在没有先前的阴道分娩的剖腹产后分娩的妇女中,第二阶段的持续时间和分娩结果
Gabriel Levin1,2, Abraham Tsur3,4,5, Lee Tenenbaum4
1The Department of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel.
Birth (Berkeley, Calif.)
|June 27, 2023
概括
剖腹产后的阴道分娩成功率随着第二个分娩阶段的延长而下降. 然而,延长的第二阶段 (≥3小时) 与增加孕产妇和新生儿不良后果,包括发作有关.
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:
- 在剖腹产 (LAC) 后评估分娩的成功对于以前一次剖腹产 (CD) 并且没有先前的阴道分娩的女性至关重要.
- 劳动第二阶段的持续时间是影响分娩结果的关键因素.
研究的目的:
- 评估分娩时间的第二阶段与剖腹产后分娩成功 (LAC) 之间的关联.
- 为了确定与LAC接受治疗的女性中延长第二阶段持续时间相关的不良孕妇和新生儿结果的风险.
主要方法:
- 追溯队列研究,包括1397名接受LAC的妇女,她们达到分娩的第二阶段.
- 将第二阶段的持续时间分为五个组进行分析.
- 基于第二阶段持续时间的LAC成功率和不良母亲/新生儿结局的比较,特别关注<3小时与≥3小时.
主要成果:
- 剖腹产后阴道分娩 (VBAC) 的成功率随着第二阶段持续时间的增加而显著下降 (<1小时的96.4%,≥4小时的79.5%).
- 手术性阴道分娩和重复剖腹产更频繁,第二阶段更长.
- 在不同组中,母亲的综合结果是可比的,但新生儿发作率在3-4小时和≥4小时的第二阶段组中较高.
结论:
- 随着第二阶段持续时间的增加,VBAC率下降,尽管即使在长时间的分娩中,它们仍然相对较高.
- 持续3小时或更长时间的第二阶段分娩与复合不良孕妇结果和新生儿发作的风险增加有关.
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