指南速递 | SOGC临床实践指南 NO.382 剖宫产术后再次妊娠阴道试产（三）

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译者：汪文雁 陈琼 张茜 田迪雅 厦门大学附属成功医院（解放军陆军第七十三集团军医院）

审校：郑剑兰 厦门大学附属成功医院（解放军陆军第七十三集团军医院）

2次或2次以上剖宫产史的孕产妇

有2次剖宫产史的孕产妇的VBAC成功率似乎与只有1次剖宫产史的相似[78-81]。一项包括17项研究的系统回顾，比较了1次和2次剖宫产后选择TOLAC和选择第三次重复剖宫产的母婴结局[78]。其中6项研究报道50685名1次剖宫产史VBAC和4565名2次剖宫产史VBAC孕产妇，其VBAC成功率相似(76.5% vs. 71.7%; OR 1.48 [1.23−1.78])[80-85]。然而，1次剖宫产史孕产妇的子宫破裂、输血和子宫切除率低于2次剖宫产史的孕产妇，(0.72% vs. 1.59%; OR 0.42 [0.29−0.60];1.21% vs. 1.99%; OR 0.56 [0.40−0.77]; 0.19% vs.0.56%; OR 0.29 [0.13−0.61])，但两组的新生儿结局似乎相似。与选择第三次重复剖宫产的10897名孕产妇相比，有2次剖宫产史的TOLAC（2829名）孕产妇发生子宫破裂风险(1.09% vs.0.11%)更高[80,81,86-91]，而输血、子宫切除和新生儿结局似乎无统计学差异[78]。

Miller等探讨了有1次剖宫产史(4100名)与有2次剖宫产史(152名)的孕产妇IOL的差异[79]。在这两组中，VBAC成功率（69%和65%）同样比总体的估计值低。研究表明，有2次剖宫产史的孕产妇选择IOL和TOLAC与有1次剖宫产史的孕产妇ERCS的母婴结局相似。值得注意的是，尽管本研究中的总样本量较大（10262名孕产妇），但有2次剖宫产史TOLAC的孕产妇仅152名[79]。

建议

13、有2次剖宫产史的与有1次剖宫产史的孕产妇的VBAC相似。但在剖宫产史超过1次的情况下，应告知孕产妇在TOLAC过程中出现子宫破裂的风险较高(II-2B)。   

14、关于2次以上剖宫产史孕产妇的研究有限。

臀位

Hannah等的大型多中心研究表明：臀位的足月择期剖宫产与良好的母婴结局密切相关[92]。

虽然，SOGC及其他国际组织的确支持选择合适的孕产妇进行阴道试产。但还没有解决臀位TOLAC后阴道分娩问题的数据。因此，应单独考虑这些情况。对有剖宫产史的孕产妇，可以采用臀位倒转术[93,94]。

建议

15、TOLAC并不是臀位孕产妇的绝对禁忌症。但应告知孕产妇，目前没有足够的资料来评估臀位TOLAC的风险(III-B)。

多胎妊娠

9项研究中1533名多胎妊娠孕产妇选择TOLAC的的研究表明[95-98]，双胎妊娠的TOLAC成功率与单胎妊娠看起来相似，而且临床上子宫破裂的发生率也没有显著增加。因此，TOLAC对双胎妊娠孕产妇是可行的，其结局与单胎妊娠的相似[7,57,99]。

建议

16、多胎妊娠不是TOLAC的禁忌症(II-2B)。

分娩间隔

6项在9040名孕产妇中探讨分娩间隔与TOLAC成功率和子宫破裂风险之间关系的研究[100-105]。有1次剖宫产史的单胎、足月妊娠的孕产妇中，VBAC成功率似乎与分娩间隔无关[102]。然而，较短的分娩间隔与子宫破裂风险增加有关。最准确的估计范围为分娩间隔小于12个月的绝对破裂风险为4.8%[101,106]，间隔小于15个月的绝对破裂风险为4.7%[101]。Bujold等2010年的一项研究结果显示，调整混杂因素后，分娩间隔小于18个月时，子宫破裂发生率显著增加（OR 3.0；95%CI 1.3−7.2），而分娩间隔在18至24个月之间时，子宫破裂发生率无明显增加（OR 1.1；95%CI 0.4−3.2）。因此，分娩间隔小于18个月是子宫破裂的危险因素之一；然而，与超过24个月（1.3%）的子宫破裂率相比，18至24个月（绝对风险1.9%）的子宫破裂率没有显著差异[100]。

建议

17、分娩间隔小于18个月的孕产妇应被告知TOLAC过程中发生子宫破裂的风险增加(II-2A)。

子宫厚度

有许多变量会影响VBAC成功率和子宫破裂风险。大多数研究采用回归分析来更好地评估个体变量的影响然而，每个变量的实际影响程度仍然不确定。更重要的是，常同时发挥作用的多因素综合影响更加不确定。

建议

超声测量子宫下段厚度可用于预测子宫破裂的风险。然而，重要的是要识别不同的测量方法，即测量子宫下段全层厚度或仅子宫肌层厚度。医务工作者必须认识到这些测量方法之间的差异。

2013年，Kok等进行包括21项研究2776名孕产妇的的荟萃分析，评估产前超声测量子宫下段厚度在预测TOLAC过程中子宫破裂风险的准确性[107]。研究表明，测量子宫下段厚度用于临床实践前，必须先分解决分析其临床有效性和实用性的问题[107]。最近的荟萃分析表明，测量子宫下段全层厚度和子宫肌层厚度的方法是等效的。然而，每种方法都有不同的推荐值、特异性和敏感性。预测子宫破裂似乎没有明确的界限，表6列出了TOLAC过程中出现子宫破裂的较强的阴性预测值，可用于临床指导咨询[107]。

同时，我们不能仅仅通过超声测量子宫下段厚度来明确告知孕产妇TOLAC可行或不可行。尽管，子宫下段厚度的测量对预测子宫破裂的发生具有重要意义，但其临床适用性还需在前瞻性观察研究中使用标准化的测量方法进行评估[28,107]。

建议

18、尽管子宫下段厚度与子宫破裂风险相关，但TOLAC安全或不安全的绝对界限并不存在。因此，目前，我们还不能仅仅通过超声测量子宫下段厚度来明确告知患者TOLAC可行或不可行(II-2B)。

切口类型

古典式剖宫产切口

古典式剖宫产切口的孕产妇子宫破裂的风险增加（4%-9%）[17,23,108]。与前次子宫下段横切口相比，前次子宫下段纵切口或不确定切口类型的孕产妇子宫裂开或破裂的风险没有明显增加。 

不确定切口类型

应认真查阅与既往剖宫产相关的所有可用或可取的记录。若没有，关于剖宫产情况的信息将有助于确定子宫纵切口的的可能性[109,110]。大多数不确定切口类型是子宫下段横切口（92%），故子宫破裂的风险较低[111]。如果手术记录提示有古典式切口可能性时，明智的做法是建议重复剖宫产，但在病史提示是子宫下段横切口可能且孕产妇希望咨询后决定时，TOLAC是可以接受的。

子宫下段横切口单层和双层缝合比较

1997年，Chapman等发表了一篇145名孕产妇接受TOLAC治疗的的综述，她们在之前的剖宫产术中被随机分为子宫切口单层缝合组和双层缝合组[112]。研究表明，下一次的妊娠结局没有显著差异[112]。2002年，Bujold等回顾分析了2142名接受TOLAC的孕产妇，指出单层锁边缝合比双层缝合子宫破裂的风险增加(3.1 % vs. 0.5%;P < 0.001; OR 3.95; 95% Cl 1.35−11.49)[106]。2011年，Roberge等回顾了包括5810名孕产妇在内的9项研究，发现子宫切口单层锁边缝合与双层缝合相比，可能会增加未来妊娠中接受TOLAC的孕产妇子宫破裂的风险。无锁边单层缝合的子宫破裂风险似乎与双层缝合相当[113]。

建议

19、采用古典式剖宫产术或T型切口的孕产妇不建议TOLAC(II-2A)。

20、既往剖宫产子宫采用单层缝合的孕产妇，如欲尝试TOLAC，应注意子宫破裂的风险可能增加(II-2A)。

21、应尽一切努力取得既往的剖宫产手术记录，以确定子宫切口的类型。在切口类型未知的情况下，有关既往分娩情况的信息将有助于确定子宫下段横切口的可能性。如果子宫下段横切口的可能性高，则可TOLAC(II-2B)。

孕产妇肥胖

肥胖孕产妇VBAC成功率低于BMI正常的孕产妇。指未孕期BMI>30，OR为0.66 (CI 0.54 - 0.80);或孕期BMI>35，OR为0.38 (CI 0.30 - 0.38)的孕产妇[114-116]。此外，1项研究指出肥胖妇女子宫破裂/裂开的风险增加了5倍（2.1% vs.0.4%; OR 5.6;95% CI 2.7−11.7）[115]。而且，与ERCS相比，体重指数高的TOLAC后的孕产妇的发病率增加(OR 1.8; CI 1.3−2.5)[115]。同时，体重指数较高的孕产妇，决定分娩的时间可能更长，因此在有意向TOLAC时应予以考虑。

其他因素

曾因第二产程难产而剖宫产的孕产妇，在下次分娩时发生第二产程子宫破裂的风险更高，特别是在怀疑巨大胎儿或第二产程延长的情况下[117]。如子宫扩张、剖宫产后发热[118]、缝线类型、米勒管发育异常[119]、产妇年龄[120]等与子宫破裂风险相关的因素已在小样本中检测了，但尚未得出明确结论。

新生儿结局

新生儿死亡率和发病率主要与子宫破裂有关。基于中等质量的研究，TOLAC比ERCS的新生儿死亡率(1.1 per 1000 vs. 0.55 per 1000)和围产期死亡率(1.3 per 1000 vs. 0.5 per 1000)均显著增加(RR 2.06; 95%CI 1.35−3.13; and RR 1.82; 95% CI 1.24−2.67)[26]。与ERCS（小于1/10000）相比，TOLAC（8/10000）的新生儿永久性神经损伤的风险同样增加。值得注意的是， 60%的TOLAC的新生儿缺氧缺血性脑病与子宫破裂有关。据报道，由子宫破裂导致的围产期死亡率的总风险为6.2%[29]。在新生儿败血症、Apgsr评分、新生儿入住重症监护病房和母乳喂养等其他新生儿结局方面，没有显著差异。

加拿大最近的大型研究一致表明，TOLAC的新生儿发病率风险增加，包括新生儿死亡、辅助通气和新生儿癫痫[3]。据报告，ERCS的新生儿总死亡率和发病率为14.5%，而TOLAC的新生儿总死亡率和发病率为20.8%（aRR 1.49,95%CI 1.38-1.61）[3]。与孕产妇的发病率相似，在TOLAC后再次剖宫产时，新生儿的发病率显著增加。呼吸窘迫综合征是TOLAC显著降低的一种新生儿结局，（aRR为0.90，95%置信区间为0.86−0.94）[3]。

建议

22、计划VBAC的孕产妇应注意，与ERCS相比，VBAC的孕产妇围产期死亡率和发病率的相对风险较高，但绝对风险较低。

专家简介

郑剑兰

郑剑兰，主任医师，教授，研究生导师，厦门大学附属成功医院、解放军第七十三集团军医院暨全军计划生育优生优育技术指导中心妇儿科主任，全军妇产科专业委员及产科学组秘书长，南京军区妇产科副主任委员，英国帝国理工大学母婴研究中心签约学者，全球健康中心及美国辛辛那提大学交流学者，中华医学会围产医学分会委员，中国医师协会母胎医学分会委员，中国对外交流促进会妇产科分会委员，中国妇幼保健协会高危妊娠常务委员，中国研究型医院学会孕产期母儿心脏病专业委员会常务委员，福建省围产医学分会委员、优生优育及妇幼保健协会盆底委员会常务委员、骨质疏松及骨矿盐学会委员，厦门市围产医学分会候任主任委员、妇产科副主任委员、产科质控中心副主任，SCI期刊《ANZJOG》 及《JOGR》审稿专家。

妇产科临床工作30多年，擅长妇科腔镜及产科危急重症抢救，近年来主要从事围产医学研究。主编专著2部；发表SCI及国内核心期刊论著20余篇；主持国家自然科学基金面上项目，省市及军队科研项目10项；引进Bakri产后止血球囊和CRB促宫颈成熟及引产球囊；发明Zheng子宫压迫缝合术，第一完成人获国家专利3项，并获军队和福建省、厦门市医疗成果及科技进步奖9项，享受军队一类科技人才岗位津贴，是军队334工程拔尖人才和厦门大学科技创新人才，多次荣立军队二等功及三等功。

参考文献

1. Canadian Institute for Health Information. Health indicators interactive tool. Ottawa: Canadian Institute for Health Information; 2012.

2. Canadian Institute for Health Information. QuickStats: childbirth indicators by place of residence. Ottawa: Canadian Institute for Health Information; 2017. https://apps.cihi.ca/mstrapp/asp/Main.aspx

3. Young CB, Liu S, Muraca GM, et al. Mode of delivery after a previous cesarean birth, and associated maternal and neonatal morbidity. CMAJ 2018;190:E556–64.

4. Smithies M, Woolcott CG, Brock JK, et al. Factors associated with trial of labour and mode of delivery in Robson group 5: a select group of women with previous Caesarean section. J Obstet Gynaecol Can 2018;40:704–11.

5. Russillo B, Sewitch MJ, Cardinal L, et al. Comparing rates of trial of labour attempts, VBAC success, and fetal and maternal complications among family physicians and obstetricians. J Obstet Gynaecol Can 2008;30:123–8.

6. Vaginal birth after Caesarean in Ontario. Ontario: 2018. http://www. ontarioprenataleducation.ca/vbac/

7. American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 115: vaginal birth after previous cesarean delivery. Obstet Gynecol 2010;116:450–63. 8. Duan XH, Wang YL, Han XW, et al. Caesarean section combined with temporary aortic balloon occlusion followed by uterine artery embolisation for the management of placenta accreta. Clin Radiol 2015;70:932–7.

9. Committee on Practice Bulletins-Obstetrics. Practice bulletin no. 184: vaginal birth after cesarean delivery. Obstet Gynecol 2017;130:e217–33.

10. SOGC. Vaginal birth after previous Caesarean birth. Clinical practice guideline 1997;68.

11. National Institutes of Health. Cesarean childbirth. Am J Obstet Gynecol 1981;139:902–9.

12. Flamm BL, Lim OW, Jones C, et al. Vaginal birth after cesarean section: results of a multicenter study. Am J Obstet Gynecol 1988;158:1079–84.

13. Socol ML, Peaceman AM. Vaginal birth after cesarean: an appraisal of fetal risk. Obstet Gynecol 1999;93:674–9.

14. Martel MJ, MacKinnon CJ. Clinical Practice Obstetrics Committee of the Society of Obstetricians and Gynaecologists of Canada. Guidelines for vaginal birth after previous Caesarean birth. J Obstet Gynaecol Can 2004;26:660–83. quiz 84−6.

15. Martel MJ, MacKinnon CJ. Clinical Practice Obstetrics Committee of the Society of Obstetricians and Gynaecologists of Canada. Guidelines for vaginal birth after previous Caesarean birth. J Obstet Gynaecol Can 2005;27:164–88.

16. Kline J, Arias F. Analysis of factors determining the selection of repeated cesarean section or trial of labor in patients with histories of prior cesarean delivery. J Reprod Med 1993;38:289–92.

17. McMahon MJ. Vaginal birth after cesarean. Clin Obstet Gynecol 1998;41:369–81.

18. Canadian Task Force on the Periodic Health Exam. The Canadian guide to clinical preventive health care. Ottawa: Health Canada; 1994. p. xxxvii. https://canadiantaskforce.ca/wp-content/uploads/2016/09/1994-redbrick-en.pdf.

19. Roberts LJ, Beardsworth SA, Trew G. Labour following caesarean section: current practice in the United Kingdom. Br J Obstet Gynaecol 1994;101:153–5.

20. Norman P, Kostovcik S, Lanning A. Elective repeat cesarean sections: how many could be vaginal births? CMAJ 1993;149:431–5.

21. Biswas A. Management of previous cesarean section. Curr Opin Obstet Gynecol 2003;15:123–9.

22. Quilligan EJ. Vaginal birth after cesarean section: 270 degrees. J Obstet Gynaecol Res 2001;27:169–73.

23. Scott JR. Avoiding labor problems during vaginal birth after cesarean delivery. Clin Obstet Gynecol 1997;40:533–41.

24. Rageth JC, Juzi C, Grossenbacher H. Delivery after previous cesarean: a risk evaluation. Swiss Working Group of Obstetric and Gynecologic Institutions. Obstet Gynecol 1999;93:332–7.

25. Lovell R. Vaginal delivery after Caesarean section: factors influencing success rates. Aust N Z J Obstet Gynaecol 1996;36:4–8.

26. Davies GA, Hahn PM, McGrath MM. Vaginal birth after cesarean. Physicians’ perceptions and practice. J Reprod Med 1996;41:515–20.

27. Landon MB, Leindecker S, Spong CY, et al. The MFMU Cesarean Registry: factors affecting the success of trial of labor after previous cesarean delivery. Am J Obstet Gynecol 2005;193:1016–23.

28. Guise JM, Eden K, Denman MA, et al. Vaginal birth after cesarean: new insights. Rockville, MD: Agency for Healthcare Research and Quality; 2010.

29. Weinstein D, Benshushan A, Tanos V, et al. Predictive score for vaginal birth after cesarean section. Am J Obstet Gynecol 1996;174:192–8.

30. Srinivas SK, Stamilio DM, Sammel MD, et al. Vaginal birth after caesarean delivery: does maternal age affect safety and success? Paediatr Perinat Epidemiol 2007;21:114–20.

31. Bujold E, Gauthier RJ. Should we allow a trial of labor after a previous cesarean for dystocia in the second stage of labor? Obstet Gynecol 2001;98:652–5.

32. Hoskins IA, Gomez JL. Correlation between maximum cervical dilatation at cesarean delivery and subsequent vaginal birth after cesarean delivery. Obstet Gynecol 1997;89:591–3.

33. Shipp TD, Zelop CM, Repke JT, et al. Labor after previous cesarean: influence of prior indication and parity. Obstet Gynecol 2000;95:913–6.

34. Rossi AC, Prefumo F. Pregnancy outcomes of induced labor in women with previous cesarean section: a systematic review and meta-analysis. Arch Gynecol Obstet 2015;291:273–80.

35. Zelop CM, Shipp TD, Cohen A, et al. Trial of labor after 40 weeks’ gestation in women with prior cesarean. Obstet Gynecol 2001;97:391–3.

36. Zelop CM, Shipp TD, Repke JT, et al. Outcomes of trial of labor following previous cesarean delivery among women with fetuses weighing >4000 g. Am J Obstet Gynecol 2001;185:903–5.

37. Flamm BL, Goings JR. Vaginal birth after cesarean section: is suspected fetal macrosomia a contraindication? Obstet Gynecol 1989;74:694–7.

38. Sarno Jr AP, Phelan JP, Ahn MO, et al. Vaginal birth after cesarean delivery. Trial of labor in women with breech presentation. J Reprod Med 1989;34:831–3.

39. Elkousy MA, Sammel M, Stevens E, et al. The effect of birth weight on vaginal birth after cesarean delivery success rates. Am J Obstet Gynecol 2003;188:824–30.

40. Srinivas SK, Stamilio DM, Stevens EJ, et al. Safety and success of vaginal birth after cesarean delivery in patients with preeclampsia. Am J Perinatol 2006;23:145–52.

41. Mercer BM, Gilbert S, Landon MB, et al. Labor outcomes with increasing number of prior vaginal births after cesarean delivery. Obstet Gynecol 2008;111:285–91.

42. Rossi AC, D’Addario V. Maternal morbidity following a trial of labor after cesarean section vs elective repeat cesarean delivery: a systematic review with metaanalysis. Am J Obstet Gynecol 2008;199:224–31.

43. Grobman WA, Lai Y, Landon MB, et al. Development of a nomogram for prediction of vaginal birth after cesarean delivery. Obstet Gynecol 2007;109:806–12.

44. Chaillet N, Bujold E, Dube E, et al. Validation of a prediction model for vaginal birth after caesarean. J Obstet Gynaecol Can 2013;35: 119–24.

45. Costantine MM, Fox KA, Pacheco LD, et al. Does information available at delivery improve the accuracy of predicting vaginal birth after cesarean? Validation of the published models in an independent patient cohort. Am J Perinatol 2011;28:293–8.

46. Schoorel EN, Melman S, van Kuijk SM, et al. Predicting successful intended vaginal delivery after previous caesarean section: external validation of two predictive models in a Dutch nationwide registrationbased cohort with a high intended vaginal delivery rate. BJOG 2014;121:840–7. discussion 7.

47. Yokoi A, Ishikawa K, Miyazaki K, et al. Validation of the prediction model for success of vaginal birth after cesarean delivery in Japanese women. Int J Med Sci 2012;9:488–91.

48. Annessi E, Del Giovane C, Magnani L, et al. A modified prediction model for VBAC, in a European population. J Matern Fetal Neonatal Med 2016;29:435–9.

49. Eden KB, McDonagh M, Denman MA, et al. New insights on vaginal birth after cesarean: can it be predicted? Obstet Gynecol 2010;116:967–81.

50. Caesarean section. National Institute for Health and Clinical Excellence: guidance. London: National Institute for Health and Clinical Excellence; 2011.

51. Wen SW, Rusen ID, Walker M, et al. Comparison of maternal mortality and morbidity between trial of labor and elective cesarean section among women with previous cesarean delivery. Am J Obstet Gynecol 2004;191:1263–9.

52. Zwart JJ, Richters JM, Ory F, et al. Uterine rupture in The Netherlands: a nationwide population-based cohort study. BJOG 2009;116:1069–78. discussion 78−80.

53. Stattmiller S, Lavecchia M, Czuzoj-Shulman N, et al. Trial of labor after cesarean in the low-risk obstetric population: a retrospective nationwide cohort study. J Perinatol 2016;36:808–13.

54. Palatnik A, Grobman WA. Induction of labor versus expectant management for women with a prior cesarean delivery. Am J Obstet Gynecol 2015;212:358.e1−6.

55. Huisman C, Rengerink KO, Jozwiak M, et al. Effectiveness and safety of different methods for induction of labor in women with a previous cesarean section. Am J Obstet Gynecol 2014;210:S333–4.

56. West HM, Jozwiak M, Dodd JM. Methods of term labour induction for women with a previous caesarean section. Cochrane Database Syst Rev 2017(6):CD009792.

57. Cheng YW, Eden KB, Marshall N, et al. Delivery after prior cesarean: maternal morbidity and mortality. Clin Perinatol 2011;38:297–309.

58. Pickhardt MG, Martin Jr JN, Meydrech EF, et al. Vaginal birth after cesarean delivery: are there useful and valid predictors of success or failure? Am J Obstet Gynecol 1992;166:1811–5. discussion 5−9.

59. Rouse DJ, Owen J, Hauth JC. Active-phase labor arrest: oxytocin augmentation for at least 4 hours. Obstet Gynecol 1999;93:323–8.

60. Kehl S, Weiss C, Rath W. Balloon catheters for induction of labor at term after previous cesarean section: a systematic review. Eur J Obstet Gynecol Reprod Biol 2016;204:44–50.

61. Lamourdedieu C, Gnisci A, Agostini A. [Risk of uterine rupture after cervical ripening with ballon catheter on uterus with previous cesarean section]. J Gynecol Obstet Biol Reprod (Paris) 2016;45:496–501. [in French].

62. van Gelderen CJ, England MJ, Naylor GA, et al. Labour in patients with a caesarean section scar. The place of oxytocin augmentation. S Afr Med J 1986;70:529–32.

63. Kacmar J, Bhimani L, Boyd M, et al. Route of delivery as a risk factor for emergent peripartum hysterectomy: a case-control study. Obstet Gynecol 2003;102:141–5.

64. Chilaka VN, Cole MY, Habayeb OM, et al. Risk of uterine rupture following induction of labour in women with a previous caesarean section in a large UK teaching hospital. J Obstet Gynaecol 2004;24: 264–5.

65. Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol 2005;192:1458–61.

66. Yucel O, Ozdemir I, Yucel N, et al. Emergency peripartum hysterectomy: a 9-year review. Arch Gynecol Obstet 2006;274:84–7.

67. Stone C, Halliday J, Lumley J, et al. Vaginal births after Caesarean (VBAC): a population study. Paediatr Perinat Epidemiol 2000;14:340–8.

68. Zelop CM, Shipp TD, Repke JT, et al. Uterine rupture during induced or augmented labor in gravid women with one prior cesarean delivery. Am J Obstet Gynecol 1999;181:882–6.

69. Tikkanen M, Nuutila M, Hiilesmaa V, et al. Prepregnancy risk factors for placental abruption. Acta Obstet Gynecol Scand 2006;85:40–4.

70. Katz VL, Farmer RM, Dean CA, et al. Use of misoprostol for cervical ripening. South Med J 2000;93:881–4.

71. Hill DA, Chez RA, Quinlan J, et al. Uterine rupture and dehiscence associated with intravaginal misoprostol cervical ripening. J Reprod Med 2000;45:823–6.

72. Choy-Hee L, Raynor BD. Misoprostol induction of labor among women with a history of cesarean delivery. Am J Obstet Gynecol 2001;184:1115– 7.

73. Cunha M, Bugalho A, Bique C, et al. Induction of labor by vaginal misoprostol in patients with previous cesarean delivery. Acta Obstet Gynecol Scand 1999;78:653–4.

74. Plaut MM, Schwartz ML, Lubarsky SL. Uterine rupture associated with the use of misoprostol in the gravid patient with a previous cesarean section. Am J Obstet Gynecol 1999;180:1535–42. 75. Wing DA, Lovett K, Paul RH. Disruption of prior uterine incision following misoprostol for labor induction in women with previous cesarean delivery. Obstet Gynecol 1998;91:828–30.

76. Blanchette HA, Nayak S, Erasmus S. Comparison of the safety and efficacy of intravaginal misoprostol (prostaglandin E1) with those of dinoprostone (prostaglandin E2) for cervical ripening and induction of labor in a community hospital. Am J Obstet Gynecol 1999;180: 1551–9.

77. ACOG Committee on Obstetric Practice. Committee opinion. Induction of labor for vaginal birth after cesarean delivery. Obstet Gynecol 2002;99:679–80.

78. Tahseen S, Griffiths M. Vaginal birth after two caesarean sections (VBAC2)-a systematic review with meta-analysis of success rate and adverse outcomes of VBAC-2 versus VBAC-1 and repeat (third) caesarean sections. BJOG 2010;117:5–19.

79. Miller ES, Grobman WA. Obstetric outcomes associated with induction of labor after 2 prior cesarean deliveries. Am J Obstet Gynecol 2015;213:89. e1−5.

80. Macones GA, Cahill A, Pare E, et al. Obstetric outcomes in women with two prior cesarean deliveries: is vaginal birth after cesarean delivery a viable option? Am J Obstet Gynecol 2005;192:1223–8. discussion 8−9.

81. Landon MB, Spong CY, Thom E, et al. Risk of uterine rupture with a trial of labor in women with multiple and single prior cesarean delivery. Obstet Gynecol 2006;108:12–20.

82. Miller DA, Diaz FG, Paul RH. Vaginal birth after cesarean: a 10-year experience. Obstet Gynecol 1994;84:255–8.

83. Flamm BL, Newman LA, Thomas SJ, et al. Vaginal birth after cesarean delivery: results of a 5-year multicenter collaborative study. Obstet Gynecol 1990;76:750–4.

84. Caughey AB, Shipp TD, Repke JT, et al. Rate of uterine rupture during a trial of labor in women with one or two prior cesarean deliveries. Am J Obstet Gynecol 1999;181:872–6.

85. Asakura H, Myers SA. More than one previous cesarean delivery: a 5-year experience with 435 patients. Obstet Gynecol 1995;85:924–9.

86. Spaans WA, van der Vliet LM, Roell-Schorer EA, et al. Trial of labour after two or three previous caesarean sections. Eur J Obstet Gynecol Reprod Biol 2003;110:16–9.

 87. Phelan JP, Ahn MO, Diaz F, et al. Twice a cesarean, always a cesarean? Obstet Gynecol 1989;73:161–5.

88. Novas J, Myers SA, Gleicher N. Obstetric outcome of patients with more than one previous cesarean section. Am J Obstet Gynecol 1989;160:364–7.

89. Hansell RS, McMurray KB, Huey GR. Vaginal birth after two or more cesarean sections: a five-year experience. Birth 1990;17:146–50. discussion 50−1.

90. Granovsky-Grisaru S, Shaya M, Diamant YZ. The management of labor in women with more than one uterine scar: is a repeat cesarean section really the only “safe” option? J Perinat Med 1994;22:13–7.

91. Chattopadhyay SK, Sherbeeni MM, Anokute CC. Planned vaginal delivery after two previous caesarean sections. Br J Obstet Gynaecol 1994;101:498–500.

92. Hannah ME, Hannah WJ, Hewson SA, et al. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group. Lancet 2000;356:1375–83.

93. de Meeus JB, Ellia F, Magnin G. External cephalic version after previous cesarean section: a series of 38 cases. Eur J Obstet Gynecol Reprod Biol 1998;81:65–8.

94. Flamm BL, Fried MW, Lonky NM, et al. External cephalic version after previous cesarean section. Am J Obstet Gynecol 1991;165:370–2.

95. Miller DA, Mullin P, Hou D, et al. Vaginal birth after cesarean section in twin gestation. Am J Obstet Gynecol 1996;175:194–8.

96. Strong Jr TH, Phelan JP, Ahn MO, et al. Vaginal birth after cesarean delivery in the twin gestation. Am J Obstet Gynecol 1989;161:29–32.

97. Sansregret A, Bujold E, Gauthier RJ. Twin delivery after a previous caesarean: a twelve-year experience. J Obstet Gynaecol Can 2003;25: 294–8.

98. Varner MW, Thom E, Spong CY, et al. Trial of labor after one previous cesarean delivery for multifetal gestation. Obstet Gynecol 2007;110:814–9.

99. Sentilhes L, Vayssiere C, Beucher G, et al. Delivery for women with a previous cesarean: guidelines for clinical practice from the French College of Gynecologists and Obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol 2013;170:25–32.

100. Bujold E, Gauthier RJ. Risk of uterine rupture associated with an interdelivery interval between 18 and 24 months. Obstet Gynecol 2010;115:1003–6.

101. Esposito MA, Menihan CA, Malee MP. Association of interpregnancy interval with uterine scar failure in labor: a case-control study. Am J Obstet Gynecol 2000;183:1180–3.

102. Huang WH, Nakashima DK, Rumney PJ, et al. Interdelivery interval and the success of vaginal birth after cesarean delivery. Obstet Gynecol 2002;99:41–4.

103. Shipp TD, Zelop CM, Repke JT, et al. Interdelivery interval and risk of symptomatic uterine rupture. Obstet Gynecol 2001;97:175–7.

104. Kessous R, Sheiner E. Is there an association between short interval from previous cesarean section and adverse obstetric and perinatal outcome? J Matern Fetal Neonatal Med 2013;26:1003–6.

105. Stamilio DM, DeFranco E, Pare E, et al. Short interpregnancy interval: risk of uterine rupture and complications of vaginal birth after cesarean delivery. Obstet Gynecol 2007;110:1075–82.

106. Bujold E, Bujold C, Hamilton EF, et al. The impact of a single-layer or double-layer closure on uterine rupture. Am J Obstet Gynecol 2002;186:1326–30.

107. Kok N, Wiersma IC, Opmeer BC, et al. Sonographic measurement of lower uterine segment thickness to predict uterine rupture during a trial of labor in women with previous Cesarean section: a meta-analysis. Ultrasound Obstet Gynecol 2013;42:132–9.

108. Gilliam M, Rosenberg D, Davis F. The likelihood of placenta previa with greater number of cesarean deliveries and higher parity. Obstet Gynecol 2002;99:976–80.

109. Grubb DK, Kjos SL, Paul RH. Latent labor with an unknown uterine scar. Obstet Gynecol 1996;88:351–5.

110. Lau TK, Chan F. Unknown uterine scars, unknown risks. Aust N Z J Obstet Gynaecol 1994;34:216–7.

111. Beall M, Eglinton GS, Clark SL, et al. Vaginal delivery after cesarean section in women with unknown types of uterine scar. J Reprod Med 1984;29:31–5.

112. Chapman SJ, Owen J, Hauth JC. One- versus two-layer closure of a low transverse cesarean: the next pregnancy. Obstet Gynecol 1997;89:16–8.

113. Roberge S, Chaillet N, Boutin A, et al. Single- versus double-layer closure of the hysterotomy incision during cesarean delivery and risk of uterine rupture. Int J Gynaecol Obstet 2011;115:5–10.

114. Bujold E, Hammoud A, Schild C, et al. The role of maternal body mass index in outcomes of vaginal births after cesarean. Am J Obstet Gynecol 2005;193:1517–21.

115. Hibbard JU, Gilbert S, Landon MB, et al. Trial of labor or repeat cesarean delivery in women with morbid obesity and previous cesarean delivery. Obstet Gynecol 2006;108:125–33.

116. Chauhan SP, Magann EF, Carroll CS, et al. Mode of delivery for the morbidly obese with prior cesarean delivery: vaginal versus repeat cesarean section. Am J Obstet Gynecol 2001;185:349–54.

117. Jastrow N, Demers S, Gauthier RJ, et al. Adverse obstetric outcomes in women with previous cesarean for dystocia in second stage of labor. Am J Perinatol 2013;30:173–8.

118. Shipp TD, Zelop C, Cohen A, et al. Post-cesarean delivery fever and uterine rupture in a subsequent trial of labor. Obstet Gynecol 2003;101:136–9.

119. Ravasia DJ, Brain PH, Pollard JK. Incidence of uterine rupture among women with mullerian duct anomalies who attempt vaginal birth after cesarean delivery. Am J Obstet Gynecol 1999;181:877–81.

120. Shipp TD, Zelop C, Repke JT, et al. The association of maternal age and symptomatic uterine rupture during a trial of labor after prior cesarean delivery. Obstet Gynecol 2002;99:585–8.

121. American College of Obstetricians and Gynecologists. Vaginal birth after previous cesarean delivery. ACOG practice bulletin. Int J Gynaecol Obstet 1999;66:197–204.

122. Frost J, Shaw A, Montgomery A, et al. Women’s views on the use of decision aids for decision making about the method of delivery following a previous caesarean section: qualitative interview study. BJOG 2009;116:896–905.

123. Vaginal birth after cesarean and planned repeat cesarean birth. http:// www.powertopush.ca/birth-options/types-of-birth/vaginal-birth-aftercesarean/

124. Eden KB, Hashima JN, Osterweil P, et al. Childbirth preferences after cesarean birth: a review of the evidence. Birth 2004;31:49–60.

125. Craver Pryor E, Mertz HL, Beaver BW, et al. Intrapartum predictors of uterine rupture. Am J Perinatol 2007;24:317–21.

126. Desseauve D, Bonifazi-Grenouilleau M, Fritel X, et al. Fetal heart rate abnormalities associated with uterine rupture: a case-control study: a new time-lapse approach using a standardized classification. Eur J Obstet Gynecol Reprod Biol 2016;197:16–21.

127. Leung AS, Leung EK, Paul RH. Uterine rupture after previous cesarean delivery: maternal and fetal consequences. Am J Obstet Gynecol 1993;169:945–50.

128. Ayres AW, Johnson TR, Hayashi R. Characteristics of fetal heart rate tracings prior to uterine rupture. Int J Gynaecol Obstet 2001;74:235– 40.

129. Guiliano M, Closset E, Therby D, et al. Signs, symptoms and complications of complete and partial uterine ruptures during pregnancy and delivery. Eur J Obstet Gynecol Reprod Biol 2014;179:130–4.

130. Madaan M, Trivedi SS. Intrapartum electronic fetal monitoring vs. intermittent auscultation in postcesarean pregnancies. Int J Gynaecol Obstet 2006;94:123–5.

131. Holmgren C, Scott JR, Porter TF, et al. Uterine rupture with attempted vaginal birth after cesarean delivery: decision-to-delivery time and neonatal outcome. Obstet Gynecol 2012;119:725–31.

132. Bujold E, Gauthier RJ. Neonatal morbidity associated with uterine rupture: what are the risk factors? Am J Obstet Gynecol 2002;186:311–4.

133. Leung TY, Lao TT. Timing of caesarean section according to urgency. Best Pract Res Clin Obstet Gynaecol 2013;27:251–67.

134. Schauberger CW, Chauhan SP. Emergency cesarean section and the 30- minute rule: definitions. Am J Perinatol 2009;26:221–6.

135. Yap OW, Kim ES, Laros Jr RK. Maternal and neonatal outcomes after uterine rupture in labor. Am J Obstet Gynecol 2001;184:1576–81.

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