McMahon M J, Luther E R, Bowes W A, Olshan A F
Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina, Chapel Hill 27599-7570, USA.
N Engl J Med. 1996 Sep 5;335(10):689-95. doi: 10.1056/NEJM199609053351001.
In an attempt to reduce the rate of cesarean section, obstetricians now offer a trial of labor to pregnant women who have had a previous cesarean section. Although a trial of labor is usually successful and is relatively safe, few studies have directly addressed the maternal and perinatal morbidity and mortality associated with this method of delivery.
We performed a population-based, longitudinal study of 6138 women in Nova Scotia who had previously undergone cesarean section and had delivered a singleton live infant in the period from 1986 through 1992.
A total of 3249 women elected a trial of labor, and 2889 women chose to undergo a second cesarean section. There were no maternal deaths. The overall rate of maternal morbidity was 8.1 percent; 1.3 percent had major complications (a need for hysterectomy, uterine rupture, or operative injury) and 6.9 percent had minor complications (puerperal fever, a need for blood transfusion, or abdominal-wound infection). Although the overall rate of maternal complications did not differ significantly between women who chose a trial of labor and the women who elected cesarean section (odds ratio for the trial-of-labor group, 0.9; 95 percent confidence interval, 0.8 to 1.1), major complications were nearly twice as likely among women undergoing a trial of labor (odds ratio, 1.8; 95 percent confidence interval, 1.1 to 3.0). Apgar scores, admission to the neonatal intensive care unit, and perinatal mortality were similar among the infants whose mothers had a trial of labor and those whose mothers underwent elective cesarean section.
Among pregnant women who have had a cesarean section, major maternal complications are almost twice as likely among those whose deliveries are managed with a trial of labor as among those who undergo an elective second cesarean section.
为降低剖宫产率，产科医生现向曾行剖宫产的孕妇提供试产机会。尽管试产通常成功且相对安全，但很少有研究直接探讨这种分娩方式相关的孕产妇及围产儿发病率和死亡率。
我们对新斯科舍省6138名曾行剖宫产且在1986年至1992年期间分娩单胎活婴的妇女进行了一项基于人群的纵向研究。
共有3249名妇女选择试产，2889名妇女选择再次剖宫产。无孕产妇死亡。孕产妇总体发病率为8.1%；1.3%发生严重并发症（需要行子宫切除术、子宫破裂或手术损伤），6.9%发生轻微并发症（产褥热、需要输血或腹部伤口感染）。尽管选择试产的妇女与选择剖宫产的妇女之间孕产妇并发症的总体发生率无显著差异（试产组优势比为0.9；95%置信区间为0.8至1.1），但试产妇女发生严重并发症的可能性几乎是剖宫产妇女的两倍（优势比为1.8；95%置信区间为1.1至3.0）。母亲接受试产的婴儿与母亲接受择期剖宫产的婴儿在阿氏评分、入住新生儿重症监护病房情况及围产儿死亡率方面相似。
在曾行剖宫产的孕妇中，经试产分娩的孕妇发生严重孕产妇并发症的可能性几乎是接受择期再次剖宫产孕妇的两倍。
