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劳动与选择性剖腹产的试验,对患者有两次先前的剖腹产:一个回顾性倾向得分分析
Léa Roux1, Marie-Charlotte Chiemlewski1, Linda Lassel1
1Department of Obstetrics and Gynecology, University Hospital of Rennes, France.
概括
对于经过两次剖腹产的精心挑选的女性来说,试产是一个安全的选择. 这项研究发现,新生儿的结局和子宫破裂的风险较低,支持经过两次剖腹产后的阴道分娩.
科学领域:
- 产科和妇科 产科和妇科
- 孕产妇和胎儿医学 孕产妇和胎儿医学
- 生殖健康 生殖健康
背景情况:
- 剖腹产率不断上升,需要对先前剖腹产的女性进行分娩选择的评估.
- 对子宫破裂的恐惧影响了之前两次剖腹产的患者的分娩方式决定.
- 有证据表明,经过两次剖腹产后的阴道分娩在特定条件下可以成功且安全.
研究的目的:
- 为了比较计划性剖腹产和分娩试验之间的孕产妇和新生儿结果,在之前有两次剖腹产的妇女中进行分娩试验.
- 评估两个剖腹产后阴道分娩的安全性和有效性.
- 为了在这个患者群体中为临床决策提供有关分娩方式的信息.
主要方法:
- 追溯观察性比较研究.
- 涉及410名之前两次剖腹产 (2013年1月 - 2020年12月) 的患者.
- 倾向性得分匹配用于比较新生儿结局;评估母亲结局和子宫破裂.
主要成果:
- 358名 (87.3%) 接受了预防性剖腹产;52名 (12.7%) 试图进行分娩.
- 在两个剖腹产后成功的阴道分娩在67.3%的试验分娩组中实现.
- 在劳动组的试验中,可比的新生儿结局 (绳索pH值,Apgar分数) 和一个子宫破裂.
结论:
- 试产是一个可行的和合理的选择,选择的妇女之前有两次剖腹产.
- 经过两次剖腹产后的阴道分娩可以在精心挑选的人群中安全地实现.
- 研究结果支持为符合条件的患者提供分娩试验作为一种选择.
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