Planned Home VBAC in the United States, 2004-2009: Outcomes, Maternity Care Practices, and Implications for Shared Decision Making
Planned Home VBAC in the United States, 2004-2009: Outcomes, Maternity Care Practices, and Implications for Shared Decision Making
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DOI：
10.1111/birt.12188
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发表时间：
2015-12-01
影响因子：
2.5
通讯作者：
Leeman, Lawrence M.
中科院分区：
文献类型：
--
作者：
Cox, Kim J.;Bovbjerg, Marit L.;Leeman, Lawrence M.
背景：在美国，剖宫产后计划家庭阴道分娩（VBAC）的数量有所增加。本研究描述了计划在家中与助产士进行VBAC的妇女的孕产妇和新生儿结局，这些助产士在2004 - 2009年期间为北美统计项目2.0队列的助产士联盟提供数据。方法：从父母队列中创建两个子样本：12，092名未经剖宫产的经产妇女和1，052名剖宫产妇女。计算两组产妇和新生儿结局的描述性统计量。敏感性分析比较妇女与以前阴道分娩和那些谁是在最低风险与各亚组的父母队列也进行了。结果如下：有剖宫产史的妇女VBAC率为87%，尽管转移率高于无剖宫产史的妇女（18%比7%，p <0.001）。最常见的转移指征是进展失败。有剖宫产史的妇女比无剖宫产史的妇女有更高比例的失血、产妇产后感染、子宫破裂和新生儿重症监护室入院。有剖宫产史组新生儿死亡5例（4.75/1000），无剖宫产史的多次剖宫产组新生儿死亡1.24/1000（p = 0.015）。结论：虽然在家中阴道分娩的可能性很高，但计划在家中进行VBAC的妇女应咨询产妇转移率和新生儿风险增加的可能性，特别是如果在家中发生子宫破裂。（2015年12月4日）
Background: In the United States, the number of planned home vaginal births after cesarean (VBACs) has increased. This study describes the maternal and neonatal outcomes for women who planned a VBAC at home with midwives who were contributing data to the Midwives Alliance of North America Statistics Project 2.0 cohort during the years 2004-2009. Method: Two subsamples were created from the parent cohort: 12,092 multiparous women without a prior cesarean and 1,052 women with a prior cesarean. Descriptive statistics were calculated for maternal and neonatal outcomes for both groups. Sensitivity analyses comparing women with a prior vaginal birth and those who were at the lowest risk with various subgroups in the parent cohort were also conducted. Results: Women with a prior cesarean had a VBAC rate of 87 percent, although transfer rates were higher compared with women without a prior cesarean (18% vs 7%, p < 0.001). The most common indication for transfer was failure to progress. Women with a prior cesarean had higher proportions of blood loss, maternal postpartum infections, uterine rupture, and neonatal intensive care unit admissions than those without a prior cesarean. Five neonatal deaths (4.75/1,000) occurred in the prior cesarean group compared with 1.24/1,000 in multiparas without a history of cesarean (p = 0.015). Conclusion: Although there is a high likelihood of a vaginal birth at home, women planning a home VBAC should be counseled regarding maternal transfer rates and potential for increased risk to the newborn, particularly if uterine rupture occurs in the home setting. (BIRTH 42:4 December 2015)