Vaginal Birth After Cesarean New Insights on Maternal and Neonatal Outcomes
Vaginal Birth After Cesarean New Insights on Maternal and Neonatal Outcomes
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DOI：
10.1097/aog.0b013e3181df925f
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发表时间：
2010-06-01
影响因子：
7.2
通讯作者：
McDonagh, Marian
中科院分区：
文献类型：
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作者：
Guise, Jeanne-Marie;Denman, Mary Anna;McDonagh, Marian
目的：系统评价与剖宫产后阴道分娩 (VBAC) 相关的孕产妇和新生儿结局的证据。 数据来源：通过多次检索 MEDLINE、DARE 和 Cochrane 数据库（1980 年至 2009 年 9 月）以及最近的系统评价、参考文献列表、评论、社论、网站和专家，确定了相关研究。 研究选择方法： 纳入标准仅限于研究在美国和发达国家进行的英语和人体研究，专门评估先前剖腹产后的分娩情况。针对高危孕产妇或新生儿状况（包括臀位阴道分娩）或少于 10 名患者的研究被排除在外。分析中不包括质量差的研究。制表、整合和结果：我们确定了 3,134 条引用，并审查了 963 篇文章以供纳入； 203 篇文章符合纳入标准并获得质量评级。试产和选择性再次剖宫产的产妇伤害总体率都很低。尽管选择性重复剖宫产和试产的情况都很罕见，但选择性重复剖宫产的孕产妇死亡率显着增加，为 0.013%，而试产的孕产妇死亡率为 0.004%。试产和选择性再次剖宫产之间，产妇子宫切除术、出血和输血的发生率没有显着差异。所有接受过剖宫产的女性的子宫破裂率为 0.30%，试产的风险显着增加（0.47%，而选择性再次剖宫产的风险为 0.03%）。试产的围产期死亡率也显着增加（0.13%，而选择性再次剖宫产的围产期死亡率为 0.05%）。 结论：总体而言，最佳证据表明 VBAC 对于大多数女性来说是一个合理的选择。选择性再次剖腹产和试产均很少出现不良后果。缺乏确定性研究来确定哪些患者出现不良后果的风险最大。 （妇产科 2010 年；115：1267-78）
OBJECTIVE: To systematically review the evidence about maternal and neonatal outcomes relating to vaginal birth after cesarean (VBAC).DATA SOURCES: Relevant studies were identified from multiple searches of MEDLINE, DARE, and the Cochrane databases (1980 to September 2009) and from recent systematic reviews, reference lists, reviews, editorials, Web sites, and experts.METHODS OF STUDY SELECTION: Inclusion criteria limited studies to the English-language and human studies conducted in the United States and developed countries specifically evaluating birth after previous cesarean delivery. Studies focusing on high-risk maternal or neonatal conditions, including breech vaginal delivery, or fewer than 10 patients were excluded. Poor-quality studies were not included in analyses.TABULATION, INTEGRATION, AND RESULTS: We identified 3,134 citations and reviewed 963 articles for inclusion; 203 articles met the inclusion criteria and were quality rated. Overall rates of maternal harms were low for both trial of labor and elective repeat cesarean delivery. Although rare in both elective repeat cesarean delivery and trial of labor, maternal mortality was significantly increased for elective repeat cesarean delivery at 0.013% compared with 0.004% for trial of labor. The rates of maternal hysterectomy, hemorrhage, and transfusions did not differ significantly between trial of labor and elective repeat cesarean delivery. The rate of uterine rupture for all women with prior cesarean was 0.30%, and the risk was significantly increased for trial of labor (0.47% compared with 0.03% for elective repeat cesarean delivery). Perinatal mortality was also significantly increased for trial of labor (0.13% compared with 0.05% for elective repeat cesarean delivery).CONCLUSION: Overall the best evidence suggests that VBAC is a reasonable choice for the majority of women. Adverse outcomes were rare for both elective repeat cesarean delivery and trial of labor. Definitive studies are lacking to identify patients who are at greatest risk for adverse outcomes. (Obstet Gynecol 2010; 115: 1267-78)