Penso C
Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts.
Curr Opin Obstet Gynecol. 1994 Oct;6(5):417-25.
The increased number of women having a vaginal birth after a cesarean section can be attributed to changing physician trends. Women eligible for vaginal birth after cesarean section include those with previous low vertical incisions, multiple previous incisions and even unknown scars, regardless of the method of closure or previous indication. Limited data suggest that in carefully selected women a current twin gestation, breech presentation, or the presence of fetal macrosomia are not contraindications for a trial of labor, in the presence of a uterine scar. Changing trends in the management of labor may also contribute to an increase in successful trial of labor with the use of oxytocin for the induction or augmentation of labor, the administration of epidural anesthesia for pain relief, and the instillation of prostaglandin E2 gel for cervical ripening. External cephalic version and amnioinfusion may also be reasonable alternatives in appropriately selected cases. Despite the documented safety and success of vaginal birth after cesarean section, and the lack of increased morbidity of failed trial of labor, 50% of women who are eligible for vaginal birth after cesarean section will decline an attempt, even after extensive counseling and encouragement. Patient resistance, largely attributed to the fear and inconvenience of labor, is still a major deterrent to a further rise in vaginal birth after cesarean section rates.
剖宫产术后经阴道分娩的女性数量增加可归因于医生趋势的变化。符合剖宫产术后经阴道分娩条件的女性包括那些既往有低位纵切口、多次既往切口甚至不明瘢痕的女性，无论缝合方法或既往指征如何。有限的数据表明，在经过精心挑选的女性中，当前的双胎妊娠、臀位或巨大儿的存在，在有子宫瘢痕的情况下，并非试产的禁忌证。分娩管理趋势的变化也可能导致使用缩宫素引产或加强宫缩、给予硬膜外麻醉缓解疼痛以及滴注前列腺素E2凝胶促进宫颈成熟的试产成功率增加。在适当选择的病例中，外倒转术和羊膜腔灌注术也可能是合理的选择。尽管有文献证明剖宫产术后经阴道分娩的安全性和成功率，且试产失败的发病率没有增加，但50%符合剖宫产术后经阴道分娩条件的女性即使在经过广泛咨询和鼓励后仍会拒绝尝试。患者的抵触情绪，主要归因于对分娩的恐惧和不便，仍然是剖宫产术后经阴道分娩率进一步上升的主要阻碍。
