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在先前的剖腹产产后选择性诱导分娩

Alexander M Saucedo¹, George A Macones¹, Alison G Cahill¹

¹Department of Women's Health, Dell Medical School, University of Texas at Austin, Austin, Texas.

American journal of perinatology

|April 22, 2024

概括

在之前剖腹产的患者中,在39周选择性诱导分娩增加了子宫破裂的风险,并减少了成功的阴道分娩. 等待自发分娩并不会增加破裂的风险.

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

背景情况:

在美国,ARRIVE试验导致39周的劳动诱导增加.
在之前剖腹产的患者中,子宫破裂的风险和选择性诱导的最佳时间尚未确定.
这些患者被排除在ARRIVE试验之外.

研究的目的:

为了确定子宫破裂的风险,在接受选择性诱导分娩的患者,先前进行剖腹产.
在选择性诱导和预期管理组之间比较剖腹产后阴道分娩成功率 (VBAC).

主要方法:

前期剖腹产患者 (1996-2000) 的回顾性队列研究.
包括两次或更多次先前剖腹产的患者;不包括具有特定风险因素的患者.
怀孕39周,40周和41周的预期管理与选择性诱导进行了比较.

主要成果:

在39周,选择性诱导 (n=618) 与预期管理 (n=5,365) 相比,有较高的子宫破裂率 (2.1%对0.9%) 和较低的VBAC率 (66.8%对75%).
在40周和41周的两组之间,子宫破裂的风险是相似的.
在39周,子宫破裂的调整后几率比为2.5 (95% CI,1.3-4.6).

结论:

在之前剖腹产痕的患者中,在39周选择性诱导分娩与子宫破裂的风险增加有关.
39周的选择性诱导也导致VBAC的成功率较低.
在这个队列中,预期的管理似乎不会增加子宫破裂的风险.

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