剖宫产术后再次妊娠经阴道分娩预测模型研究进展

陈晓明 陈震宇

[摘要] 既往的高剖宫产率致使“二胎”政策全面放开以来，有剖宫产史的女性再次妊娠的比例逐年增高，面临分娩方式的选择，给这些女性及产科医生均带来了困扰。目前多国权威指南已指出，剖宫产术后再次妊娠行阴道试产（TOLAC）应该被推荐，并已有诸多研究构建剖宫产术后再次妊娠经阴道分娩（VBAC）预测模型，在严格把握指征的前提下，评估和筛选VBAC成功率相对较高人群进行阴道试产，以提高TOLAC安全性及TOLAC率，進一步降低剖宫产率，并降低由重复剖宫产（ERCS）带来的近远期并发症发生率。本文对国内外有关剖宫产术后再次妊娠经阴道分娩（VBAC）预测模型的研究进展进行综述，包括VBAC预测模型的基本情况、预测模型的比较分析及未来可能的发展方向。

[关键词] 剖宫产术后再次妊娠;阴道分娩;预测模型;Logistic回归

[中图分类号] R719.8          [文献标识码] A          [文章编号] 1673-9701（2021）25-0184-05

Research progress on a predictive model of vaginal birth after cesarean

CHEN Xiaoming   CHEN Zhenyu

Department of Obstetrics and Gynecology， General Hospital of Northern Theater Command of Chinese People's Liberation Army， Shenyang   110000， China

[Abstract] Since the high rate of cesarean section in the past led to the full liberalization of the "second-child" policy， the proportion of women with a history of cesarean section getting pregnant again is increasing year by year. They are faced with the choice of delivery methods， which has brought troubles to these women and obstetricians. At present， authoritative guidelines in many countries have pointed out that trial of labor after cesarean（TOLAC）should be recommended， and many studies have established a predictive model of vaginal birth after cesarean（VBAC）. Under the premise of strictly grasping the indications， the population with a relatively high success rate of VBAC was assessed and screened for vaginal trial delivery to improve the safety and the rate of TOLAC， further reduce the rate of short-term and long-term complications brought by elective repeated cesarean sections（ERCS）. This article reviews the research progress of prediction models for vaginal delivery after cesarean（VBAC）at home and abroad， including the basic situation of VBAC prediction models， comparative analysis of prediction models， and possible future development directions.

[Key words] Repeated pregnancy after cesarean; Vaginal delivery; Prediction model; Logistic regression

近些年剖宫产率持续升高，随着“全面二胎政策”的放开，剖宫产术后再次妊娠的孕妇比例不断上升，甚至在一些三级甲等医院，瘢痕子宫已成为剖宫产指征的第一位[1]。早在20世纪初，“一次剖宫产，永远剖宫产”的观点深入人心，然而，随着现代医学的发展和妇产科的不断进步，国内外已有大量研究证实，一次剖宫产术后再次妊娠经阴道试产（Trial of labor after cesarean section，TOLAC）安全可行，是一种合理的选择，成功率可达60%～80%[2-3]，并有证据表明，剖宫产术后再次妊娠成功经阴道分娩（Vaginal birth after cesarean section，VBAC）降低了孕产妇和围产儿的发病率和死亡率，并且降低了经济成本[4-5]，故多个国家的指南与共识均提倡符合适应证的瘢痕子宫孕妇选择TOLAC。……