Weinstein D, Benshushan A, Tanos V, Zilberstein R, Rojansky N
Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
Am J Obstet Gynecol. 1996 Jan;174(1 Pt 1):192-8. doi: 10.1016/s0002-9378(96)70393-9.
Our purpose was to evaluate the relative weight of the different variables that may influence the chances of vaginal birth after one cesarean delivery, with the aim of developing a predictive score for success of such a trial.
In this retrospective study, which covered a 10-year period (1981 to 1990), 471 women who attempted vaginal birth at a level III university hospital after one abdominal delivery were studied as to the subsequent delivery outcome. An attempt to identify possible prognostic factors for success of such a trial was made.
A trial of labor was successful in 368 (78.1%) of women and 103 (21.9%) had a repeat cesarean section. Variables of significant predictive value were vaginal birth before cesarean section (odds ratio 1.8), malpresentation (odds ratio 1.9), pregnancy-induced hypertension (odds ratio 2.3), and Bishop score > or = 4 (odds ratio 6.0). Cephalopelvic disproportion and failure to progress did not demonstrate a significant predictive value (odds ratio 0.81) for success or failure in subsequent delivery. In fact, 63.8% of women with this indication have successfully undergone vaginal delivery. Maternal age (odds ratio 0.9) had no bearing on vaginal delivery success rates, whereas both macrosomia (odds ratio 0.2) and intrauterine growth retardation tended to decrease the chances for vaginal birth after cesarean section.
A trial of labor after one cesarean section should be encouraged in most women who are willing to attempt it, provided no obstetric contraindication exists. A scoring system that may help to identify women with a greater chance for vaginal delivery is proposed.
我们的目的是评估可能影响剖宫产术后阴道分娩几率的不同变量的相对权重，旨在制定此类试验成功的预测评分。
在这项为期10年（1981年至1990年）的回顾性研究中，对471名在三级大学医院经一次剖宫产术后尝试阴道分娩的妇女的后续分娩结局进行了研究。试图确定此类试验成功的可能预后因素。
368名（78.1%）妇女的试产成功，103名（21.9%）进行了再次剖宫产。具有显著预测价值的变量为剖宫产术前阴道分娩（比值比1.8）、胎位异常（比值比1.9）、妊娠高血压（比值比2.3）以及Bishop评分≥4（比值比6.0）。头盆不称和产程无进展对后续分娩成功或失败未显示出显著预测价值（比值比0.81）。事实上，有此指征的妇女中有63.8%成功进行了阴道分娩。产妇年龄（比值比0.9）与阴道分娩成功率无关，而巨大儿（比值比0.2）和胎儿宫内生长受限均倾向于降低剖宫产术后阴道分娩的几率。
对于大多数愿意尝试的妇女，在无产科禁忌证的情况下，应鼓励进行一次剖宫产术后的试产。提出了一种有助于识别阴道分娩几率较大的妇女的评分系统。
