Risk Factors Associated with Unsuccessful Vaginal Birth after One Cesarean (VBAC-1) in Puerto Rico

Background: Cesarean section (CS) has increased steadily over the last decade, with an estimated one-third of women delivering by cesarean section worldwide. Objective: Our study aimed to investigate the demographic and associated factors influencing vaginal birth after one cesarean (VBAC-1) success focusing on variables like pre-pregnancy BMI, diabetes, hypertension, education, and smoking. Study Design and Methods: In this retrospective study, we analyzed 285 cases (81 unsuccessful VBAC-1, 204 successful VBAC-1) from San Juan City Hospital (Puerto Rico) between January 1, 2019, and December 31, 2020. We used odds ratios and model selection comparison to assess the impact of variables on successful VBAC-1, using a significance threshold of 95% CI. Model selection assessed binomial model combinations using a generalized linear approach to identify key risk factors. Results: Unsuccessful VBAC-1 (a repeat cesarean), was associated with diabetes (OR: 0.376, p = 0.086), hypertension (OR: 0.23, p = 0.006), and university-educated women (OR: 1.372, p = 0.711). High school-educated women had an OR of 3.966 (p = 0.105), while overweight women were 0.481 times more likely to have unsuccessful VBAC-1 (p = 0.041). Significant associations were not found with obesity (OR: 0.574, p = 0.122), underweight/normal (OR: 1.01, p = 0.810), or smoking (OR: 1.227, p = 0.990). Conclusion: Results revealed women with higher education levels, hypertension, or diabetes are less likely to have a successful VBAC-1. Understanding the complex interactions affecting these outcomes is aimed at establishing guidelines for healthcare professionals to conduct systematic risk/benefit assessments. This study lays a foundation for evidence-based practices and policies, offering initial insights into VBAC-1 success factors in Puerto Rico.

Vaginal Birth after Cesarean after Zavanelli Maneuver: A Woman’s Right to Choose

Introduction: Vaginal birth after cesarean (VBAC) plays an essential role in lowering cesarean rates. Despite endorsement, trial of labor after cesarean (TOLAC) attempt rates remain low, in part due to fear of lawsuits. Zavanelli maneuver is a last resort procedure in the management of shoulder dystocia. We discuss a case of a woman determined to have a vaginal birth after her prior birth was complicated by shoulder dystocia requiring a Zavanelli maneuver. Her physicians were reluctant to allow her a TOLAC given her prior obstetric history. Case: A 34-year-old para 1 with prior cesarean delivery due to shoulder dystocia that required Zavanelli maneuver presents determined to pursue VBAC in her current pregnancy. She considered her delivery route options and addressed her modifiable risk factors. She consulted with multiple perinatologists who agreed that a TOLAC was reasonable, however she had to travel more than 70 miles (from Pennsylvania to New Jersey) to find an obstetrical practice and hospital willing to consider VBAC. She transferred care and the remainder of her prenatal course was uncomplicated. She went into labor at 41 weeks and had a successful VBAC without complication. In a thank you letter to her obstetrician, she described her birth experience as euphoric. Conclusion: This case illustrates how a woman’s choice of delivery route may be impacted by fear of litigation. Local providers focused on her prior delivery instead of her overall improved risk profile. Delivery route decisions should be based on a thorough evaluation of all risk factors and individualized to meet the reproductive goals of each woman. .

Vaginal Cesarean Section, an Alternative to High-Risk Trigger on Scarred Uterus

The objective is to report a clinical case of vaginal cesarean section performed to expel a dead fetus in scarred uterus. For this indication, vaginal hysterectomy constitutes an alternative to vaginal expulsion with a high risk of uterine rupture and to classic abdominal cesarean section with risk of significant surgical trauma, particularly adhesions. However, this surgical technique, described since the 19th century, remains unknown to many practitioners and few publications exist on the subject throughout the world. Considered obsolete by some practitioners, it retains all its advantages in the practice of modern obstetrics. We report this case of expulsion of fetal death on a tri-scarred uterus performed by vaginal cesarean section at the Health District Reference Health Center (District Hospital) of Commune I in Bamako, Mali in a 37-year-old patient with a pregnancy of 27 weeks of amenorrhea.

Prediction of Success Rates of Vaginal Birth after Cesarean Delivery According to the Previous Indication for Cesarean Delivery

Background: Trial of labor after cesarean delivery (TOLAC) has long been accepted as a safe option for women with previous cesarean delivery. Previous efforts have been exerted in trials to predict the success rates of TOLAC according to specific parameters related to previous cesarean section and before TOLAC. We aimed to investigate the different indications of previous cesarean delivery as independent predictors for successful vaginal birth. Methods: A retrospective study was conducted in Armed Forces Hospitals of the Southern Region between December 15, 2019, and July 1, 2020. The included 566 patients with previous cesarean section who were willing to undergo a trial of labor were divided into two groups according to the success of vaginal birth (VBAC). Results: The nonrecurring indications for previous cesarean delivery were higher in the successful group (fetal distress 54.7% vs 41.1%, malpresentation 26% vs 21.4%, multifetal pregnancy 3.8% vs 2.7%). Additionally, the successful VBAC group had a significantly higher percentage of previous successful VBAC (47.7% vs 21.9%) and prior vaginal deliveries (58.5% vs 44.2%) and less coincidence of medical disorders and meconium-stained liquor (18.1% vs 26.3% and 3.2% vs 8.2%, respectively) than the unsuccessful group. Conclusion: During counseling regarding trial of labor after cesarean section, indications for previous cesarean section not related to arrest of labor can predict higher success of VBAC. Moreover, previous successful vaginal delivery or VBAC improves the success rates.

Vaginal Birth after a Cesarean Section at Good Shepherd Mission Hospital at Tshikaji in Democratic Republic of the Congo (DRC)

Background: The success rate of vaginal birth after cesarean section with a single cesarean scar is greater than 50%, the lack of the information about the safety of vaginal birth after cesarean delivery pushes most of obstetricians to increase the num ber of cesarean sections following a previous cesarean section. Guidelines for Vaginal birth after cesarean (VBAC) indicate that TOLAC offers women with no contraindications and one previous transverse low-segment cesarean. The objective of the current study was to study the outcome of trial of labour after caesarean section (TOLAC), the indications for emergency repeat cesarean section and to determine the maternal and fetal prognosis in vaginal birth after caesarian section (VBAC) at Tshikaji Mission Hospital. Patients, Material and Methods: This is a retrospective study of the records of 126 women were selected to undergo the TOLAC in the department of gynecology and obstetrics at the Tshikaji Mission Hospital over the period from January 1st to December 31st, 2021. The data on demography, antenatal care, labour and delivery and outcomes were collected from the maternity unit of this hospital. The data were analyzed using SPSS version 2.0. Results: The TOLAC in 126 studied women. The course of work allowed vaginal delivery 107 parturient women, a success rate of successful VBAC of 85% after the TOLAC. The repeat emergency cesarean section was necessary for delivery in 15% of cases for failed TOLAC. There was no maternal mortality, but we recorded one fetal death or 0.8% of perinatal mortality, 2 cases of cicatricial dehiscence, the incidence of 1.6%. Maternal morbidity after delivery on cicatricial uterus was dominated by postpartum hemorrhages, with 19 cases or 15.1% of cases. Cervical dilatation of more than 3 cm at the time of admission, the parity more than 3 and were the significant factors in favor of a successful VBAC. Birth weight of more than 3500 g, fetal distress and malpresentation were associated with a lower success rate of VBAC. The TOLAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. Conclusion: Pregnancy on a cicatricial uterus represents a high-risk pregnancy. Trial of VBAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. There is a significantly high vaginal birth after caesarian section (VBAC) success rate among selected women undergoing trial of scar in Tshikaji Hospital. TOLAC remains the option for childbirth in low resource settings as Kasai region in DRC. Adequate patient education and counselling in addition to appropriate patient selection for TOLAC remain the cornerstone to achieving high VBAC success rate.

Pre-Induction Cervical Ripening Using a Transcervical Foley Catheter Combined with ISMN Vaginal Tablets for Vaginal Birth after Previous Caesarean Section (VBAC)—A Comparative Study

Objective: To compare the effectiveness, safety and client acceptability of concurrent application of transcervical Foley catheter with vaginal ISMN-sustained release (SR) 60 mg tablet versus transcervical Foley catheter alone for pre-induction cervical ripening in women who are undergoing Vaginal birth after C-section (VBAC). Method: A prospective single blind randomized control study was carried out including 110 pregnant women who had unfavorable cervix (MBS less than 6) at 40 weeks and 3 days of gestation. The two groups received either the trans-cervical foley catheter with a vaginal ISMN 60 mg sustained release (SR) tablet on 40 weeks and 3 days (Treatment arm 1, n = 57), or trans-cervical Foley alone on 40 weeks and 3 days (Treatment arm 2, n = 53). Results: At 40 weeks + 3 days gestation, the mean age, mean parity and the mean modified Bishop Score (MBS) were comparable among the two treatment groups. Majority (n = 98, 89.1%) remained without spontaneously establishing labour at 24 hours of intervention. The difference in mean MBS at 40 weeks + 4 days (24-hours following the intervention) in the two groups was statistically not significant (P > 0.05). The group who received concurrent ISMN vaginal tablets achieved a higher number of successful VBACs (n = 33, 62.3%) over the group who received the Foley catheter only method (n = 29, 50.9%), however, not statistically significant (P > 0.05). Conclusions: The concurrent use of vaginal ISMN tablets (60 mg SR) with a transcervical Foley catheter failed to show higher effectiveness compared to a transcervical Foley catheter alone as an induction method.

Comparative study for success rate of vaginal birth after cesarean section following labor induction by two forms of vaginal dinosprostone: A pilot study

Background: Cesarean delivery has become the most common major surgical procedure in many parts of the world. Induction of labor in women with prior cesarean delivery is an alternative to mitigate the rising cesarean rates. Objectives: To compare the VBAC success rate between two vaginal forms of dinoprostone for labor induction in women with prior cesarean section. Material and Methods: A pilot study was conducted at a large Governmental Hospital, Dhahran, Saudi Arabia, including 200 women with prior cesarean section and planned for labor induction. Participants were randomly allocated into two groups. Group A (n = 100) received dinoprostone 1.5 mg vaginal tablet. Group B (n = 100) received 10 mg dinoprostone sustained release vaginal pessary. Primary outcome was vaginal delivery rate. Secondary outcomes included maternal and neonatal outcomes. Results: The dinoprostone vaginal tablet and dinoprostone vaginal pessary had a comparable vaginal delivery rate (67% and 64%, respectively;p = 0.78). The median patient satisfaction with the birth process was superior in the dinoprostone vaginal pessary group (p = 0.04). Maternal and neonatal outcomes were similar in both groups. Conclusion: Both forms of dinoprostone were effective methods for labor induction in women with prior cesarean section. However, the patient satisfaction with the birth process was in favor of the dinoprostone sustained release vaginal pessary.

剖宫产后阴道试产在无阴道分娩史妇女早产中的应用

目的探讨剖宫产后阴道试产(TOLAC)在无阴道分娩史的妇女早产中的应用。方法回顾性纳入2018年1月至2022年6月在本院接受TOLAC的无阴道分娩史且因早产住院的116名孕妇。根据TOLAC是否成功将研究对象分为TOLAC成功组(n=89)和TOLAC失败组(n=27)。采用最小绝对收缩和选择算子(LASSO)回归筛选TOLAC成功率相关变量,并构建TOLAC成功率预测模型,采用一致性指数(C-index)对预测模型进行内部验证。结果TOLAC成功组及TOLAC失败组的入院时宫颈扩张、入院时宫颈消失、破膜时间比较差异均有统计学意义(t=3.382、3.377、2.027,P<0.05),两组间的入院时硬膜外镇痛、Bishop评分<4、引产、胎膜早破、催产素给药比例比较差异均有统计学意义(χ^(2)值分别为3.517、8.024、14.111、6.570、4.038,P<0.05)。共纳入9个变量(入院时宫颈扩张、入院时宫颈消失、硬膜外镇痛、Bishop评分<4、引产、胎膜早破、破膜时间、催产素给药、分娩时宫颈扩张)用于LASSO回归筛选TOLAC成功率预测变量。应用列线图显示TOLAC成功率模型的预测因子:入院时宫颈扩张(OR=1.11,95%CI:1.04~1.19,P=0.003),引产(OR=0.89,95%CI:0.79~1.00,P=0.049),催产素给药(OR=0.71,95%CI:0.58~0.88,P=0.002),胎膜早破(OR=3.27,95%CI:2.49~4.45,P<0.001),Bishop评分<4(OR=0.33,95%CI:0.17~0.62,P=0.001)和硬膜外麻醉(OR=2.92,95%CI:1.42~6.48,P=0.005)。内部验证的结果显示以C指数衡量的TOLAC成功率的预测准确性为0.89。结论该模型对无阴道分娩史的早产妇女是否可行剖宫产后阴道试产的评估,有一定指导意义。

麦角新碱联合卡孕栓对剖宫产术后再次妊娠阴道分娩产妇产后出血的影响

目的探究麦角新碱联合卡孕栓对剖宫产术后再次妊娠阴道分娩(VBAC)产妇产后出血的影响。方法回顾性选取100例于2019年3月至2021年2月在首都医科大学附属北京妇产医院进行VBAC的产妇作为研究对象,根据产妇分娩后接受预防产后出血用药方案的差异分为观察组(n=50)和对照组(n=50)。对照组使用缩宫素联合卡孕栓治疗,观察组在对照组基础上加用麦角新碱治疗。比较两组产妇出血及止血情况、实验室检查结果、临床表现和安全性。结果对照组产妇的产后2 h及产后24 h出血量均大于观察组,对照组产妇的止血时间也长于观察组(P<0.05);治疗后,两组产妇的活化部分凝血活酶时间(APTT)、凝血酶凝固时间(TT)、血红蛋白(Hb)和纤维蛋白原(FIB)均有所降低,且对照组产妇的APTT、TT、FIB均高于观察组,Hb低于观察组(P<0.05);观察组产妇的宫缩持续时间较对照组更长,恶露持续时间和住院时间较对照组显著更短(P<0.05);观察组和对照组产妇的总不良反应发生率分别为14.00%和18.00%,差异无统计学意义(P>0.05)。结论麦角新碱联合卡孕栓能有效改善VBAC产妇产后出血的情况。

气囊仿生助产联合硬膜外麻醉分娩镇痛对剖宫产后阴道分娩女性盆底功能的影响

目的探讨气囊仿生助产联合硬膜外麻醉分娩镇痛对剖宫产后阴道分娩(vaginal birth after cesarean section,VBAC)女性盆底功能的影响。方法选取2020年1月至2021年12月南宁市妇幼保健院剖宫产后再次妊娠并成功阴道分娩的经产妇120例为研究对象,根据随机数字表法将其分为观察组和对照组,每组各60例。观察组产妇在分娩过程中采用气囊仿生助产联合硬膜外麻醉分娩镇痛,对照组产妇单纯采用硬膜外麻醉分娩镇痛。比较两组产妇的疼痛视觉模拟评分法(visual analogue scale,VAS)评分、会阴裂伤情况、总产程、产后出血量、新生儿窒息率及产妇产后6~8周尿失禁发生率、阴道或子宫脱垂发生率、盆底肌肌力及功能状态。结果观察组产妇的总产程显著短于对照组,产后出血量显著少于对照组,尿失禁发生率显著低于对照组(P<0.05)。观察组产妇的盆底肌肌力、盆底肌疲劳度、盆底动态压力均显著优于对照组(P<0.05)。两组产妇的会阴裂伤或侧切、阴道和子宫脱垂发生率比较差异均无统计学意义(P>0.05)。结论剖宫产后阴道试产时采用气囊仿生助产联合硬膜外麻醉镇痛可缩短产程,减少产后出血,改善产后盆底功能状况。

前次剖宫产手术时机对再孕阴道分娩母婴并发症的影响

目的探讨前次剖宫产手术时机对再孕阴道分娩母婴并发症的影响。方法回顾性分析本院收治的1034例足月剖宫产术后阴道分娩(VBAC)孕产妇资料。按前次剖宫产手术时机分为择期组(择期行剖宫产术)426例、第一产程组(第一产程行剖宫产术)278例、第二产程组(第二产程行剖宫产术)330例。分析前次剖宫产手术时机对VBAC孕产妇的产程、产后并发症及新生儿出生情况的影响。结果第二产程组子宫收缩乏力比例、产后24 h出血量、产后出血发生率及产后住院天数均大于择期组和第一产程组(P<0.05),而择期组与第一产程组比较,以上指标差异无统计学意义(P>0.05)。3组间第二、第三产程时限、助产率、会阴裂伤率、产后尿潴留率、发热比例及新生儿1 min Apgar评分、新生儿窒息发生率及转入新生儿科比例比较,差异无统计学意义(P>0.05)。结论前次第二产程剖宫产手术孕产妇再孕阴道分娩时发生子宫收缩乏力及产后出血风险增加。

改良VBAC评分法在剖宫产后阴道试产中的应用

目的探讨改良VBAC评分法在剖宫产后阴道试产中的应用价值。方法选择2014年1月至2019年10月沧州市中心医院产科住院的519例瘢痕子宫再妊娠有阴道分娩要求的孕妇作为研究对象。参考国外的评分方法,即Flamm、Gonen、Grobman、Metz的评分法,进行改良,建立新的评分法,选择与阴道分娩结局相关的各个因素,分为临产前评分及临产后评分两项,利用ROC曲线得到最佳截断值,分析改良的VBAC评分法与试产结局的关系。结果改良的VBAC评分法与Flamm、Metz法比较,ROC曲线下面积(0.979)明显大于Metz法(0.711)、Flamm法(0.623),三者相比,差异具有统计学意义(P<0.05),改良的VBAC评分法得到的最佳截断值为16,大于截断值与小于截断值的阴道分娩率相比,差异有统计学意义(P<0.05);对比分析分值大于截断值的阴道分娩组与非瘢痕子宫阴道分娩组的妊娠结局,肩难产、产后出血、产褥病率、子宫切除、新生儿窒息、产后住院天数比较,差异无统计学意义(P>0.05)。会阴侧切、阴道助产例数较对照组增高,差异具有统计学意义(P<0.05)。结论改良VBAC评分法与其它预测方法比较,能较好的预测剖宫产后阴道分娩的成功率,有一定的临床应用价值。

Labor Onset, Oxytocin Use, and Epidural Anesthesia for Vaginal Birth after Cesarean Section and Associated Effects on Maternal and Neonatal Outcomes in a Tertiary Hospital in China： A Retrospective Study

Background：In the mainland of China, the trial of labor after cesarean section is still a relatively new technique. In this study, we aimed to investigate the effects of labor onset, oxytocin use, and epidural anesthesia on maternal and neonatal outcomes for vaginal birth after cesarean section （VBAC） in a tertiary hospital in China.Methods：This was a retrospective study carried out on 212 VBAC cases between January 2015 and June 2017 in Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Relevant data were acquired on a form, including maternal age, gravidity and parity, body mass index before pregnancy, weight gain during pregnancy, type of labor onset, gestational age, the use of oxytocin and epidural anesthesia, birth mode, the duration of labor, and neonatal weight. The factors affecting maternal and neonatal outcomes for cases involving VBAC, especially with regards to postpartum hemorrhage （PPH） and fetal distress, were evaluated by univariate analysis and multivariable logistic regression.Results：Data showed that 36 women （17.0%） had postpartum hemorrhage （PPH） and 51 cases （24.1%） featured fetal distress. Normal delivery took place for 163 infants （76.9%） while 49 infants （23.1%） underwent operative vaginal deliveries with forceps. There were 178 cases （84.0%） of spontaneous labor and 34 cases （16.0%） required induction. Oxytocin was used in 54 cases （25.5%） to strengthen uterine contraction, and 65 cases （30.7%） received epidural anesthesia. The rate of normal delivery in cases involving PPH was significantly lower than those without PPH （61.1% vs. 80.1%; χ2 = 6.07, P = 0.01）. Multivariate logistic analysis showed that the intrapartum administration of oxytocin （odds ratio [OR] = 2.47; 95% confidence interval [CI] = 1.07–5.74; P = 0.04） and birth mode （OR = 0.40; 95% CI = 0.18–0.87; P = 0.02） was significantly associated with PPH in VBAC cases. Operative vaginal delivery occurred more frequently in the group with fetal distress than the group without （49.0% vs. 14.9%, χ2 = 25.36, P = 0.00）. Multivariate logistic analysis also revealed that the duration of total labor （OR = 1.01; 95% CI = 1.00–1.03; P = 0.04） and the gestational week of delivery （OR = 1.08; 95% CI = 1.05–1.11; P = 0.00） were significantly associated with fetal distress in VBAC.Conclusions：The administration of oxytocin during labor and birth was identified as a protective factor for PPH in VBAC while birth mode was identified as a risk factor. Finally, the duration of total labor and the gestational week of delivery were identified as risk factors for fetal distress in cases of VBAC. This information might help obstetricians provide appropriate interventions during labor and birth for VBAC.

VBAC试产结局的相关因素分析

目的探讨分析剖宫产后再阴道分娩(VBAC)试产结局的影响因素。方法回顾性分析深圳市罗湖区妇幼保健院妇产科2017年1月-2018年1月收拾的120例VBAC试产孕妇的临床资料,采用多因素logistic回归分析VBAC试产结局的影响因素。结果依据VBAC试产是否成功分为试产成功组和试产失败组,VBAC试产成功率为60.00%;两组在年龄、距离上次剖宫产时间、是否具有阴道分娩史及宫口扩张程度等方面比较具有显著差异(P<0.05);logistic回归分析显示,年龄、距离上次剖宫产时间、阴道分娩史及宫口扩张均是VBAC试产结局的影响因素。结论年龄、距离上次剖宫产时间、阴道分娩史及宫口扩张程度均是VBAC试产结局的重要影响因素,应做好产前检查,提高VBAC试产成功率,改善母婴结局。

剖宫产术后再次妊娠阴道试产影响因素探讨

目的:探讨剖宫产术后再次妊娠阴道分娩(vaginal birth after cesarean section,VBAC)成功率的影响因素,指导剖宫产术后再次妊娠阴道试产(trial of labor after cesarean,TOLAC)临床决策,提高VBAC成功率,减少不良母婴结局的发生。方法:回顾性分析2020年1月至2022年10月于重庆医科大学附属妇女儿童医院(重庆市妇幼保健院)产科中心TOLAC孕妇共452例,其中VBAC孕妇342例,TOLAC失败孕妇110例,根据最终分娩方式从各随机选取110例孕妇分为VBAC组和TOLAC失败组。采用单因素分析和多因素Logistic回归分析VBAC的影响因素,并比较2组孕产妇的妊娠结局。结果:①总体VBAC率为75.67%(342/452),TOLAC失败率为24.33%(110/452)。②产前影响因素单因素分析发现,VBAC组与TOLAC失败组孕妇的孕周分别为(38.44±2.13)、(38.96±1.34)周,既往因不良孕产史行引产分别为11.82%、2.80%,存在妊娠合并症为32.73%、20.56%,比较差异有统计学意义(均P<0.05)。入院时宫颈Bishop评分(5.15±1.69、3.71±1.52),既往阴道分娩史(32.73%、20.56%),自然临产(86.36%、17.76%)分别比较,差异也有统计学意义(均P<0.001)。③母婴妊娠结局单因素分析发现,新生儿体质量分别为(3191.82±489.00)、(3334.15±375.9)g,产后24 h出血量分别为(408.75±142.31)、(560.85±168.61)mL,VBAC组均低于TOLAC失败组,差异有统计学意义(均P<0.05)。TOLAC失败组中有7例不全子宫破裂。2组妊娠结局中输血、产褥感染、新生儿5 min Apgar评分的分别比较,差异无统计学意义。无孕产妇及围产儿死亡病例。④多因素Logistic回归分析显示,入院时宫颈Bishop评分(OR=0.122,95%CI=0.010~1.441)、既往阴道分娩史(OR=0.034,95%CI=1.297~715.194)、早产(OR=186.54,95%CI=2.225~15638.578)及自然临产(OR=52.37,95%CI=8.949~306.517)均是VBAC的影响因素。结论:VBAC的影响因素为孕妇的孕周、既往阴道分娩分娩史、既往因不良孕产史引产、存在妊娠合并症、入院时宫颈Bishop评分、自然临产、早产史。VBAC组产后24 h出血量低于TOLAC失败组。

剖宫产后阴道试产失败的影响因素分析

目的:探讨剖宫产后阴道试产(TOLAC)失败的影响因素。方法:回顾性分析2017年1月至2020年12月在首都医科大学附属北京积水潭医院妇产科住院分娩的TOLAC患者的病例资料共174例。根据此次分娩结局分为剖宫产后阴道分娩(VBAC)组(122例)和TOLAC失败组(52例),对两组的一般资料进行单因素分析,对TOLAC失败的影响因素进行Logistic回归分析;再根据此次分娩是否自然临产,分为自然临产组(124例)和引产组(50例),比较两组在TOLAC失败率上是否有差异;分析引产组中VBAC(26例)和TOLAC失败者(24例)一般资料的差异性;分析TOLAC失败组中自然临产(28例)和引产者(24例)的再次剖宫产指征构成比有无差异。结果:VBAC组与TOLAC失败组在分娩孕周[39^(+3)(38^(+5),40^(+1))周vs.40^(+1)(39^(+2),40^(+4))周,P=0.002]、新生儿出生体质量(3308.44±451.57 g vs.3469.23±334.04 g,P=0.022)、自然临产率(78.69%vs.53.85%,P=0.001)差异有统计学意义;在年龄、2次分娩间隔时间、前次分娩是否临产差异均无统计学意义(P>0.05)。经Logistic回归分析自然临产是TOLAC失败的保护因素(OR 0.395,95%CI 0.186~0.838,P=0.015)。引产组的TOLAC失败率高于自然临产组(48.00%vs.22.58%,P=0.001),但两组在年龄(P=0.612)、分娩孕周(P=0.704)、子宫颈评分(P=0.120)、新生儿出生体质量(P=0.688)差异均无统计学意义。TOLAC失败组中自然临产和引产者再次剖宫产指征的构成比差异无统计学意义(P=0.924)。结论:自然临产降低TOLAC失败的风险,需引产者TOLAC失败率升高。但对于有引产指征的TOLAC孕妇,引产仍然是一种可行的选择。仅孕周>40周不应排除TOLAC。

Profile of Pregnant Women and Success of the Uterine Test on a Uni or Bi-Scar Uterus at the Maternity Ward of Panzi Hospital, in the Democratic Republic of the Congo

Introduction: Trial of labor after a previous cesarean section (TOLAC) is a method that requires strict monitoring to decrease the cesarean section (CS) rate and improve the maternal and neonatal prognosis. The objective is to determine the profile and outcome of patients with one and two previous CSs who performed TOLAC at Panzi General Referral Hospital. Methodology: This is a cross-sectional study with a prospective collection of data of 111 patients with one and two previous CSs at Panzi Hospital from January 2021 to August 2022. Statistical Package for the Social Sciences SPSS version 23 software was used to analyze the collected data. The percentages of categorical variables were summarized in a frequency table. The mean or median with standard deviation was used to summarize quantitative variables. Results: The overall success rate of the TOLAC was 64%, with 63.8% following one previous CS and 64.3% following two CSs. The mean age of the patients was 27.09 years, with an age range of 25 - 34 years. They were mostly pauciparous (52.2%), married (88.3%), with a high school education (60.4%). The inter-delivery interval > 18 months was noted (64.1%) and overweight in 63.9%. More than three antenatal consultations were performed (58.6%). We found a mean gestational age of 38 (34 - 41) weeks. The perinatal mortality rate was 0.9%. However, we did not record any cases of maternal mortality during the study period. Conclusion: TOLAC after one and two previous CS is implemented in the maternity Unit of Panzi Hospital for well-selected patients. In addition, the success rate is similar after TOLAC with an acceptable maternal-neonatal prognosis.

3613例瘢痕子宫再次妊娠分娩结局分析

目的探讨瘢痕子宫对再次妊娠分娩结局的影响。方法回顾性收集3613例瘢痕子宫临床资料,按最终的分娩方式分为选择性再次剖宫产(ERCS组)和剖宫产后阴道分娩(VBAC组)组,分析两组妊娠期、分娩期的合并症及并发症发生情况。结果3613例瘢痕子宫再次妊娠,妊娠分娩合并症和并发症的发病率前10位依次是妊娠糖尿病(26.7%)、贫血(22.5%)、胎膜早破(13.1%)、产后出血(8.8%)、早产(6.7%)、巨大儿(6.5%)、妊娠高血压(6.4%)、前置胎盘(4.6%)、臀位(4.3%)及妊娠合并子宫肌瘤(3.8%)。ERCS组妊娠高血压、臀位、前置胎盘、产后出血发病率均高于VBAC组(P均<0.05);而VBAC组的妊娠合并甲状腺功能减退、胎膜早破、早产、子宫破裂发病率均高于ERCS组(P均<0.05)。结论瘢痕子宫会增加再次妊娠分娩合并症与并发症的发生,分娩方式的选择需权衡利弊,以改善母婴预后。

GDM孕妇剖宫产术后再次妊娠阴道分娩对母儿结局的影响

目的探讨妊娠期糖尿病孕妇剖宫产术后再次妊娠阴道分娩对母儿结局的影响。方法选择2016年1月—2021年12月在厦门市妇幼保健院收治的血糖控制正常的妊娠期糖尿病剖宫产术后再次妊娠产妇200例,按照不同的分娩方式分为剖宫产术后阴道分娩(vaginal birth after cesarean,VBAC)组和再次剖宫产(elective repeat cesarean,ERCS)组,其中VBAC组100例,ERCS组100例,分析不同分娩方式对母儿结局的影响。结果VBAC组和ERCS组比较,住院时间、费用以及产后出血量,ERCS组比VBAC组高,差异有统计学意义(P<0.05)。产褥感染、新生儿Apgar评分、新生儿窒息、新生儿低血糖症、新生胆红素血症,差异均无统计学意义(P>0.05)。结论在血糖控制好的情况下,妊娠期糖尿病剖宫产术后再次妊娠孕妇实施阴道分娩是较为理想的分娩方式,住院时间更短、费用更少,且母儿结局良好。

缩宫素联合分娩镇痛对剖宫产术后再次妊娠阴道分娩孕妇产程及母婴结局的影响

目的探讨缩宫素联合分娩镇痛对剖宫产术后再次妊娠阴道分娩孕妇产程及母婴结局的影响。方法选取2020年6月至2022年6月聊城市东昌府区妇幼保健院收治的140例剖宫产术后再次妊娠阴道分娩孕妇,采用随机数字表法分为对照组、观察组。对照组(70例)采用分娩镇痛,观察组(70例)采用缩宫素联合分娩镇痛,比较两组产程、母婴结局。结果观察组第一产程、第二产程和总产程短于对照组(P<0.05)。观察组产后出血、会阴侧切、胎吸助产发生率低于对照组(P<0.05)。观察组转儿科率低于对照组(P<0.05);两组新生儿1、5 min Apgar评分及胎儿窘迫发生率比较,差异无统计学意义(P>0.05)。结论缩宫素联合分娩镇痛在剖宫产术后再次妊娠阴道分娩孕妇中的应用效果较好,能够缩短产程,降低产后出血、会阴侧切、胎吸助产及转儿科的发生率。