Safety and efficacy of vaginal birth after cesarean attempts at or beyond 40 weeks of gestation
Safety and efficacy of vaginal birth after cesarean attempts at or beyond 40 weeks of gestation
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DOI：
10.1097/01.aog.0000179389.82986.50
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发表时间：
2005-10-01
影响因子：
7.2
通讯作者：
Macones, GA
中科院分区：
文献类型：
--
作者：
Coassolo, KM;Stamilio, DM;Macones, GA
目的：比较预产期 (EDD) 前后尝试 VBAC 的女性剖宫产 (VBAC) 失败率和主要并发症的发生率。 方法：这是一项为期 5 年的回顾性队列研究，在 17 所大学和社区医院中进行，研究对象为至少有过 1 次剖腹产史的女性。将在 EDD 之前尝试 VBAC 的女性与妊娠 40 周或以上的女性进行比较。进行逻辑回归分析以评估 EDD 之外的分娩与 VBAC 失败或并发症发生率之间的关系。 结果：该队列中共有 11,587 名女性尝试了 VBAC。妊娠超过 40 周的女性 VBAC 失败的可能性更大。控制混杂因素后，超过 40 周 VBAC 失败的风险增加仍然显着（31.3% 与 22.2% 相比，比值比 1.36，95% 置信区间 1.24-1.50）。在 EDD 之外尝试 VBAC 的女性中，子宫破裂风险（1.1% 与 1.0%）或总体发病率（2.7% 与 2.1%）并没有显着增加。当队列被定义为妊娠 41 周或更长时，VBAC 失败的风险再次显着增加（35.4% 与 24.3% 相比，比值比 1.35，95% 置信区间 1.20-1.53），但子宫破裂或总体发病率的风险并未增加。 结论：妊娠 40 周以上的女性可以安全地尝试 VBAC，尽管VBAC 故障增加。
OBJECTIVE: To compare rates of vaginal birth after cesarean (VBAC) failure and major complications in women attempting VBAC before and after the estimated date of delivery (EDD).METHODS: This was a 5-year retrospective cohort study in 17 university and community hospitals of women with at least 1 prior cesarean delivery. Women who attempted VBAC before the EDD were compared with those at or beyond 40 weeks of gestation. Logistic regression analyses were performed to assess the relationship between delivery beyond the EDD and VBAC failure or complication rate.RESULTS: A total of 11,587 women in the cohort attempted VBAC. Women past 40 weeks of gestation were more likely to have a failed VBAC. After controlling for confounders, the increased risk of a failed VBAC beyond 40 weeks remained significant (31.3% compared with 22.2%, odds ratio 1.36, 95% confidence interval 1.24-1.50). The risk of uterine rupture (1.1% compared with 1.0%) or overall morbidity (2.7% compared with 2.1%) was not significantly increased in the women attempting VBAC beyond the EDD. When the cohort was defined as 41 weeks or more of gestation, the risk of a failed VBAC was again significantly increased (35.4% compared with 24.3%, odds ratio 1.35, 95% confidence interval 1.20-1.53), but the risk of uterine rupture or overall morbidity was not increased.CONCLUSION: Women beyond 40 weeks of gestation can safely attempt VBAC, although the risk of VBAC failure is increased.