Kaplan B, Royburt M, Peled Y, Hirsch M, Hod M, Ovadia Y, Neri A
Department of Obstetrics and Gynecology, Beilinson Medical Center, Petah-Tikva, Israel.
Acta Obstet Gynecol Scand. 1994 Jul;73(6):473-5. doi: 10.3109/00016349409013434.
Up until the early seventies fear of uterine rupture led to the widespread practice of 'once a section, always a section'. Nowadays, there is a consistent trend toward vaginal birth after a prior cesarean delivery, making early detection of uterine scar dehiscence at delivery important. However, the need for routine transcervical revision of the uterine scar following vaginal delivery is controversial in the medical literature. The present study reviewed 467 women who underwent vaginal delivery following a previous cesarean section. In 414 patients the scar was examined transcervically, and not one case of dehiscence of the scar was detected. The patients included four with twin pregnancies, and four with breech presentations (two underwent external cephalic version). Intrauterine pressure was monitored in 17 cases; Prostaglandin E2 vaginal tablets were used in 46 patients, and in 14 cases labor was augmented by Pitocin. Our results suggest that routine revision of a uterine scar at the time of a subsequent vaginal delivery is usually unnecessary.
直到七十年代初，由于担心子宫破裂，“一次剖宫产，永远剖宫产”的做法广泛存在。如今，既往剖宫产术后经阴道分娩的趋势持续存在，因此在分娩时早期发现子宫瘢痕裂开很重要。然而，在医学文献中，阴道分娩后常规经宫颈修复子宫瘢痕的必要性存在争议。本研究回顾了467例既往剖宫产术后经阴道分娩的女性。在414例患者中经宫颈检查瘢痕，未发现一例瘢痕裂开。患者包括4例双胎妊娠和4例臀位（2例行外倒转术）。17例监测了宫内压力；46例患者使用了前列腺素E2阴道片，14例患者使用缩宫素加强宫缩。我们的结果表明，后续阴道分娩时常规修复子宫瘢痕通常没有必要。
