Vaginal birth after cesarean in California: Before and after a change in guidelines
Vaginal birth after cesarean in California: Before and after a change in guidelines
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DOI：
10.1370/afm.544
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发表时间：
2006-05-01
影响因子：
4.4
通讯作者：
Lau, M
中科院分区：
文献类型：
--
作者：
Zweifler, J;Garza, A;Lau, M
1999年，美国妇产科医师学会（ACOG）对剖宫产后阴道分娩（VBAC）采用了更严格的指南。本研究评估了加州州VBAC的趋势，并比较了本指南修订前后尝试VBAC分娩或重复剖宫产的妇女的新生儿和孕产妇死亡率。232名加州居民，他们以前曾通过剖宫产分娩，并计划在加州医院进行单胎分娩。指南修订前为13.5%（1996 - 1999年或2000 - 2002年研究期间P = 1，500 g）。在同一时期，体重<1，500 g的新生儿中，尝试VBAC分娩的新生儿死亡率高于重复剖宫产分娩的新生儿死亡率（尝试VBAC：1996-1999年，253.2; 95%泊松置信区间[CI]，197.7-308.6; 2000-2002年，336.8; CI，254.3-419.4;再次剖宫产：1996-1999，59.1; Cl，48.3-69.9; 2000-2002，60.5，Cl，48.472.5）。在这两个时期，每100 000名活产中因尝试使用维生素BACs分娩而死亡的产妇死亡率相似（1996-1999年，2.0;置信区间，0.1-11.0; 2000-2002年，8.5; Cl，1.0-30.6）结论：尽管在ACOG 1999年VBAC之后的几年中，重复剖宫产率增加，但新生儿和孕产妇死亡率并未改善。指南修订。婴儿体重>= 1，500 g的女性在使用VBAC或重复剖腹产时的新生儿和孕产妇死亡率相似。
PURPOSE In 1999 the American College of Obstetricians and Gynecologists (ACOG) adopted more-restrictive guidelines for vaginal birth after cesarean delivery (VBAC). This study assesses trends in VBAC in California and compares neonatal and maternal mortality rates among women attempting VBAC delivery or undergoing repeat cesarean delivery before and after this guideline revision.METHODS The 1996 through 2002 California Birth Statistical Master Files were used to identify 386,232 California residents who previously gave birth by cesarean delivery and had a singleton birth planned in a California hospital.RESULTS Attempted VBAC deliveries decreased significantly from 24% before to 13.5% after guideline revision (P = 1,500 g in either the study periods 1996 to 1999 or 2000 to 2002. Neonatal mortality rates for attempted VBAC deliveries were higher for repeat cesarean deliveries among neonates weighing < 1,500 g in the same periods (attempted VBAC: 1996-1999, 253.2; 95% Poisson confidence interval [CI], 197.7-308.6; 2000-2002, 336.8; Cl, 254.3-419.4; repeat cesarean delivery: 1996-1999, 59.1; Cl, 48.3-69.9; 2000-2002, 60.5, Cl, 48.472.5). Maternal death rates per 100,000 live births for attempted VBAC deliveries were similar for both periods (1996-1999, 2.0; Cl, 0.1-11.0; 2000-2002, 8.5; Cl, 1.0-30.6).CONCLUSIONS Neonatal and maternal mortality rates did not improve despite increasing rates of repeat cesarean delivery during the years after the ACOG 1999 VBAC guideline revision. Women with infants weighing >= 1,500 g encountered similar neonatal and maternal mortality rates with VBAC or repeat cesarean delivery.