{"title":"剖宫产后阴道分娩成功的决定因素：中国东南部回顾性队列研究。","authors":"Ying-Ling Xiu, Bing-Qing Lv","doi":"10.2147/IJWH.S507648","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to identify factors influencing the success of a trial of labor after cesarean section (TOLAC) and to evaluate associated maternal and neonatal outcomes.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on data from women with a prior cesarean section who underwent TOLAC at Fujian Maternity and Child Health Hospital in Southeast China between January 2016 and January 2018. Of the 1179 women who attempted TOLAC, 1038 achieved vaginal birth after cesarean (VBAC) while 141 experienced unsuccessful trials. Sociodemographic and clinical characteristics were compared between the successful and unsuccessful TOLAC groups using the <i>t</i>-test for normally distributed data, non-parametric tests for non-normally distributed data, and the χ2 test, corrected chi-square test, or Fisher's exact test for categorical variables, as appropriate. Logistic regression analysis was performed to identify factors independently associated with successful TOLAC, with the results expressed as Odds Ratios (ORs) and corresponding 95% Confidence Intervals (CIs).</p><p><strong>Results: </strong>Multivariable logistic regression analysis revealed that maternal height (OR = 1.09, 95% CI = 1.05-1.14), abdominal circumference (OR = 0.95, 95% CI = 0.91-0.98), ultrasound-estimated fetal weight (OR = 0.99, 95% CI = 0.99-1.00), and history of vaginal delivery (OR = 9.62, 95% CI = 2.33-39.67) were independently associated with successful TOLAC. No significant differences were observed between the successful and unsuccessful TOLAC groups in terms of neonatal asphyxia, postpartum hemorrhage, placental abruption, or bladder injury.</p><p><strong>Conclusion: </strong>Maternal height, abdominal circumference, ultrasound-estimated fetal weight, and history of vaginal delivery were identified as influential factors for VBAC success. Clinical evaluation of these factors may enhance the selection criteria for TOLAC candidates, potentially increasing VBAC rates and reducing cesarean section rates overall.</p>","PeriodicalId":14356,"journal":{"name":"International Journal of Women's Health","volume":"17 ","pages":"1183-1191"},"PeriodicalIF":2.5000,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12050019/pdf/","citationCount":"0","resultStr":"{\"title\":\"Determinants of Successful Vaginal Birth After Cesarean Section: A Retrospective Cohort Study in Southeast China.\",\"authors\":\"Ying-Ling Xiu, Bing-Qing Lv\",\"doi\":\"10.2147/IJWH.S507648\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>This study aimed to identify factors influencing the success of a trial of labor after cesarean section (TOLAC) and to evaluate associated maternal and neonatal outcomes.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on data from women with a prior cesarean section who underwent TOLAC at Fujian Maternity and Child Health Hospital in Southeast China between January 2016 and January 2018. Of the 1179 women who attempted TOLAC, 1038 achieved vaginal birth after cesarean (VBAC) while 141 experienced unsuccessful trials. Sociodemographic and clinical characteristics were compared between the successful and unsuccessful TOLAC groups using the <i>t</i>-test for normally distributed data, non-parametric tests for non-normally distributed data, and the χ2 test, corrected chi-square test, or Fisher's exact test for categorical variables, as appropriate. Logistic regression analysis was performed to identify factors independently associated with successful TOLAC, with the results expressed as Odds Ratios (ORs) and corresponding 95% Confidence Intervals (CIs).</p><p><strong>Results: </strong>Multivariable logistic regression analysis revealed that maternal height (OR = 1.09, 95% CI = 1.05-1.14), abdominal circumference (OR = 0.95, 95% CI = 0.91-0.98), ultrasound-estimated fetal weight (OR = 0.99, 95% CI = 0.99-1.00), and history of vaginal delivery (OR = 9.62, 95% CI = 2.33-39.67) were independently associated with successful TOLAC. No significant differences were observed between the successful and unsuccessful TOLAC groups in terms of neonatal asphyxia, postpartum hemorrhage, placental abruption, or bladder injury.</p><p><strong>Conclusion: </strong>Maternal height, abdominal circumference, ultrasound-estimated fetal weight, and history of vaginal delivery were identified as influential factors for VBAC success. Clinical evaluation of these factors may enhance the selection criteria for TOLAC candidates, potentially increasing VBAC rates and reducing cesarean section rates overall.</p>\",\"PeriodicalId\":14356,\"journal\":{\"name\":\"International Journal of Women's Health\",\"volume\":\"17 \",\"pages\":\"1183-1191\"},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2025-04-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12050019/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal of Women's Health\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.2147/IJWH.S507648\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"OBSTETRICS & GYNECOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Women's Health","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2147/IJWH.S507648","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的：本研究旨在确定影响剖宫产后分娩试验（TOLAC）成功的因素，并评估相关的孕产妇和新生儿结局。方法：回顾性分析2016年1月至2018年1月在福建省妇幼保健院行剖宫产术的孕妇资料。在1179名尝试TOLAC的妇女中，1038名在剖宫产后阴道分娩（VBAC）， 141名试验失败。使用正态分布数据的t检验，非正态分布数据的非参数检验，以及对分类变量的χ2检验、校正卡方检验或Fisher精确检验（视情况而定），比较成功组和不成功组之间的社会人口学和临床特征。进行Logistic回归分析，以确定与TOLAC成功相关的独立因素，结果以比值比（ORs）和相应的95%置信区间（CIs）表示。结果：多变量logistic回归分析显示，产妇身高（OR = 1.09, 95% CI = 1.05-1.14）、腹围（OR = 0.95, 95% CI = 0.91-0.98）、超声估计胎儿体重（OR = 0.99, 95% CI = 0.99-1.00）、阴道分娩史（OR = 9.62, 95% CI = 2.33-39.67）与TOLAC的成功与否独立相关。在新生儿窒息、产后出血、胎盘早剥或膀胱损伤方面，成功组与不成功组之间无显著差异。结论：产妇身高、腹围、超声估计胎儿体重、阴道分娩史是影响VBAC成功的因素。对这些因素的临床评估可能会提高TOLAC候选人的选择标准，潜在地提高VBAC率并降低剖宫产率。
Determinants of Successful Vaginal Birth After Cesarean Section: A Retrospective Cohort Study in Southeast China.
Objective: This study aimed to identify factors influencing the success of a trial of labor after cesarean section (TOLAC) and to evaluate associated maternal and neonatal outcomes.
Methods: A retrospective analysis was conducted on data from women with a prior cesarean section who underwent TOLAC at Fujian Maternity and Child Health Hospital in Southeast China between January 2016 and January 2018. Of the 1179 women who attempted TOLAC, 1038 achieved vaginal birth after cesarean (VBAC) while 141 experienced unsuccessful trials. Sociodemographic and clinical characteristics were compared between the successful and unsuccessful TOLAC groups using the t-test for normally distributed data, non-parametric tests for non-normally distributed data, and the χ2 test, corrected chi-square test, or Fisher's exact test for categorical variables, as appropriate. Logistic regression analysis was performed to identify factors independently associated with successful TOLAC, with the results expressed as Odds Ratios (ORs) and corresponding 95% Confidence Intervals (CIs).
Results: Multivariable logistic regression analysis revealed that maternal height (OR = 1.09, 95% CI = 1.05-1.14), abdominal circumference (OR = 0.95, 95% CI = 0.91-0.98), ultrasound-estimated fetal weight (OR = 0.99, 95% CI = 0.99-1.00), and history of vaginal delivery (OR = 9.62, 95% CI = 2.33-39.67) were independently associated with successful TOLAC. No significant differences were observed between the successful and unsuccessful TOLAC groups in terms of neonatal asphyxia, postpartum hemorrhage, placental abruption, or bladder injury.
Conclusion: Maternal height, abdominal circumference, ultrasound-estimated fetal weight, and history of vaginal delivery were identified as influential factors for VBAC success. Clinical evaluation of these factors may enhance the selection criteria for TOLAC candidates, potentially increasing VBAC rates and reducing cesarean section rates overall.
期刊介绍：
International Journal of Women''s Health is an international, peer-reviewed, open access, online journal. Publishing original research, reports, editorials, reviews and commentaries on all aspects of women''s healthcare including gynecology, obstetrics, and breast cancer. Subject areas include: Chronic conditions including cancers of various organs specific and not specific to women Migraine, headaches, arthritis, osteoporosis Endocrine and autoimmune syndromes - asthma, multiple sclerosis, lupus, diabetes Sexual and reproductive health including fertility patterns and emerging technologies to address infertility Infectious disease with chronic sequelae including HIV/AIDS, HPV, PID, and other STDs Psychological and psychosocial conditions - depression across the life span, substance abuse, domestic violence Health maintenance among aging females - factors affecting the quality of life including physical, social and mental issues Avenues for health promotion and disease prevention across the life span Male vs female incidence comparisons for conditions that affect both genders.
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