The association between gestational age and maternal adverse outcomes in patients undergoing trial of labor after cesarean.

IF 17.7 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY Accounts of Chemical Research Pub Date : 2024-08-01 Epub Date: 2022-11-07 DOI:10.23736/S2724-606X.22.05174-0

Stephen S Rasiah, Amber Young, Christina Raker, Adam K Lewkowitz, Megha Gupta, Michal F Bartal, Stephen M Wagner

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Abstract

Background: Although successful trial of labor after cesarean (TOLAC) resulting in vaginal birth after cesarean (VBAC) can lead to improved maternal and neonatal outcomes, an unsuccessful TOLAC is associated with increased risk of uterine rupture, higher blood loss, and increased risk of infection. Data remain limited in terms of whether differences in gestational age of patients who attempt TOLAC affect maternal morbidity. The aim of this study was to examine the association between gestational age and maternal adverse outcomes in women undergoing trial of labor after cesarean.

Methods: This population-based cross-sectional study used birth data from the U.S. National Vital Statistics from 2014 to 2018. Women with liveborn singleton gestation who underwent TOLAC at 23-41 weeks' gestation were included in the analytic population. The primary outcome was a composite of maternal adverse outcomes: admission to the Intensive Care Unit, blood transfusion, uterine rupture, or unplanned hysterectomy. Secondary outcomes were individual measures within the primary composite outcome. Outcomes were compared between patients who underwent TOLAC at term (37-41 weeks gestational age) and those who underwent TOLAC at preterm (23-36 weeks gestational age). Multivariable analyses were adjusted for demographic and obstetric differences between the two groups.

Results: 455,284 patients met inclusion criteria for the study; 39,589 (8.7%) were at a preterm gestational age (GA) and 415,695 (91.3%) were at a term GA. The overall composite maternal adverse outcome was significantly higher for patients undergoing TOLAC at preterm GA (12.0 per 1000 live births) compared to term GA (8.0 per 1000 live births; aRR=1.42; 95% CI: 1.29-1.56). Among individual conditions within the primary composite outcome, preterm gestational age was associated with increased risk of admission to the Intensive Care Unit, blood transfusion, and unplanned hysterectomy.

Conclusions: In patients who underwent TOLAC, preterm gestational age was associated with increased risk of adverse maternal outcomes.

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剖宫产后试产患者的胎龄与产妇不良结局之间的关系。

背景：虽然成功的剖宫产后试产（TOLAC）会导致剖宫产后阴道分娩（VBAC），从而改善产妇和新生儿的预后，但不成功的 TOLAC 与子宫破裂风险增加、失血量增加和感染风险增加有关。关于尝试 TOLAC 的患者的孕龄差异是否会影响孕产妇发病率的数据仍然有限。我们的目的是研究剖宫产后试产妇女的孕龄与产妇不良结局之间的关系：这项基于人群的横断面研究使用了 2014 年至 2018 年美国国家生命统计的出生数据。在妊娠 23 - 41 周时接受 TOLAC 的活产单胎妊娠妇女被纳入分析人群。主要结局是产妇不良结局的综合结果：入住重症监护室、输血、子宫破裂或意外子宫切除。次要结果是主要综合结果中的个别测量指标。对足月（胎龄 37-41 周）和早产（胎龄 23-36 周）接受 TOLAC 的患者的结局进行了比较。多变量分析对两组之间的人口统计学和产科差异进行了调整：有 455 284 名患者符合研究的纳入标准，其中 39 589 人（8.7%）为早产孕龄（GA），415 695 人（91.3%）为足月孕龄。与足月胎龄（8.0‰；aRR1.42；95% CI 1.29-1.56）相比，在早产胎龄（12.0‰）时接受 TOLAC 的患者的总体产妇综合不良结局明显更高。在主要综合结果中，早产胎龄与入住重症监护室、输血和计划外子宫切除术的风险增加有关：结论：在接受TOLAC手术的患者中，早产妊娠与孕产妇不良结局风险增加有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.

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