Abstract：
BACKGROUND: Despite awareness of obstetricians to the constant increase in the number of cesarean sections in recent years, the fear of a uterine scar rupture is still present and influences the choice of the mode of delivery in patients with two previous cesarean sections. However, several clinical studies have suggested that, under certain conditions, vaginal birth after two cesarean sections is usually successful and safe.
OBJECTIVE: The objective of this study was to compare maternal and neonatal issues according to the planned mode of delivery in patients with two previous cesarean sections.
METHODS: It was a retrospective observational comparative study at Rennes University Hospital between January 1, 2013, and December 31, 2020. We performed a propensity score for the comparison of neonatal outcomes: cord pH, cord lactates, Apgar scores, transfer to neonatal unit and deaths, according to the planned delivery mode. Secondary outcomes were maternal issues: uterine rupture, post-partum hemorrhage, deaths.
RESULTS: A total of 410 patients with two previous cesarean section were eligible for our study. Prophylactic cesarean was performed in 358 cases (87.3%). Trial of labor was attempted in the 52 remaining patients (12.7%), 67.3 % of whom were successful. Neonatal weight, APGAR score at 1-5-10 min, and pH on cord blood were comparable in both groups. One case of uterine rupture occurred in the trial of labor group.
CONCLUSIONS: Trial of labor seems to be a reasonable option for women with two previous cesarean sections in a selected population.
OBJECTIVE: The objective of this study was to compare maternal and neonatal issues according to the planned mode of delivery in patients with two previous cesarean sections.
METHODS: It was a retrospective observational comparative study at Rennes University Hospital between January 1, 2013, and December 31, 2020. We performed a propensity score for the comparison of neonatal outcomes: cord pH, cord lactates, Apgar scores, transfer to neonatal unit and deaths, according to the planned delivery mode. Secondary outcomes were maternal issues: uterine rupture, post-partum hemorrhage, deaths.
RESULTS: A total of 410 patients with two previous cesarean section were eligible for our study. Prophylactic cesarean was performed in 358 cases (87.3%). Trial of labor was attempted in the 52 remaining patients (12.7%), 67.3 % of whom were successful. Neonatal weight, APGAR score at 1-5-10 min, and pH on cord blood were comparable in both groups. One case of uterine rupture occurred in the trial of labor group.
CONCLUSIONS: Trial of labor seems to be a reasonable option for women with two previous cesarean sections in a selected population.
摘要：
背景：尽管产科医生意识到近年来剖宫产的数量不断增加，对子宫瘢痕破裂的恐惧仍然存在，并影响了两次剖宫产患者分娩方式的选择。然而,一些临床研究表明，在一定条件下,两次剖宫产后阴道分娩通常是成功和安全的。
目的：本研究的目的是根据计划的分娩方式比较两次剖宫产的产妇和新生儿的问题。
方法：这是一项回顾性观察性比较研究，于2013年1月1日至2020年12月31日在雷恩大学医院进行。我们对新生儿结局的比较进行了倾向评分：脐带pH，脐带乳酸盐，阿普加得分,转移到新生儿单元和死亡，根据计划的交付模式。次要结果是产妇问题：子宫破裂，产后出血,死亡。
结果：共有410例两次剖宫产的患者符合我们的研究条件。预防性剖宫产358例(87.3%)。在剩下的52名患者（12.7％）中尝试了分娩试验，其中67.3%成功。新生儿体重,APGAR评分在1-5-10分钟，两组脐带血pH值相当。分娩组1例发生子宫破裂。
结论：对于在特定人群中两次剖宫产的妇女，试产似乎是一个合理的选择。
目的：本研究的目的是根据计划的分娩方式比较两次剖宫产的产妇和新生儿的问题。
方法：这是一项回顾性观察性比较研究，于2013年1月1日至2020年12月31日在雷恩大学医院进行。我们对新生儿结局的比较进行了倾向评分：脐带pH，脐带乳酸盐，阿普加得分,转移到新生儿单元和死亡，根据计划的交付模式。次要结果是产妇问题：子宫破裂，产后出血,死亡。
结果：共有410例两次剖宫产的患者符合我们的研究条件。预防性剖宫产358例(87.3%)。在剩下的52名患者（12.7％）中尝试了分娩试验，其中67.3%成功。新生儿体重,APGAR评分在1-5-10分钟，两组脐带血pH值相当。分娩组1例发生子宫破裂。
结论：对于在特定人群中两次剖宫产的妇女，试产似乎是一个合理的选择。
