Hoskins I A, Gomez J L
Department of Obstetrics and Gynecology, New York University Medical Center, New York, New York 10016, USA.
Obstet Gynecol. 1997 Apr;89(4):591-3. doi: 10.1016/s0029-7844(97)00046-x.
To determine whether the extent of cervical dilatation at cesarean delivery affects the subsequent vaginal birth after cesarean (VBAC) rate.
Relevant records of the index pregnancy (group I) were reviewed for cervical dilatation at cesarean delivery, oxytocin use, indication, neonatal weight, and epidural use. The records of the subsequent pregnancy (group II) were reviewed for successful VBAC rates, neonatal weight, oxytocin, and epidural use.
There were 1917 patients in the study. The indications for cesarean in group I were malpresentation (5.1%), fetal distress (14.9%), and arrest disorders (80%). In group II, the VBAC success rates were 73% for previous malpresentation and 68% for previous fetal distress. In those with previous cesarean deliveries for arrest disorders with cervical dilatation at 5 cm or less, the VBAC success rate was 67%. It was 73% for 6-9 cm dilatation and 13% for the fully dilated group (P < .05).
Patients who attempt a VBAC may be counseled that a cesarean delivery at full dilatation is associated with a reduced chance of a subsequent successful VBAC.
确定剖宫产时宫颈扩张程度是否会影响后续剖宫产术后阴道分娩（VBAC）率。
回顾索引妊娠（I组）的相关记录，包括剖宫产时的宫颈扩张情况、催产素使用情况、指征、新生儿体重和硬膜外使用情况。回顾后续妊娠（II组）的记录，包括成功VBAC率、新生儿体重、催产素和硬膜外使用情况。
本研究共有1917例患者。I组剖宫产的指征包括胎位异常（5.1%）、胎儿窘迫（14.9%）和产程停滞（80%）。在II组中，既往胎位异常患者的VBAC成功率为73%，既往胎儿窘迫患者的VBAC成功率为68%。对于既往因产程停滞行剖宫产且宫颈扩张5cm及以下的患者，VBAC成功率为67%。宫颈扩张6 - 9cm时成功率为73%，宫颈完全扩张组的成功率为13%（P <.05）。
对于尝试VBAC的患者，可告知其宫颈完全扩张时进行剖宫产会降低后续VBAC成功的几率。
