■剖腹产(CS)率在全球范围内一直在上升,导致越来越多的妇女面临两次剖腹产后试产(TOLAC-2)或选择选择性重复剖腹产(ERCS)之间的决定。这项研究评估和比较了TOLAC和ERCS在有两次CS分娩史的女性中的安全性结果。
■PubMed,MEDLINE,EMBase,和Cochrane中央对照试验登记册(CENTRAL)数据库被搜索到2023年6月30日之前发表的研究。根据预定标准纳入符合条件的研究,并采用随机效应模型汇集孕产妇和新生儿结局数据.
■纳入了13项研究,样本量合计为101,011名曾有两次CS的女性。与ERCS相比,TOLAC-2与更高的孕产妇死亡率(比值比(OR)=1.50,95%置信区间(CI)=1.25-1.81)和更高的子宫破裂机会(OR=7.15,95%CI=3.44-14.87)相关。然而,没有发现其他产妇结局的相关性,包括输血,子宫切除术,或产后出血。此外,新生儿结局,比如阿普加分数,NICU入院,和新生儿死亡率,在TOLAC-2和ERCS组中具有可比性。
我们的研究结果表明,使用TOLAC-2会增加子宫破裂和孕产妇死亡的风险,强调需要个性化风险评估和医疗保健专业人员共同决策。需要更多的研究来完善我们在TOLAC-2背景下对这些结果的理解。
UNASSIGNED: Cesarean section (CS) rates have been on the rise globally, leading to an increasing number of women facing the decision between a Trial of Labor after two Cesarean Sections (TOLAC-2) or opting for an Elective Repeat Cesarean Section (ERCS). This study evaluates and compares safety outcomes of TOLAC and ERCS in women with a history of two previous CS deliveries.
UNASSIGNED: PubMed, MEDLINE, EMbase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched for studies published until 30 June 2023. Eligible studies were included based on predetermined criteria, and a random-effects model was employed to pool data for maternal and neonatal outcomes.
UNASSIGNED: Thirteen studies with a combined sample size of 101,011 women who had two prior CS were included. TOLAC-2 was associated with significantly higher maternal mortality (odds ratio (OR)=1.50, 95% confidence interval (CI)= 1.25-1.81) and higher chance of uterine rupture (OR = 7.15, 95% CI = 3.44-14.87) compared to ERCS. However, no correlation was found for other maternal outcomes, including blood transfusion, hysterectomy, or post-partum hemorrhage. Furthermore, neonatal outcomes, such as Apgar scores, NICU admissions, and neonatal mortality, were comparable in the TOLAC-2 and ERCS groups.
UNASSIGNED: Our findings suggest an increased risk of uterine rupture and maternal mortality with TOLAC-2, emphasizing the need for personalized risk assessment and shared decision-making by healthcare professionals. Additional studies are needed to refine our understanding of these outcomes in the context of TOLAC-2.