导读：澳大利亚研究人员发现，在头一胎生产时采用剖腹产的孕妇如果试图自然生产第二胎，生产风险会增加。澳大利亚妇幼健康研究中心研究员卡罗琳·克劳瑟在报告中说：“这一研究结果有助于女性、医生和政策制定者改进健康建议、作出有利于第二胎孕妇健康的决定。”
剖腹产后再自然生产风险高
澳大利亚研究人员发现，在头一胎生产时采用剖腹产的孕妇如果试图自然生产第二胎，生产风险会增加。
《科学公共图书馆—医学》杂志3月13日刊登澳大利亚妇产科研究人员的这篇学术报告。研究人员调用澳大利亚14家医院2300多名第二次怀孕的头胎剖腹产孕妇的产科记录，其中大约一半女性在产前登记时选择剖腹产，另一半女性登记时倾向于自然生产。
统计发现，在两个对比组中，自然生产的孕妇在生产时出现母亲或婴儿死亡的比例为2.4%，而剖腹产孕妇的这一比例为0.9%；前者出现大出血的比例为2.3%，后者的这一比例为0.8%。
澳大利亚妇幼健康研究中心研究员卡罗琳·克劳瑟在报告中说：“这一研究结果有助于女性、医生和政策制定者改进健康建议、作出有利于第二胎孕妇健康的决定。”
按法新社说法，在全球范围内，剖腹产比例呈现上升趋势。如今在澳大利亚，大约三分之一的婴儿经由剖腹产降生。
Planned Vaginal Birth or Elective Repeat Caesarean: Patient Preference Restricted Cohort with Nested Randomised Trial
Caroline A. Crowther, Jodie M. Dodd, Janet E. Hiller, Ross R. Haslam, Jeffrey S. Robinson
Background Uncertainty exists about benefits and harms of a planned vaginal birth after caesarean (VBAC) compared with elective repeat caesarean (ERC). We conducted a prospective restricted cohort study consisting of a patient preference cohort study, and a small nested randomised trial to compare benefits and risks of a planned ERC with planned VBAC. Methods and findings 2,345 women with one prior caesarean, eligible for VBAC at term, were recruited from 14 Australian maternity hospitals. Women were assigned by patient preference (n = 2,323) or randomisation (n = 22) to planned VBAC (1,225 patient preference, 12 randomised) or planned ERC (1,098 patient preference, ten randomised). The primary outcome was risk of fetal death or death of liveborn infant before discharge or serious infant outcome. Data were analysed for the 2,345 women (100%) and infants enrolled. The risk of fetal death or liveborn infant death prior to discharge or serious infant outcome was significantly lower for infants born in the planned ERC group compared with infants in the planned VBAC group (0.9% versus 2.4%; relative risk [RR] 0.39; 95% CI 0.19–0.80; number needed to treat to benefit 66; 95% CI 40–200). Fewer women in the planned ERC group compared with women in the planned VBAC had a major haemorrhage (blood loss ≥1,500 ml and/or blood transfusion), (0.8% [9/1,108] versus 2.3% [29/1,237]; RR 0.37; 95% CI 0.17–0.80). Conclusions Among women with one prior caesarean, planned ERC compared with planned VBAC was associated with a lower risk of fetal and infant death or serious infant outcome. The risk of major maternal haemorrhage was reduced with no increase in maternal or perinatal complications to time of hospital discharge. Women, clinicians, and policy makers can use this information to develop health advice and make decisions about care for women who have had a previous caesarean.
文献链接：https://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001192
