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

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Open Journal of Obstetrics and Gynecology 2014年第1期4卷 33-41页

作者： Mahmoud Fathy Hassan Osama El-Tohamy Assistant Professor in Obstetrics and Gynecology Faculty of Medicine Ain-Shams University Cairo Egypt Lecturer of Obstetrics and Gynecology Faculty of Medicine Ain-Shams University Cairo Egypt

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.

关键词： Dinoprostone Induction of Labor Trial of Labor after Cesarean tolac Vaginal Birth after Cesarean VBAC

Transvaginal Ultrasonographic Measurement of Lower Uterine Segment in Term Pregnant Patients with Previous Cesarean Section

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Open Journal of Obstetrics and Gynecology 2015年第11期5卷 646-653页

作者： Anitha Thomas Grace Rebekah Reeta Vijayaselvi Ruby Jose Christian Medical College Vellore India

Background: With an aim to reduce the rates of repeat cesarean section in women with a previous scar, prediction of scar rupture or dehiscence is important. If we could predict the risk of rupture by measuring the scar thickness closer to term, we could pursue a trial of scar safely. Aims: To evaluate the use of ultrasound measured thickness of lower uterine segment as one of the predictors of scar rupture or dehiscence in labour and establish a cut off beyond which trial of labour can be attempted safely. Methodology: 187 randomly selected pregnant women with history of one previous cesarean section in the past who satisfied the inclusion criteria, attending the outpatient clinic over a period of six months, at a tertiary level teaching institution in southern India were selected and counseled to undergo a transvaginal measurement of the scar region. These women were then followed up until delivery and the outcome of trial of scar, successful vaginal delivery, rupture or dehiscence of uterus was analysed in relation to the scar thickness and various other contributing factors. Results: 187 women with history of previous cesarean section, attending the outpatient clinic were randomly chosen to undergo trans vaginal scan at term. 52 underwent elective cesarean section and 135 went through trial of scar. The median cut-off of the lower uterine segment in this study population of 135 was 2.4 mm. The sensitivity was 90.9%, specificity was 43.5%, positive predictive value was 12.5%, and negative predictive value was 98.3% at this cut-off for scar rupture or dehiscence. Conclusions: The lower uterine scar thickness could be a useful tool to predict scar rupture. This could aid in making decisions regarding induction of labour with oxytocin in women with previous cesarean section.

关键词： tolac Transvaginal Ultrasonography Scar Thickness

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

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Open Journal of Obstetrics and Gynecology 2023年第1期13卷 37-46页

作者： Hytham Atia Amani Khider Nagy M. Metwally Faculty of Medicine Zagazig University Zagazig Sharkia Egypt King Faisal Military City Hospital Armed Forces Hospital Southern Region Khamis Mushait KSA

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.

关键词： tolac VBAC Cesarean Section Indication Prediction of Success of Vaginal Birth after Cesarean

剖宫产术后瘢痕子宫再次妊娠分娩方式和结局的分析

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剖宫产术后瘢痕子宫再次妊娠分娩方式和结局的分析

作者：孙云霞昆明医科大学

学位级别：硕士

[目的]分析剖宫产术后瘢痕子宫再次妊娠患者分娩方式及母婴结局。[方法]回顾性分析2016年7月1日至2017年6月30日昆明医科大学第一附属医院产科收治的1144例剖宫产术后瘢痕子宫再次妊娠患者分娩方式及母婴结局。将1144例剖宫产术后瘢痕... 详细信息

[目的]分析剖宫产术后瘢痕子宫再次妊娠患者分娩方式及母婴结局。[方法]回顾性分析2016年7月1日至2017年6月30日昆明医科大学第一附属医院产科收治的1144例剖宫产术后瘢痕子宫再次妊娠患者分娩方式及母婴结局。将1144例剖宫产术后瘢痕子宫再次妊娠患者根据其个人意愿和医师综合评估结果分为 tolac(trial of labor after cesarean)组 522 例,其中 VBAC(vaginal birth after cesarean)组405例(A组),tolac失败组117例(B组);非tolac组622例(C组),比较各组在年龄、孕周、产前体重指数(BMI)、术后再孕间隔时间、首次剖宫产指征、既往有无阴道试产史或阴道分娩史、此次入院Bishop评分、再次剖宫产指征、产后出血量、产后出血率、输血率、子宫瘢痕裂开率、阴道试产过程中分娩诱导与子宫瘢痕裂开的关系、产后转ICU率、住院天数以及新生儿出生体重、新生儿Apgar评分、产后转NICU率方面的差异。[结果]本文1144例剖宫产术后瘢痕子宫再次妊娠患者,其中tolac522例,tolac成功405例,成功率为77.59%。1144例孕产妇中无完全性子宫破裂者和产褥感染者,有8例子宫瘢痕裂开者(0.70%)。A组1例新生儿因母亲重度子痫前期、低蛋白血症、早产、轻度窒息经抢救无效而夭折。C组2例新生儿因母亲凶险性前置胎盘、早产、重度窒息家属放弃抢救自行抱走。1.三组患者产前一般资料情况比较,A组与B组之间年龄、术后再孕间隔时间、此次入院Bishop评分比较差异有统计学意义(P0.05)。三组首次剖宫产指征中因母亲要求而行首次剖宫产为各组首要原因。2.三组患者产后情况比较,A组患者产后出血量、输血率、住院天数均低于B组、C组(P0.05)。A组产后转ICU率低于C组(P0.05)。A组与B组在阴道试产过程中行分娩诱导不增加子宫瘢痕裂开的风险(P>0.05)。3.三组新生儿情况比较,A组新生儿出生体重均低于B组、C组(P0.05)。A组新生儿1分钟Apgar评分高于C组(P0.05)。B组新生儿产后转NICU率均高于A组、C组(P0.05)。三组新生儿产后转NICU指征中因早产转NICU为各组首要原因。[结论]1、妊娠年龄、BMI、术后再孕间隔时间、既往有无阴道试产史或阴道分娩史、Bishop评分、首次剖宫产指征、胎儿体重是剖宫产术后瘢痕子宫再次妊娠患者tolac成功的影响因素。2、既往有阴道试产史或阴道分娩史是tolac成功的有利条件。3、在严密监护下,根据患者实际情况选择适合的分娩诱导方式,如CRB球囊促宫颈成熟、缩宫素加强宫缩、人工破膜分娩诱导不增加子宫瘢痕裂开风险。4、有阴道试产意愿和条件的患者经综合评估后给予阴道试产具有可行性,并且VBAC可降低产后出血量、输血率,缩短住院天数,降低再次剖宫产率。

关键词：剖宫产术后瘢痕子宫剖宫产术 tolac VBAC 子宫瘢痕裂开

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瘢痕子宫再次妊娠的孕期管理

中国实用乡村医生杂志 2018年第3期25卷 8-10页

作者：许慧京李秋玲中国医科大学附属盛京医院妇产科沈阳110022

本文对瘢痕子宫再次妊娠的孕期管理进行介绍。

关键词：瘢痕子宫孕期管理 tolac VBAC

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剖宫产术后阴道试产90例的临床观察

甘肃医药 2019年第5期38卷 426-428页

作者：和丽娟庆阳市人民医院

目的:通过对剖宫产术后阴道试产90例孕妇临床观察,探讨在本院开展剖宫产后阴道试产(tolac)的可行性。方法:将2015年7月至2017年10月,既往1次剖宫产术史并2年以上、孕周38~41周无阴道分娩禁忌症的90例tolac孕妇,在严格观察下试产成功、... 详细信息

目的:通过对剖宫产术后阴道试产90例孕妇临床观察,探讨在本院开展剖宫产后阴道试产(tolac)的可行性。方法:将2015年7月至2017年10月,既往1次剖宫产术史并2年以上、孕周38~41周无阴道分娩禁忌症的90例tolac孕妇,在严格观察下试产成功、中转剖宫产以及子宫破裂的相关因素进行回顾性分析比较,探讨tolac成功率和安全性的影响因素。结果:90例剖宫产术后阴道试产者顺产73例,2例因胎儿宫内窘迫急诊行剖宫产术,2例产程中要求剖宫产、8例因产程不进展中转剖宫产术,4例因机转不正中转剖宫产术,1例子宫破裂;tolac成功与孕妇年龄、体质指数,胎儿体重,孕周,阴道分娩史、自然临产有关;子宫破裂与前次子宫切口方式有关;孕期宣教管理、产前评估、严密监测产程及胎心、即刻剖宫产术是影响tolac成功率和安全性的重要因素。结论:本院在开展tolac中阴道分娩、提高剖宫产后再次妊娠中tolac的比率、减少手术损伤及并发症。

关键词：剖宫产后 tolac 阴道试产基层医院

剖宫产术后再次妊娠经阴道试产导致子宫破裂的因素及其预防

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武警医学 2018年第6期29卷 561-565页

作者：王晓宏于莎莎富冬梅陈晔虹郭方方大兴区妇幼保健院产科北京102600

目的探讨孕产妇首次剖宫术后再次妊娠经阴道试产(trial of labor after previous cesarean delivery,tolac)引起子宫破裂的重要因素及预防。方法选取2015-10至2017-10剖宫产术后再次妊娠,在孕30周首次筛查符合阴道试产条件的,无试产绝... 详细信息

目的探讨孕产妇首次剖宫术后再次妊娠经阴道试产(trial of labor after previous cesarean delivery,tolac)引起子宫破裂的重要因素及预防。方法选取2015-10至2017-10剖宫产术后再次妊娠,在孕30周首次筛查符合阴道试产条件的,无试产绝对禁忌证者共412例,分析样本的分娩方式及导致子宫破裂重要因素。结果经过回顾性分析得出,共有215例进行了tolac,试产阴道分娩(vaginal birth after cesarean,VBAC)成功率为72.56%(156/215),剖宫产率为27.44%(59/215),完全子宫破裂发生率仅为0.47%(1/215)。根据试产结局将样本分为两组,阴道分娩组及再次剖宫产组,其中阴道分娩组的产后出血量明显低于再次剖宫产组(Ptolac绝对危险性很小,产妇年龄、巨大儿及瘢痕厚度等均不是绝对禁忌证,但在做最后决策时,必须考虑本文推断出的共性因素,即胎心和宫缩情况,以提高tolac的成功率,降低子宫破裂发生率。

关键词： tolac 子宫破裂分娩结局胎心异常

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剖宫产术后再次妊娠阴道试产的研究进展

中文科技期刊数据库（引文版）医药卫生 2023年第5期 171-174页

作者：赖春玲侯兴娟广西钦州市第一人民医院广西钦州535099

随着生育政策的转变,越来越多的剖宫产术后再次妊娠孕妇面临选择分娩方式的问题。传统的选择性重复剖宫产术虽然可以规避子宫破裂风险,但造成的母体二次损伤和较高的产后出血风险仍是无法忽视的。相比之下,剖宫产术后再次妊娠阴道试产... 详细信息

随着生育政策的转变,越来越多的剖宫产术后再次妊娠孕妇面临选择分娩方式的问题。传统的选择性重复剖宫产术虽然可以规避子宫破裂风险,但造成的母体二次损伤和较高的产后出血风险仍是无法忽视的。相比之下,剖宫产术后再次妊娠阴道试产和分娩逐渐被广泛推广。通过转变围生保健模式,提高人们对这种方式的认知和接受度,产前准确评估孕妇的可行性条件,严格把控适应证和禁忌证,并在产时采取合理的辅助手段干预,可以显著提高剖宫产术后再次妊娠阴道试产和分娩的安全性和成功率。本文通过分析相关文献,综述了剖宫产术后再次妊娠阴道试产和分娩的研究进展。

关键词：剖宫产术 tolac VBAC 再次妊娠阴道试产