Comparison of a trial of labor with an elective second cesarean section
Comparison of a trial of labor with an elective second cesarean section
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DOI：
10.1056/nejm199609053351001
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发表时间：
1996-09-05
影响因子：
158.5
通讯作者：
Olshan, AF
中科院分区：
文献类型：
--
作者：
McMahon, MJ;Luther, ER;Olshan, AF
背景为了降低剖宫产率，产科医生现在为以前做过剖宫产的孕妇提供试产。虽然分娩试验通常是成功的，而且相对安全，但很少有研究直接涉及与这种分娩方法相关的孕产妇和围产期发病率和死亡率。对新斯科舍省的6138名妇女进行了纵向研究，这些妇女在1986年至1992年期间曾接受过剖宫产手术并分娩过一个单胎活婴。3249例选择试产，2889例选择第二次剖宫产。没有产妇死亡。产妇的总发病率为8.1%; 1.3%有严重并发症（需要子宫切除术、子宫破裂或手术损伤），6.9%有轻微并发症（产褥热、需要输血或腹部伤口感染）。虽然产妇并发症的总体发生率在选择试产的妇女和选择剖宫产的妇女之间没有显著差异，（试产组的优势比为0.9; 95%可信区间为0.8 ~ 1.1），试产组的主要并发症发生率几乎是试产组的两倍（比值比，1.8; 95%置信区间，1.1至3.0）。Apgar评分，新生儿重症监护室入院，围产期死亡率是相似的婴儿的母亲进行了一次试产和那些母亲进行了择期剖宫产。结论在孕妇谁有剖宫产，主要的产妇并发症几乎是两倍的可能性，在那些谁进行了选择性第二次剖宫产的分娩与试产管理。(C)1996年，马萨诸塞州医学会。
Background 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.Methods 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.Results 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 the 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.Conclusions 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. (C) 1996, Massachusetts Medical Society.