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AJOG：剖后再顺的产程进展

2015-05-14 MedSci MedSci原创

TOLAC阴道分娩产程
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美国妇产科医师学会(ACOG)发布的最新指南，对有1次剖宫产史的大部分女性及有2次剖宫产史的许多女性而言，在剖宫产后尝试进行阴道分娩是更恰当的选择。Grantz KL等人进行了一项研究，纳入2892名首次剖宫产术后再次妊娠阴道试产(TOLAC)孕妇和56,301初产妇，参与者均是37-41+6周孕。研究者观察了两组人群自然临床或是引产临产后宫颈扩张速度和产程进展情况等。研究结果显示，TOLAC组有

美国妇产科医师学会(ACOG)发布的最新指南，对有1次剖宫产史的大部分女性及有2次剖宫产史的许多女性而言，在剖宫产后尝试进行阴道分娩是更恰当的选择。

Grantz KL等人进行了一项研究，纳入2892名首次剖宫产术后再次妊娠阴道试产(TOLAC)孕妇和56,301初产妇，参与者均是37-41+6周孕。研究者观察了两组人群自然临床或是引产临产后宫颈扩张速度和产程进展情况等。

研究结果显示，TOLAC组有23.4%的孕妇使用了引产，该数据在初产妇组为44.1% (P < .001)。TOLAC组最终分娩方式为剖宫产的比例是57.7%，高数据在初产妇组为19.0%(P < .001)。TOLAC组自然发动分娩机制的孕妇使用缩宫素的有52.4%，该数据在相配对初产妇组为64.3% (P < .001)。TOLAC组通过引产发动分娩机制的孕妇使用缩宫素的有89.8%，该数据在相配对初产妇组为91.6% (P = .099)；虽然人数上统计学差异不大，但是TOLAC组使用的缩宫素最大剂量低于初产妇组，该剂量的中位数(第90百分位数)分别为：6 (18) mU/min vs 12 (28) mU/min(P < .001)。


研究者还发现TOLAC组自然发动分娩机制的孕妇较想配对的初产妇组，其宫口4-10 cm所需要时间更长，中位数(第95百分位数) 长了0.9 (2.2)小时(P = .007)。自然发动分娩机制并且成功阴道分娩的孕妇，其产程进展在两组间无统计学差异。TOLAC组通过引产发动分娩机制的孕妇较配对的初产妇组，其宫口油4-10 cm所需要时间更长，中位数(第95百分位数)长了 1.5 (4.6)小时(P < .001)，并且TOLAC组通过引产发动分娩机制的孕妇其产程进展慢于配对的初产妇组。

研究结果表明，剖宫产术后再次妊娠阴道试产(TOLAC)孕妇比初产妇试产，所需产程时间更长，尤其是通过引产发动分娩机制的孕妇。研究者提出可以根据研究结果对TOLAC组产程进展上的差异使用新的或者特定的产程进展图，或许会更有助于掌握和管理该类人群的阴道分娩情况。

原始出处：

Grantz KL, Gonzalez-Quintero V, Troendle J, et al. Labor Patterns in Women Attempting Vaginal Birth After Cesarean With Normal Neonatal Outcomes. Am J Obstet Gynecol. 2015 .

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1771357, encodeId=fc131e71357c6, content=<a href='/topic/show?id=e4aa24540af' target=_blank style='color:#2F92EE;'>#产程#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=24540, encryptionId=e4aa24540af, topicName=产程)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Mon Apr 04 11:03:00 CST 2016, time=2016-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23910, encodeId=7a9b2391075, content=看看, beContent=null, objectType=article, channel=null, level=null, likeNumber=134, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Sun May 17 20:05:00 CST 2015, time=2015-05-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23545, encodeId=03612354568, content=厉害, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=hbwang006, createdTime=Thu May 14 23:00:00 CST 2015, time=2015-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23531, encodeId=6e45235318f, content=。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=MedSci客户端网友, createdTime=Thu May 14 18:22:00 CST 2015, time=2015-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23530, encodeId=c70723530c5, content=。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=MedSci客户端网友, createdTime=Thu May 14 18:14:00 CST 2015, time=2015-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23529, encodeId=89b4235296e, content=技术厉害啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=159, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=MedSci客户端网友, createdTime=Thu May 14 18:10:00 CST 2015, time=2015-05-14, status=1, ipAttribution=)]
    2016-04-04 zhaojie88

    #产程#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1771357, encodeId=fc131e71357c6, content=<a href='/topic/show?id=e4aa24540af' target=_blank style='color:#2F92EE;'>#产程#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=24540, encryptionId=e4aa24540af, topicName=产程)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Mon Apr 04 11:03:00 CST 2016, time=2016-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23910, encodeId=7a9b2391075, content=看看, beContent=null, objectType=article, channel=null, level=null, likeNumber=134, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Sun May 17 20:05:00 CST 2015, time=2015-05-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23545, encodeId=03612354568, content=厉害, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=hbwang006, createdTime=Thu May 14 23:00:00 CST 2015, time=2015-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23531, encodeId=6e45235318f, content=。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=MedSci客户端网友, createdTime=Thu May 14 18:22:00 CST 2015, time=2015-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23530, encodeId=c70723530c5, content=。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=MedSci客户端网友, createdTime=Thu May 14 18:14:00 CST 2015, time=2015-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23529, encodeId=89b4235296e, content=技术厉害啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=159, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=MedSci客户端网友, createdTime=Thu May 14 18:10:00 CST 2015, time=2015-05-14, status=1, ipAttribution=)]
    2015-05-17 huaxipanxing

    看看

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1771357, encodeId=fc131e71357c6, content=<a href='/topic/show?id=e4aa24540af' target=_blank style='color:#2F92EE;'>#产程#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=24540, encryptionId=e4aa24540af, topicName=产程)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Mon Apr 04 11:03:00 CST 2016, time=2016-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23910, encodeId=7a9b2391075, content=看看, beContent=null, objectType=article, channel=null, level=null, likeNumber=134, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Sun May 17 20:05:00 CST 2015, time=2015-05-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23545, encodeId=03612354568, content=厉害, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=hbwang006, createdTime=Thu May 14 23:00:00 CST 2015, time=2015-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23531, encodeId=6e45235318f, content=。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=MedSci客户端网友, createdTime=Thu May 14 18:22:00 CST 2015, time=2015-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23530, encodeId=c70723530c5, content=。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=MedSci客户端网友, createdTime=Thu May 14 18:14:00 CST 2015, time=2015-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23529, encodeId=89b4235296e, content=技术厉害啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=159, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=MedSci客户端网友, createdTime=Thu May 14 18:10:00 CST 2015, time=2015-05-14, status=1, ipAttribution=)]
    2015-05-14 hbwang006

    厉害

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1771357, encodeId=fc131e71357c6, content=<a href='/topic/show?id=e4aa24540af' target=_blank style='color:#2F92EE;'>#产程#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=24540, encryptionId=e4aa24540af, topicName=产程)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Mon Apr 04 11:03:00 CST 2016, time=2016-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23910, encodeId=7a9b2391075, content=看看, beContent=null, objectType=article, channel=null, level=null, likeNumber=134, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Sun May 17 20:05:00 CST 2015, time=2015-05-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23545, encodeId=03612354568, content=厉害, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=hbwang006, createdTime=Thu May 14 23:00:00 CST 2015, time=2015-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23531, encodeId=6e45235318f, content=。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=MedSci客户端网友, createdTime=Thu May 14 18:22:00 CST 2015, time=2015-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23530, encodeId=c70723530c5, content=。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=MedSci客户端网友, createdTime=Thu May 14 18:14:00 CST 2015, time=2015-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23529, encodeId=89b4235296e, content=技术厉害啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=159, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=MedSci客户端网友, createdTime=Thu May 14 18:10:00 CST 2015, time=2015-05-14, status=1, ipAttribution=)]
    2015-05-14 MedSci客户端网友

    。。。

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1771357, encodeId=fc131e71357c6, content=<a href='/topic/show?id=e4aa24540af' target=_blank style='color:#2F92EE;'>#产程#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=24540, encryptionId=e4aa24540af, topicName=产程)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Mon Apr 04 11:03:00 CST 2016, time=2016-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23910, encodeId=7a9b2391075, content=看看, beContent=null, objectType=article, channel=null, level=null, likeNumber=134, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Sun May 17 20:05:00 CST 2015, time=2015-05-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23545, encodeId=03612354568, content=厉害, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=hbwang006, createdTime=Thu May 14 23:00:00 CST 2015, time=2015-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23531, encodeId=6e45235318f, content=。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=MedSci客户端网友, createdTime=Thu May 14 18:22:00 CST 2015, time=2015-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23530, encodeId=c70723530c5, content=。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=MedSci客户端网友, createdTime=Thu May 14 18:14:00 CST 2015, time=2015-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23529, encodeId=89b4235296e, content=技术厉害啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=159, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=MedSci客户端网友, createdTime=Thu May 14 18:10:00 CST 2015, time=2015-05-14, status=1, ipAttribution=)]
    2015-05-14 MedSci客户端网友

    。。。

    0

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    2015-05-14 MedSci客户端网友

    技术厉害啊

    0