Background: Trial of labour after Caesarean section (TOLAC) refers to an attempt at vaginal delivery after a previous caesarean section. Outcome is influenced by a number of factors which are important in patient’s s...Background: Trial of labour after Caesarean section (TOLAC) refers to an attempt at vaginal delivery after a previous caesarean section. Outcome is influenced by a number of factors which are important in patient’s selection. Objectives: The aim of this study was to find out the incidence and feto-maternal outcome of the practice of Trial of labour after Caesarean section. Methodology: This is a retrospective study of cases of vaginal birth after Caesarean section Data were retrieved from the case notes of patients who attempted vaginal birth after Caesarean section from January 1, 2013 to December 31, 2017, a period of five years. Result: There were 10,669 deliveries, 3179 of which were through Caesarean section. This gave a Caesarean section rate of 29.8%. A total of 217 patients attempted vaginal birth after Caesarean section and 83 ended up as repeat Caesarean section (38.2%) while 138 (61.8%) had successful vaginal birth after Caesarean section. Patients with previous vaginal delivery, age range 25 - 29 years and interdelivery interval of greater than or equal to 2 years were more successful at achieving vaginal birth after Caesarean section. The leading indications for the repeat Caesarean section include cephalopelvic disproportion (45.8%), poor progress of labour (19.3%) and hypertensive disorders of pregnancy (8.4%). Conclusion: Vaginal birth after Caesarean section was successful in most of the parturients that attempted it in this study especially in patients within the age range of 25 - 29 years, those that have had previous vaginal delivery and with interdelivery interval of greater than or equal to 2 years.展开更多
目的探讨剖宫产后阴道试产(trial of labor after caesarean,TOLAC)成功阴道分娩的影响因素。方法回顾性分析2017年1月至2019年12月北京积水潭医院产科仅有1次剖宫产史,无子宫手术史,无引产史的妊娠28周及以上TOLAC孕妇161例的临床资料...目的探讨剖宫产后阴道试产(trial of labor after caesarean,TOLAC)成功阴道分娩的影响因素。方法回顾性分析2017年1月至2019年12月北京积水潭医院产科仅有1次剖宫产史,无子宫手术史,无引产史的妊娠28周及以上TOLAC孕妇161例的临床资料,并根据阴道分娩结局分为成功组(n=101)和失败组(n=60),采用logistic回归法分析各种因素在两组之间的差异。结果161例孕妇中,TOLAC成功101例,失败60例,成功率为62.7%,无子宫破裂和孕妇死亡,新生儿结局均良好。两组孕妇的孕周、体质指数(body mass index,BMI)、妊娠前BMI、瘢痕厚度、初次剖宫产试产比较,差异均无统计学意义(P>0.05)。logistic单因素回归分析显示,年龄<35岁、与前次分娩间隔时间<8年、新生儿体质量<3500 g及初次分娩宫口扩张≥3 cm为TOLAC成功的有利因素,差异有统计学意义(P<0.05);logistic多因素回归分析上述因素,差异均无统计学意义(P>0.05);两组是否自然临产比较,差异有统计学意义(P<0.05),成功组自然临产率明显高于失败组(P<0.05)。结论剖宫产术后再次妊娠孕妇在严密监测下行TOLAC是安全可行的,自然临产TOLAC成功率高。展开更多
文摘Background: Trial of labour after Caesarean section (TOLAC) refers to an attempt at vaginal delivery after a previous caesarean section. Outcome is influenced by a number of factors which are important in patient’s selection. Objectives: The aim of this study was to find out the incidence and feto-maternal outcome of the practice of Trial of labour after Caesarean section. Methodology: This is a retrospective study of cases of vaginal birth after Caesarean section Data were retrieved from the case notes of patients who attempted vaginal birth after Caesarean section from January 1, 2013 to December 31, 2017, a period of five years. Result: There were 10,669 deliveries, 3179 of which were through Caesarean section. This gave a Caesarean section rate of 29.8%. A total of 217 patients attempted vaginal birth after Caesarean section and 83 ended up as repeat Caesarean section (38.2%) while 138 (61.8%) had successful vaginal birth after Caesarean section. Patients with previous vaginal delivery, age range 25 - 29 years and interdelivery interval of greater than or equal to 2 years were more successful at achieving vaginal birth after Caesarean section. The leading indications for the repeat Caesarean section include cephalopelvic disproportion (45.8%), poor progress of labour (19.3%) and hypertensive disorders of pregnancy (8.4%). Conclusion: Vaginal birth after Caesarean section was successful in most of the parturients that attempted it in this study especially in patients within the age range of 25 - 29 years, those that have had previous vaginal delivery and with interdelivery interval of greater than or equal to 2 years.
文摘目的探讨剖宫产后阴道试产(trial of labor after caesarean,TOLAC)成功阴道分娩的影响因素。方法回顾性分析2017年1月至2019年12月北京积水潭医院产科仅有1次剖宫产史,无子宫手术史,无引产史的妊娠28周及以上TOLAC孕妇161例的临床资料,并根据阴道分娩结局分为成功组(n=101)和失败组(n=60),采用logistic回归法分析各种因素在两组之间的差异。结果161例孕妇中,TOLAC成功101例,失败60例,成功率为62.7%,无子宫破裂和孕妇死亡,新生儿结局均良好。两组孕妇的孕周、体质指数(body mass index,BMI)、妊娠前BMI、瘢痕厚度、初次剖宫产试产比较,差异均无统计学意义(P>0.05)。logistic单因素回归分析显示,年龄<35岁、与前次分娩间隔时间<8年、新生儿体质量<3500 g及初次分娩宫口扩张≥3 cm为TOLAC成功的有利因素,差异有统计学意义(P<0.05);logistic多因素回归分析上述因素,差异均无统计学意义(P>0.05);两组是否自然临产比较,差异有统计学意义(P<0.05),成功组自然临产率明显高于失败组(P<0.05)。结论剖宫产术后再次妊娠孕妇在严密监测下行TOLAC是安全可行的,自然临产TOLAC成功率高。
