ACOG Practice Bulletin No. 205: Vaginal Birth After Cesarean Delivery.
ACOG Practice Bulletin No. 205: Vaginal Birth After Cesarean Delivery.
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DOI：
10.1097/aog.0000000000003078
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发表时间：
2019-02-01
影响因子：
7.2
通讯作者：
中科院分区：
文献类型：
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剖腹产后试产（TOLAC）是指有计划地尝试由以前有过剖腹产的妇女阴道分娩，无论结果如何。这种方法为希望阴道分娩的妇女提供了实现这一目标的可能性-剖宫产后阴道分娩（VBAC）。除了满足患者对阴道分娩的偏好外，在个体水平上，VBAC还与降低孕产妇发病率和降低未来妊娠并发症风险以及降低总体剖宫产率相关（）。然而，尽管TOLAC适用于许多妇女，但有几个因素增加了试产失败的可能性，与成功试产（即VBAC）和择期重复剖宫产相比，这反过来又与孕产妇和围产期发病率增加有关（）。因此，在确定谁是TOLAC的适当候选人时，评估VBAC的可能性以及个体风险非常重要。因此，本文件的目的是审查TOLAC在各种临床情况下的风险和获益，并为既往剖宫产后尝试阴道分娩的患者的咨询和管理提供实用指南。
Trial of labor after cesarean delivery (TOLAC) refers to a planned attempt to deliver vaginally by a woman who has had a previous cesarean delivery, regardless of the outcome. This method provides women who desire a vaginal delivery the possibility of achieving that goal-a vaginal birth after cesarean delivery (VBAC). In addition to fulfilling a patient's preference for vaginal delivery, at an individual level, VBAC is associated with decreased maternal morbidity and a decreased risk of complications in future pregnancies as well as a decrease in the overall cesarean delivery rate at the population level (). However, although TOLAC is appropriate for many women, several factors increase the likelihood of a failed trial of labor, which in turn is associated with increased maternal and perinatal morbidity when compared with a successful trial of labor (ie, VBAC) and elective repeat cesarean delivery (). Therefore, assessing the likelihood of VBAC as well as the individual risks is important when determining who is an appropriate candidate for TOLAC. Thus, the purpose of this document is to review the risks and benefits of TOLAC in various clinical situations and to provide practical guidelines for counseling and management of patients who will attempt to give birth vaginally after a previous cesarean delivery.