Vaginal birth after cesarean: clinical risk factors associated with adverse outcome
Vaginal birth after cesarean: clinical risk factors associated with adverse outcome
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DOI：
10.1016/j.ajog.2008.01.008
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发表时间：
2008-04-01
影响因子：
9.8
通讯作者：
Bolton, Linda Burnes
中科院分区：
文献类型：
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作者：
Gregory, Kimberly D.;Korst, Lisa M.;Bolton, Linda Burnes
目的：本研究的目的是确定特定产前条件下剖宫产后阴道分娩 (VBAC) 的成功率以及孕产妇和新生儿并发症发生率。研究设计：这是一项基于人群的队列研究，使用 2002 年在加州医院分娩的妇女的行政出院数据。结果：在 41,450 名妇女中，29.72%（41,450 名妇女中的 12,320 名）患有产妇、新生儿并发症。妊娠并发的胎儿或胎盘状况。尝试的 VBAC 率和 VBAC 成功率因这些临床状况而异，范围从 10% 到 73%。低风险女性（无条件）的 VBAC 成功率为 73.76%，而高风险女性（至少 1 种条件）的 VBAC 成功率为 50.31%，P < .0001。孕产妇和新生儿并发症的绝对发生率较低（低于1-2%），高危临床组的不良事件发生率高于低危临床组。结论：VBAC 成功率和分娩并发症的变化部分归因于妊娠并发症的临床因素。没有这种情况的女性 VBAC 成功率更高，孕产妇和新生儿并发症也更少。
OBJECTIVE: The objective of the study was to identify vaginal birth after cesarean (VBAC) success rates and maternal and neonatal complication rates for selected antenatal conditions.STUDY DESIGN: This was a population-based cohort study using administrative discharge data for women delivering in California hospitals during 2002.RESULTS: Among 41,450 women, 29.72% ( 12,320 of 41,450) had maternal, fetal, or placental conditions complicating pregnancy. Attempted VBAC rates and VBAC success rates varied widely by these clinical condition, ranging from 10% to 73%. The VBAC success rate for low-risk women ( no conditions) was 73.76% vs 50.31% for high-risk women ( at least 1 condition), P < .0001. Absolute rates of maternal and neonatal complications were low ( less than 1-2%), and the rate of adverse events was higher in the high-risk clinical group as compared with the low-risk clinical group.CONCLUSION: Variation in rates of VBAC success and childbirth morbidities can be partially attributed to clinical factors complicating pregnancy. Women without such conditions show improved VBAC success and fewer maternal and neonatal complications.