Kline J, Arias F
Department of Obstetrics and Gynecology, St. John's Mercy Medical Center, St. Louis, Missouri.
J Reprod Med. 1993 Apr;38(4):289-92.
We investigated the motivation behind procedures in 241 patients with prior cesarean births; 120 had elective repeat cesarean sections and 121 had vaginal birth after cesarean section (VBAC). Patients were of similar age, gravity and parity, but significantly more patients in the repeat cesarean group had their initial surgery because of failure to progress in labor; significantly more patients in the VBAC group had their initial cesarean section because of fetal distress. The main factors behind the decision to attempt VBAC were patient's desire (81.0%), patient's desire and physician's advice (12.4%) and physician's advice (6.6%). The main factors behind the decision to have repeat cesarean sections were medical or obstetric indication (45.8%), patient's desire (31.6%), patient's desire and physician's advice (9.1%) and physician's advice (13.3%). We conclude that it will be difficult to substantially decrease the present rate of repeat cesarean births, and that preventive efforts should be directed toward decreasing the incidence of primary cesarean deliveries.
我们调查了241例有剖宫产史患者手术背后的动机；其中120例行择期再次剖宫产，121例行剖宫产术后阴道分娩（VBAC）。患者年龄、孕次和产次相似，但再次剖宫产组中因产程进展不顺而首次手术的患者明显更多；VBAC组中因胎儿窘迫而首次剖宫产的患者明显更多。决定尝试VBAC的主要因素是患者意愿（81.0%）、患者意愿和医生建议（12.4%）以及医生建议（6.6%）。决定行再次剖宫产的主要因素是医学或产科指征（45.8%）、患者意愿（31.6%）、患者意愿和医生建议（9.1%）以及医生建议（13.3%）。我们得出结论，大幅降低当前再次剖宫产率将很困难，预防措施应致力于降低初次剖宫产的发生率。
