Saldana L R, Schulman H, Reuss L
Am J Obstet Gynecol. 1979 Nov 1;135(5):555-61. doi: 10.1016/s0002-9378(16)32976-3.
Management of 226 patients with previous low transverse cesarean section in a special obstetric clinic for high-risk pregnancies significantly and safely reduced the incidence of purely elective cesarean section to less than 10%. A substantial incidence (25%) of other high-risk factors dictating antepartum indicated cesarean section were found in this population. There was 38.5% incidence of vaginal delivery in 145 patients who underwent a trial of labor. Patients delivered vaginally followed a normal labor curve up to full dilatation. Oxytocin was required in three cases of prolonged second stage of labor and resulted in instrumental vaginal delivery in all instances. There were no uterine ruptures on vaginal exploration after delivery or at the time of repeat cesarean section during labor. There was no maternal death or perinatal loss. No justification for the present clinical practice of a 99% inicidence of elective repeat cesarean section could be found. Substantial savings in hospital cost, as well as a decreased number of diagnostic tests for the otherwise normal gravid woman, can be safely achieved.
在一家高危妊娠专科产科诊所对226例曾行低位横切口剖宫产的患者进行管理，显著且安全地将单纯选择性剖宫产的发生率降低至10%以下。在该人群中发现了大量（25%）决定产前剖宫产的其他高危因素。在145例接受引产试验的患者中，阴道分娩发生率为38.5%。经阴道分娩的患者直至宫口完全扩张均遵循正常产程曲线。3例第二产程延长患者需要使用缩宫素，所有病例均通过器械助产经阴道分娩。产后阴道检查或分娩期间再次剖宫产时均未发现子宫破裂。无孕产妇死亡或围产儿丢失情况。未发现目前99%选择性再次剖宫产临床实践的合理性依据。可以安全地实现医院成本的大幅节省，以及减少对其他情况正常孕妇的诊断检查次数。
