Risk of uterine rupture during labor among women with a prior cesarean delivery.
Risk of uterine rupture during labor among women with a prior cesarean delivery.
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DOI：
10.1056/nejm200107053450101
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发表时间：
2001-07-01
影响因子：
158.5
通讯作者：
Martin, DP
中科院分区：
文献类型：
--
作者：
Lydon-Rochelle, M;Holt, VL;Martin, DP
背景：在美国，每年大约有 60% 的剖腹产妇女在再次怀孕后尝试分娩。人们仍然担心试产可能会增加子宫破裂的风险，这是一种罕见但严重的产科并发症。方法：我们使用 1987 年至 1996 年在华盛顿州民用医院通过剖腹产产下活单胎婴儿并在同一时期生下第二个单胎婴儿的所有初产妇的数据进行了一项基于人群的回顾性队列分析（总共 20,095妇女）。我们评估了自然分娩、前列腺素引产以及其他方式引产的子宫破裂风险；将这三组分娩与重复剖宫产无产妇进行比较。 结果：重复剖宫产无产妇（11名妇女）中子宫破裂的发生率为每1000人1.6人，自然临产妇女（56名妇女）中子宫破裂发生率为每1000人5.2人，未使用前列腺素引产的妇女中（15名妇女）子宫破裂发生率为每1000人7.7人，每1000人中子宫破裂发生率为24.5人。 1000 名接受前列腺素引产的女性（9 名女性）。与多次剖宫产但未产程的女性相比，自然分娩（相对风险，3.3；95%置信区间，1.8至6.0）、不使用前列腺素引产（相对风险，4.9；95%置信区间，2.4至9.7）和使用前列腺素引产（相对风险，15.6；95）的女性子宫破裂的可能性更大。百分比置信区间，8.1 至 30.0）。结论：对于既往有过一次剖宫产史的女性，进行引产的女性发生子宫破裂的风险高于重复剖腹产但未临产的女性。用前列腺素引产的风险最高。 （N Engl J Med 2001；345:3-8。）版权所有 (C) 2001 马萨诸塞州医学会。
Background: Each year in the United States, approximately 60 percent of women with a prior cesarean delivery who become pregnant again attempt labor. Concern persists that a trial of labor may increase the risk of uterine rupture, an uncommon but serious obstetrical complication.Methods: We conducted a population-based, retrospective cohort analysis using data from all primiparous women who gave birth to live singleton infants by cesarean section in civilian hospitals in Washington State from 1987 through 1996 and who delivered a second singleton child during the same period (a total of 20,095 women). We assessed the risk of uterine rupture for deliveries with spontaneous onset of labor, those with labor induced by prostaglandins, and those in which labor was induced by other means; these three groups of deliveries were compared with repeated cesarean delivery without labor.Results: Uterine rupture occurred at a rate of 1.6 per 1000 among women with repeated cesarean delivery without labor (11 women), 5.2 per 1000 among women with spontaneous onset of labor (56 women), 7.7 per 1000 among women whose labor was induced without prostaglandins (15 women), and 24.5 per 1000 among women with prostaglandin-induced labor (9 women). As compared with the risk in women with repeated cesarean delivery without labor, uterine rupture was more likely among women with spontaneous onset of labor (relative risk, 3.3; 95 percent confidence interval, 1.8 to 6.0), induction of labor without prostaglandins (relative risk, 4.9; 95 percent confidence interval, 2.4 to 9.7), and induction with prostaglandins (relative risk, 15.6; 95 percent confidence interval, 8.1 to 30.0).Conclusions: For women with one prior cesarean delivery, the risk of uterine rupture is higher among those whose labor is induced than among those with repeated cesarean delivery without labor. Labor induced with a prostaglandin confers the highest risk. (N Engl J Med 2001;345:3-8.) Copyright (C) 2001 Massachusetts Medical Society.