目的:我们的目的是分析一个前瞻性的基于人群的登记,包括四个低收入和中等收入国家的五个地点,以观察剖宫产后阴道分娩与再次剖宫产的相关特征,以及与既往有剖宫产史的妇女的分娩方式相关的产妇和新生儿结局。
目的:剖宫产后阴道分娩的母产和围产结局与复发性剖宫产相似。
方法:一项基于人群的前瞻性研究,包括2017年至2020年在危地马拉社区进行的家庭和设施分娩,印度(Belagavi和那格浦尔),巴基斯坦,孟加拉国。妇女在怀孕期间登记,分娩结果数据在出生后42天内收集.
结果:我们分析了8267例有剖宫产史的妇女;1389例(16.8%)剖宫产后阴道分娩,再次剖宫产分娩6878例(83.2%)。再次剖宫产与需要刮宫呈负相关(ARR0.12[0.06,0.25]),但与输血呈正相关(ARR3.74[2.48,5.63])。再次剖宫产与死产呈负相关(ARR0.24[0.15,0.49]),出生后一小时内母乳喂养(ARR0.39[0.30,0.50]),但与抗生素的使用呈正相关(ARR1.51[1.20,1.91])。
结论:在选定的南亚和拉丁美洲低收入和中等收入地区,既往有剖宫产史的女性在医院分娩的可能性是剖宫产分娩的5倍.与再次剖宫产分娩的人相比,经阴道分娩的人的妊娠和分娩过程较少复杂,但是他们死产的风险增加了。在低收入国家环境中需要进行更大规模的研究,以给出更强有力的建议。
背景:NCT01073475,2010年2月21日注册,https://clinicaltrials.gov/ct2/show/record/NCT01073475。
OBJECTIVE: Our objective was to analyze a prospective population-based registry including five sites in four low- and middle-income countries to observe characteristics associated with vaginal birth after cesarean versus repeat cesarean birth, as well as maternal and newborn outcomes associated with the mode of birth among women with a history of prior cesarean.
OBJECTIVE: Maternal and perinatal outcomes among vaginal birth after cesarean section will be similar to those among recurrent cesarean birth.
METHODS: A prospective population-based study, including home and facility births among women enrolled from 2017 to 2020, was performed in communities in Guatemala, India (Belagavi and Nagpur), Pakistan, and Bangladesh. Women were enrolled during pregnancy, and delivery outcome data were collected within 42 days after birth.
RESULTS: We analyzed 8267 women with a history of prior cesarean birth; 1389 (16.8%) experienced vaginal birth after cesarean, and 6878 (83.2%) delivered by a repeat cesarean birth. Having a repeat cesarean birth was negatively associated with a need for curettage (ARR 0.12 [0.06, 0.25]) but was positively associated with having a blood transfusion (ARR 3.74 [2.48, 5.63]). Having a repeat cesarean birth was negatively associated with stillbirth (ARR 0.24 [0.15, 0.49]) and, breast-feeding within an hour of birth (ARR 0.39 [0.30, 0.50]), but positively associated with use of antibiotics (ARR 1.51 [1.20, 1.91]).
CONCLUSIONS: In select South Asian and Latin American low- and middle-income sites, women with a history of prior cesarean birth were 5 times more likely to deliver by cesarean birth in the hospital setting. Those who delivered vaginally had less complicated pregnancy and labor courses compared to those who delivered by repeat cesarean birth, but they had an increased risk of stillbirth. More large scale studies are needed in Low Income Country settings to give stronger recommendations.
BACKGROUND: NCT01073475, Registered February 21, 2010, https://clinicaltrials.gov/ct2/show/record/NCT01073475 .