剖腹产后的阴道分娩:多中心研究中的母亲和胎儿结局
Mehmet Nuri Duran1, Serem Kel Ilgin2, Süreyya Saridas Demir3
1Department of Obstetrics and Gynecology, Medical Faculty of Canakkale, Onsekiz Mart University, Canakkale, Türkiye.
概括
剖腹产后分娩试验 (TOLAC) 为重复剖腹产提供了一个安全的替代方案,在剖腹产后成功的阴道分娩 (VBAC) 与较少的孕产妇并发症有关. 然而,失败的TOLAC会增加风险,强调需要仔细监测.
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
- 公共卫生 公共卫生
背景情况:
- 剖腹产后试产 (TOLAC) 越来越被公认为一种降低剖腹产高产率的策略.
- 剖腹产后的阴道分娩 (VBAC) 可以减轻与多次剖腹产相关的长期并发症.
- 关于高生育率地区TOLAC结果的数据有限.
研究的目的:
- 评估土耳其中级医院TOLAC的结果.
- 为了将TOLAC结果与可选重复剖腹产 (ERCS) 进行比较.
主要方法:
- 对至少有一次之前的低横剖腹产 (2020年1月至2026年1月) 的妇女进行了回顾性多中心队列研究.
- 进行ERCS和尝试TOLAC (导致VBAC或紧急剖腹产) 的女性之间的结果比较.
- 评估产妇特征,产周变量和新生儿结局,使用原始风险比率 (RRs) 和95%置信区间 (CI).
主要成果:
- 在19768名女性中,11.1%的女性尝试了TOLAC,VBAC的成功率为67.0%.
- 与ERCS相比,VBAC与妊娠糖尿病 (RR 0.68) 和与怀孕有关的高血压 (RR 0.62) 的风险明显较低.
- 在TOLAC失败后的紧急剖腹产增加了输血需求 (RR 1.36),而新生儿的结果是相似的,除了TOLAC失败后胎儿酸的发病率更高.
结论:
- 在这个土耳其队列中,VBAC的成功率与国际基准保持一致,在选定的患者中显示出有利的孕产妇结果.
- 在失败的TOLAC之后的紧急剖腹产具有最高的风险,这强调了警的产后监测和手术准备的重要性.
- 扩大对安全的TOLAC程序的访问可能会降低高生育率环境中不必要的重复剖腹产的发生率.
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