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首页> 美国政府科技报告 >Vaginal Birth After Cesarean: New Insights. Program and Abstracts. NIH Consensus Development Conference, William H. Natcher Conference Center, NIH, Bethesda, Maryland, March 8-10, 2010
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Vaginal Birth After Cesarean: New Insights. Program and Abstracts. NIH Consensus Development Conference, William H. Natcher Conference Center, NIH, Bethesda, Maryland, March 8-10, 2010

机译：剖腹产后的阴道出生：新的见解。计划和摘要。 NIH共识发展会议，William H. Natcher会议中心，美国国立卫生研究院，马里兰州贝塞斯达，2010年3月8日至10日

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摘要

Vaginal birth after cesarean (VBAC) is the delivery of a baby through the vagina after a previous cesarean delivery. For most of the 20th century, once a woman had undergone a cesarean (the delivery of a baby through an incision made in the abdominal wall and uterus), many clinicians believed that all of her future pregnancies would require delivery by cesarean as well. However, in 1980, a National Institutes of Health (NIH) Consensus Development Conference panel questioned the necessity of routine repeat cesarean deliveries and outlined situations in which VBAC could be considered. The option for a woman with a previous cesarean delivery to try to labor and deliver vaginally, rather than to plan a cesarean delivery, was therefore offered and exercised more often from the 1980s through the early 1990s. Since 1996, however, VBAC rates in the United States have consistently declined, while cesarean delivery rates have been steadily rising. The exact causes of these shifts are not entirely understood. A frequently cited concern about VBAC is the possibility of uterine rupture during labor, because a cesarean delivery leaves a scar in the wall of the uterus at the incision site, which is weaker than other uterine tissue. Attempted VBAC may also be associated with endometritis (infection of the lining of the uterus), the need for a hysterectomy (removal of the uterus), and blood transfusion, as well as neurologic injury to the baby. However, repeat cesarean delivery may also carry a risk of bleeding or the need for a hysterectomy, uterine infections, and respiratory problems for the newborn. In addition, multiple cesarean deliveries may be associated with placental problems in future pregnancies. Other important considerations that may influence the decision include the number of previous cesarean deliveries a woman has experienced; the surgical incision used during previous cesarean delivery; the reason for the previous surgical delivery; the womans age; how far along the pregnancy is, relative to her due date; and the size and position of the baby. Given the complexity of this issue, a thorough examination of the relative balance of benefits and harms to mother and baby will be of immediate utility to practitioners and pregnant women in deciding on a planned mode of delivery.

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