Abstract：
This study aims to investigate whether trial of labor after cesarean delivery (TOLAC) in women with antepartum fetal death, is associated with an elevated risk of maternal morbidity. A retrospective multicenter. TOLAC of singleton pregnancies following a single low-segment incision were included. Maternal adverse outcomes were compared between women with antepartum fetal death and women with a viable fetus. Controls were matched with cases in a 1:4 ratio based on their previous vaginal births and induction of labor rates. Univariate analysis was followed by multiple logistic regression modeling. During the study period, 181 women experienced antepartum fetal death and were matched with 724 women with viable fetuses. Univariate analysis revealed that women with antepartum fetal death had significantly lower rates of TOLAC failure (4.4% vs. 25.1%, p < 0.01), but similar rates of composite adverse maternal outcomes (6.1% vs. 8.0%, p = 0.38) and uterine rupture (0.6% vs. 0.3%, p = 0.56). Multivariable analyses controlling for confounders showed that an antepartum fetal death vs. live birth isn\'t associated with the composite adverse maternal outcomes (aOR 0.96, 95% CI 0.21-4.44, p = 0.95). TOLAC in women with antepartum fetal death is not associated with an increased risk of adverse maternal outcomes while showing high rates of successful vaginal birth after cesarean (VBAC).
摘要：
本研究旨在探讨产前胎儿死亡妇女剖宫产后分娩（TOLAC）的试验，与产妇发病风险升高有关。回顾性多中心。包括单个低段切口后单胎妊娠的TOLAC。比较了产前胎儿死亡的妇女和有存活胎儿的妇女之间的产妇不良结局。根据先前的阴道分娩和引产率，将对照组与病例以1：4的比例进行匹配。单因素分析后进行多因素logistic回归建模。在学习期间,181名妇女经历了产前胎儿死亡，并与724名具有存活胎儿的妇女相匹配。单因素分析显示，产前胎儿死亡的妇女TOLAC失败率明显较低（4.4%vs.25.1%,p<0.01),但复合不良产妇结局的发生率相似(6.1%vs.8.0%,p=0.38）和子宫破裂（0.6%vs.0.3%,p=0.56）。控制混杂因素的多变量分析表明，产前胎儿死亡与活产与复合不良母婴结局无关(aOR0.96,95%CI0.21-4.44,p=0.95)。产前胎儿死亡妇女的TOLAC与不良产妇结局的风险增加无关，同时显示剖宫产后阴道分娩成功率高（VBAC）。
