Pregestational Diabetes: A Risk Factor for Vaginal Birth after Cesarean Section Failure?
Pregestational Diabetes: A Risk Factor for Vaginal Birth after Cesarean Section Failure?
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DOI：
10.1055/s-0029-1239487
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发表时间：
2010-03-01
影响因子：
2
通讯作者：
Macones, George
中科院分区：
文献类型：
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作者：
Dharan, Vanita B.;Srinivas, Sindhu K.;Macones, George
剖宫产后阴道分娩（VBAC）失败与围产期发病率相关。在高危女性亚组中预测VBAC失败的能力是重要的。我们的目标是：（1）估计患有妊娠前糖尿病（PDM）的女性尝试VBAC是否会增加失败的风险，以及（2）确定PDM女性与失败相关的临床特征。我们对1995年至1999年在17家医院分娩的符合VBAC条件的妇女进行了一项回顾性队列研究，以研究通过图表提取确定的产妇病史/结局和新生儿结局。排除妊娠期糖尿病妇女。学生t检验用于比较连续特征。卡方/Fisher精确检验用于比较分类变量。多变量logistic回归分析用于控制混杂因素。在所有符合条件的女性（23,601）中，37%的糖尿病患者（n = 127）和56%的非糖尿病患者（n = 12968）尝试了VBAC。PDM患者VBAC失败率为38%，而非糖尿病患者为24%（p < 0.001）。在控制混杂因素后，PDM患者的失败风险增加（校正比值比1.61，95%置信区间1.06 - 2.51; p = 0.038）。PDM与VBAC失效独立相关。患有PDM的女性尝试VBAC的成功率（62%）处于一般发布的VBAC成功率范围的低端。
Vaginal birth after cesarean delivery (VBAC) failure is associated with perinatal morbidity. The ability to predict VBAC failure in subgroups of high-risk women is important. Our objectives were: (1) to estimate if women with pregestational diabetes (PDM) who attempt VBAC are at increased risk of failure, and (2) to identify clinical characteristics of PDM women associated with failure. We performed a retrospective cohort study of women eligible for VBAC, delivered between 1995 and 1999 at 17 hospitals to study maternal history/outcomes and neonatal outcomes ascertained through chart abstraction. Women with gestational diabetes were excluded. Student t test was used to compare continuous characteristics. Chi-square/Fisher exact tests were used to compare categorical variables. Multivariable logistic regression analysis was used to control for confounders. Of all eligible women (23,601), 37% of diabetics (n = 127) and 56% of nondiabetics (n = 12968) attempted VBAC. The VBAC failure rate for PDM was 38% versus 24% for nondiabetic women (p < 0.001). The risk of failure for PDM patients was increased after controlling for confounders (adjusted odds ratio 1.61, 95% confidence interval 1.06 to 2.51; p = 0.038). PDM is independently associated with VBAC failure. The success rate for women with PDM who attempted VBAC (62%) is at the lower end of the general published VBAC success rate range.