剖宫产术后再次妊娠经阴道分娩预测模型研究进展

Research progress on a predictive model of vaginal birth after cesarean

既往的高剖宫产率致使“二胎”政策全面放开以来,有剖宫产史的女性再次妊娠的比例逐年增高,面临分娩方式的选择,给这些女性及产科医生均带来了困扰。目前多国权威指南已指出,剖宫产术后再次妊娠行阴道试产(TOLAC)应该被推荐,并已有诸多研究构建剖宫产术后再次妊娠经阴道分娩(VBAC)预测模型,在严格把握指征的前提下,评估和筛选VBAC成功率相对较高人群进行阴道试产,以提高TOLAC安全性及TOLAC率,进一步降低剖宫产率,并降低由重复剖宫产(ERCS)带来的近远期并发症发生率。本文对国内外有关剖宫产术后再次妊娠经阴道分娩(VBAC)预测模型的研究进展进行综述,包括VBAC预测模型的基本情况、预测模型的比较分析及未来可能的发展方向。

Since the high rate of cesarean section in the past led to the full liberalization of the"second-child"policy,the proportion of women with a history of cesarean section getting pregnant again is increasing year by year.They are faced with the choice of delivery methods,which has brought troubles to these women and obstetricians.At present,authoritative guidelines in many countries have pointed out that trial of labor after cesarean(TOLAC)should be recommended,and many studies have established a predictive model of vaginal birth after cesarean(VBAC).Under the premise of strictly grasping the indications,the population with a relatively high success rate of VBAC was assessed and screened for vaginal trial delivery to improve the safety and the rate of TOLAC,further reduce the rate of short-term and long-term complications brought by elective repeated cesarean sections(ERCS).This article reviews the research progress of prediction models for vaginal delivery after cesarean(VBAC)at home and abroad,including the basic situation of VBAC prediction models,comparative analysis of prediction models,and possible future development directions.