Abstract：
OBJECTIVE: To compare mode of delivery and maternal and neonatal outcomes using cervical ripening balloon (CRB) for induction of labor (IOL) in nulliparous patients vs. those undergoing first trial of labor after cesarean (TOLAC).
METHODS: Retrospective cohort study including data from two tertiary medical centers. Included were all patients with a singleton pregnancy and a gestational age > 37+0 weeks and no prior vaginal birth undergoing IOL with CRB. Nulliparous patients (nulliparous group) were compared to patients with one prior cesarean delivery (CD) and no prior vaginal delivery (TOLAC group). Patients who withdrew consent for trial of labor at any time in both groups were excluded. The primary outcome was mode of delivery.
RESULTS: Overall, 161 patients were included in the TOLAC group and 1577 in the nulliparous group. The rate of CD was similar in both groups and remained similar after adjusting for confounders (29.8 % vs. 28.9 %, p = 0.86, OR 1.1, 95 %, CI 0.76-1.58). CD due to fetal distress was more common in the TOLAC group (75 % vs. 56 %, p = 0.014). Other maternal outcomes and neonatal outcomes were similar in the two groups.
CONCLUSIONS: Comparable vaginal delivery rates may be achieved in patients with or without a previous CD attempting their first trial of labor, with a cervical ripening balloon for labor induction, without increasing adverse maternal or neonatal outcomes.
METHODS: Retrospective cohort study including data from two tertiary medical centers. Included were all patients with a singleton pregnancy and a gestational age > 37+0 weeks and no prior vaginal birth undergoing IOL with CRB. Nulliparous patients (nulliparous group) were compared to patients with one prior cesarean delivery (CD) and no prior vaginal delivery (TOLAC group). Patients who withdrew consent for trial of labor at any time in both groups were excluded. The primary outcome was mode of delivery.
RESULTS: Overall, 161 patients were included in the TOLAC group and 1577 in the nulliparous group. The rate of CD was similar in both groups and remained similar after adjusting for confounders (29.8 % vs. 28.9 %, p = 0.86, OR 1.1, 95 %, CI 0.76-1.58). CD due to fetal distress was more common in the TOLAC group (75 % vs. 56 %, p = 0.014). Other maternal outcomes and neonatal outcomes were similar in the two groups.
CONCLUSIONS: Comparable vaginal delivery rates may be achieved in patients with or without a previous CD attempting their first trial of labor, with a cervical ripening balloon for labor induction, without increasing adverse maternal or neonatal outcomes.
摘要：
目的：比较未分娩患者使用宫颈成熟球囊（CRB）引产（IOL）的分娩方式和母婴结局那些在剖宫产(TOLAC)后接受第一次分娩试验的人。
方法：回顾性队列研究，包括来自两个三级医疗中心的数据。包括所有单胎妊娠和胎龄>37+0周的患者，并且没有先前的阴道分娩经历CRB的IOL。将未产患者（未产组）与先前有一次剖宫产（CD）和先前没有阴道分娩（TOLAC组）的患者进行比较。两组中在任何时间撤回同意分娩试验的患者均被排除。主要结果是分娩方式。
结果：总体而言，161例患者纳入TOLAC组，1577例纳入未产组。两组的CD发生率相似，在校正混杂因素后仍然相似(29.8%vs.28.9%,p=0.86，或1.1，95%，CI0.76-1.58）。由于胎儿窘迫引起的CD在TOLAC组中更为常见（75％vs.56%,p=0.014)。两组的其他产妇结局和新生儿结局相似。
结论：先前有或没有CD的患者尝试他们的第一次分娩试验，可以达到相当的阴道分娩率。用宫颈成熟气球引产，不会增加不良的孕产妇或新生儿结局。
方法：回顾性队列研究，包括来自两个三级医疗中心的数据。包括所有单胎妊娠和胎龄>37+0周的患者，并且没有先前的阴道分娩经历CRB的IOL。将未产患者（未产组）与先前有一次剖宫产（CD）和先前没有阴道分娩（TOLAC组）的患者进行比较。两组中在任何时间撤回同意分娩试验的患者均被排除。主要结果是分娩方式。
结果：总体而言，161例患者纳入TOLAC组，1577例纳入未产组。两组的CD发生率相似，在校正混杂因素后仍然相似(29.8%vs.28.9%,p=0.86，或1.1，95%，CI0.76-1.58）。由于胎儿窘迫引起的CD在TOLAC组中更为常见（75％vs.56%,p=0.014)。两组的其他产妇结局和新生儿结局相似。
结论：先前有或没有CD的患者尝试他们的第一次分娩试验，可以达到相当的阴道分娩率。用宫颈成熟气球引产，不会增加不良的孕产妇或新生儿结局。
