Vaginal birth after caesarean section: a cohort study investigating factors associated with its uptake and success
Vaginal birth after caesarean section: a cohort study investigating factors associated with its uptake and success
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DOI：
10.1111/1471-0528.12508
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发表时间：
2014-01-01
影响因子：
5.8
通讯作者：
Cromwell, D. A.
中科院分区：
文献类型：
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作者：
Knight, H. E.;Gurol-Urganci, I.;Cromwell, D. A.
目的探讨与剖宫产后阴道分娩（VBAC）接受率和成功率相关的人口统计学和产科因素。设计队列研究使用医院事件统计数据。设置英国国民健康服务。人口在2004年4月1日至2011年3月31日期间首次分娩通过剖宫产获得单胎活产的妇女，并在2012年3月31日之前进行第二次分娩的妇女。方法采用logistic回归估计校正优势比（OR）。主要结果测量：VBAC尝试和成功。结果在143970名女性中，75086名（52.2%）女性在二胎时尝试了VBAC。年轻女性、非白人女性和生活在贫困地区的女性尝试VBAC的比例更高。总的来说，47602名（63.4%）尝试VBAC的妇女成功地顺产了。年轻女性和白人女性的成功率更高。黑人妇女的成功率特别低（OR, 0.54； 95%可信区间[CI]， 0.50-0.57）。首次分娩时紧急剖腹产的妇女VBAC成功率也较低，特别是那些有引产失败史的妇女（OR, 0.59; 95% CI, 0.53-0.67）。结论：在这个国家队列中，只有超过一半的初次剖腹产妇女有资格进行试产，她们在第二次分娩时尝试了VBAC。其中，近三分之二的人成功地实现了阴道分娩。
ObjectivesTo investigate the demographic and obstetric factors associated with the uptake and success rate of vaginal birth after caesarean section (VBAC).DesignCohort study using data from Hospital Episode Statistics.SettingEnglish National Health Service.PopulationWomen whose first birth resulted in a live singleton delivery by caesarean section between 1 April 2004 and 31 March 2011, and who had a second birth before 31 March 2012.MethodsLogistic regression to estimate adjusted odds ratios (OR).Main outcome measuresAttempted and successful VBAC.ResultsAmong the 143970 women in the cohort, 75086 (52.2%) attempted a VBAC for their second birth. Younger women, those of non-white ethnicity and those living in a more deprived area had higher rates of attempted VBAC. Overall, 47602 women (63.4%) who attempted a VBAC had a successful vaginal birth. Younger women and women of white ethnicity had higher success rates. Black women had a particularly low success rate (OR, 0.54; 95% confidence interval [CI], 0.50-0.57). Women who had an emergency caesarean section in their first birth also had a lower VBAC success rate, particularly those with a history of failed induction of labour (OR, 0.59; 95% CI, 0.53-0.67).ConclusionIn this national cohort, just over one-half of women with a primary caesarean section who were eligible for a trial of labour attempted a VBAC for their second birth. Of these, almost two-thirds successfully achieved a vaginal delivery.