疤痕子宫阴道分娩的团队合作Anthony 课件.ppt

* * CS rate has risen to 32.9% in 2009 (from 5% in 1970) In the 1970s, recommendations to increase TOLAC 1996 – CS rate decreased to 20% However, as TOLAC rates increased so did complications Other reasons for CS are fetal compromise and EFM may be attributing. Breech deliveries By 2006, VBAC rate decreased to 8.5% * Purpose: evaluate the evidence regarding the safety and outcome of TOLAC and VBAC and to propose solutions. Over 3000 citations in literature but Data are insufficient because: Inconsistent definitions of uterine rupture and dehiscence, wide variation in induction protocols, heterogeneity in patient populations, and inconsistency in primary outcome measures. * Risk of intrapartum or neonatal death with TOLAC ~ 1/1000. One study reported no serious neonatal morbidity in 78 cases of uterine rupture when 17 min elapsed between prolonged FHR deceleration and delivery. * Uterine dehiscence is an incomplete disruption of the myometrium with intact serosa. True uterine rupture is defined as a full-thickness tear through the uterine wall. Seriousness depends on size and location. Most common presenting sign is fetal heart rate abnormality: subtle variable decelerations evolving into late decelerations, bradycardia and undetectable FHR. * * No panacea. Greater blood loss, longer recover, more neonatal respiratory disorders, thromboembolic events. Uncontrollable hemorrhage associated with these complications have become the most common indication for peripartum hysterectomy. * * * * Most studies on VBAC have been conducted in university or tertiary centers under ideal conditions. Yet the majority of women in the US are delivered in smaller community hospitals where Obs and anethesiologists may not be available. Rates quoted often represented a selected population. * Successful VBAC has less complications than a repeat CD Patients who must undergo CS after failed TOLAC have highest risk of infections and other maternal complications. * The chance for VBAC