关于剖宫产后阴道分娩的母体并发症的多中心研究

• 作 者: Macones G.A. Peipert J. Nelson D.B. 高雪莲
• 机 构: 2000 Courtyard Building 3400 Spruce St Philadelphia PA 19104 United States Dr.,
• 出 处: 世界核心医学期刊文摘(妇产科学分册)
• 发表日期: 2006年03期
• 关键词: 母体并发症 阴道分娩 子宫破裂 分娩史 引产药物 前列腺素 病例对照研究 研究设计

Objective: This study was undertaken to determine incidence and risk factors for uterine rupture in women attempting vaginal birth after cesarean delivery (VBAC) in a wide range of hospital settings. Study design: We performed a case-control study nested within a cohort of women who have had a prior cesarean to determine the incidence and risk factors for uterine rupture in women attempting VBAC. Results: The incidence rate of uterine rupture in those who attempt VBAC was 9.8 per 1000. A prior vaginal delivery was associated with a lower risk of uterine rupture (adjusted odds ratio OR = 0.40, 95%CI 0.20-0.81). Although prostaglandins alone were not associated with uterine rupture, sequential use of prostaglandin and pitocin was associated with uterine rupture (adjusted OR = 3.07, 95%CI 0.98-9.88). Conclusion: Women with a prior cesarean should be offered VBAC, and women with a prior cesarean and prior vaginal delivery should be encouraged to VBAC. Although other studies have suggested that prostaglandins should be avoided, we suggest that inductions requiring sequential agents be avoided.

Objective: This study was undertaken to determine incidence and risk factors for uterine rupture in women attempting vaginal birth after cesarean delivery (VBAC) in a wide range of hospital settings. Study design: We performed a case-control study nested within a cohort of women who had had a prior cesarean to determine the incidence and risk factors for uterine rupture in women attempting VBAC. Results: The incidence rate of uterine rupture in those who attempt VBAC was 9.8 per 1000. A prior vaginal delivery was associated with a lower risk of Uterine rupture (adjusted odds ratio OR = 0.40, 95% CI 0.20-0.81). Although prostaglandins alone were not associated with uterine rupture, sequential use of prostaglandin and pitocin was associated with uterine rupture (adjusted OR = 3.07, 95% CI 0.98- 9.88). Conclusion: Women with a prior cesarean should be offered VBAC, and women with a prior cesarean and prior vaginal delivery should be encouraged to VBAC. that prostaglandins should be avoided, we suggest that inductions require sequential agents be avoided.