩中，208 例（58.1%）尝试了 TOLAC，150 例进行了 PRCD（41.9%）。剖宫产术后阴道分娩（VBAC）成功率为 82.2%，两组均未发生子宫破裂、子宫切除术或产妇入住重症监护病房。在控制潜在混杂因素后，TOLAC 与复合不良母体结局（调整后比值比[aOR]0.62，95%置信区间[CI]0.32-1.20，p=0.16）和新生儿不良结局（aOR 0.89，95%CI 0.51-1.53，p=0.67）之间无独立关联。
在诊断为足月羊水过多的患者中，TOLAC 似乎是一种合理的替代方案，与良好的结局相关。需要更大规模的前瞻性研究来完善该情况下的管理策略，以提高母婴结局。
