Introduction

Despite awareness of obstetricians to the constant increase in the number of cesarean sections in recent years, the fear of a uterine scar rupture is still present and influences the choice of the mode of delivery in patients with two previous cesarean sections. However, several clinical studies have suggested that, under certain conditions, vaginal birth after two cesarean sections is usually successful and safe.

Objective

The objective of this study was to compare maternal and neonatal issues according to the planned mode of delivery in patients with two previous cesarean sections.

Methods

It was a retrospective observational comparative study at Rennes University Hospital between January 1, 2013, and December 31, 2020. We performed a propensity score for the comparison of neonatal outcomes: cord pH, cord lactates, Apgar scores, transfer to neonatal unit and deaths, according to the planned delivery mode. Secondary outcomes were maternal issues: uterine rupture, post-partum hemorrhage, deaths.

Results

A total of 410 patients with two previous cesarean section were eligible for our study. Prophylactic cesarean was performed in 358 cases (87.3%). Trial of labor was attempted in the 52 remaining patients (12.7%), 67.3 % of whom were successful. Neonatal weight, APGAR score at 1–5–10 min, and pH on cord blood were comparable in both groups. One case of uterine rupture occurred in the trial of labor group.

Conclusion

Trial of labor seems to be a reasonable option for women with two previous cesarean sections in a selected population.

中文翻译：

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对既往接受过两次剖腹产手术的患者进行临产与择期剖宫产的试验：回顾性倾向评分分析

介绍

尽管产科医生意识到近年来剖宫产数量不断增加，但对子宫疤痕破裂的恐惧仍然存在，并影响了两次剖宫产患者对分娩方式的选择。然而，一些临床研究表明，在某些情况下，两次剖腹产后的阴道分娩通常是成功且安全的。

客观的

本研究的目的是根据既往两次剖腹产的患者的计划分娩方式比较孕产妇和新生儿问题。

方法

这是 2013 年 1 月 1 日至 2020 年 12 月 31 日在雷恩大学医院进行的一项回顾性观察比较研究。我们对新生儿结局进行了倾向评分：脐带 pH 值、脐带乳酸、阿普加评分、转移到新生儿病房和死亡，按照计划的交付方式。次要结局是产妇问题：子宫破裂、产后出血、死亡。

结果

共有 410 名曾接受过两次剖腹产手术的患者符合我们的研究资格。358例（87.3%）进行了预防性剖宫产。其余 52 名患者（12.7%）尝试分娩，其中 67.3% 成功。两组的新生儿体重、1-5-10 分钟 APGAR 评分以及脐带血 pH 值相当。临产组试验中发生1例子宫破裂。

结论

对于特定人群中曾进行过两次剖腹产的女性来说，试产似乎是一个合理的选择。