Serial Membrane Sweeping at Term in Planned Vaginal Birth After Cesarean A Randomized Controlled Trial
Serial Membrane Sweeping at Term in Planned Vaginal Birth After Cesarean A Randomized Controlled Trial
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DOI：
10.1097/aog.0b013e3181b8fa00
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发表时间：
2009-10-01
影响因子：
7.2
通讯作者：
Tan, Peng Chiong
中科院分区：
文献类型：
--
作者：
Hamdan, Mukhri;Sidhu, Kiren;Tan, Peng Chiong
目的：评估连续扫膜对计划剖宫产后阴道分娩 (VBAC) 的妇女临产的影响。方法：选择适合并计划进行 VBAC 的足月妇女进行一次横向下段剖宫产。参与者被随机分配到每周进行膜清理或每周进行 Bishop 评分阴道评估，直至分娩。参与者和交付提供者对分配的治疗不知情。向所有参与者提供标准产科护理。主要结局是临产，定义为出现自发的规则且疼痛的宫缩，导致宫颈扩张至少 3 cm 或临产前胎膜破裂。次要结局包括引产和重复剖宫产。结果：108 名女性被随机分配至清胎组，105 名女性被分配至对照组。自然分娩率为 78.5% 对比 72.1%（相对风险 [RR] 1.1，95% 置信区间 [CI] 0.9-1.3；P=.34），引产率为 12.1% 对比 9.6%（RR 1.3，95% Cl 0.6-2.8；P=.66），全因剖宫产率膜清扫组和对照组分别为 40.2% 和 44.2%（RR 0.9，95% Cl 0.7-1.2；P=.58）。胎膜清扫组的分娩胎龄（平均+/-标准差）为 39.6±1.0 周，而对照组为 39.6±0.9 周（P=0.84），没有差异。结论：计划 VBAC 的妇女足月连续清胎对分娩开始时间、妊娠持续时间、引产或重复剖宫产没有显着影响。
OBJECTIVE: To estimate the effect of serial membrane sweeping on the onset of labor in women who planned vaginal birth after cesarean (VBAC).METHODS: Women at term with one transverse lower segment cesarean delivery who were suitable for and who planned VBAC were approached to participate. Participants were randomly assigned to weekly membrane sweeping or weekly vaginal assessment for Bishop score until delivery. Participants and delivery providers were blinded to the allocated treatment. Standard obstetric care was given to all participants. The primary outcome was onset of labor which was defined as the presence of spontaneous regular and painful contractions that cause cervical dilation to at least 3 cm or prelabor rupture of membranes. Secondary outcomes included induction of labor and repeat cesarean delivery.RESULTS: One hundred eight women were randomly assigned to membrane sweeping and 105 to control. The spontaneous labor rate was 78.5% compared with 72.1% (relative risk [RR] 1.1, 95% confidence interval [CI] 0.9-1.3; P=.34), the induction of labor rate was 12.1% compared with 9.6% (RR 1.3, 95% Cl 0.6-2.8; P=.66), and the all-cause cesarean delivery rate was 40.2% compared with 44.2% (RR 0.9, 95% Cl 0.7-1.2; P=.58) for the membrane sweeping and control groups, respectively. Gestational age at delivery (mean +/- standard deviation) of 39.6 +/- 1.0 weeks for the membrane sweeping group compared with 39.6 0.9 weeks for the control group (P=.84) was no different.CONCLUSION: Serial membrane sweeping at term in women who planned VBAC has no significant effect on the onset of labor, pregnancy duration, induction of labor, or repeat cesarean delivery.