帝王切開後の初経腟分娩の期間。前回の帝王切開時の陣痛のステージが要因か？

Duration of first vaginal birth following cesarean: Is stage of labor at previous cesarean a factor?

• Misgav Rottenstreich
• Chen Futeran Shahar
• Reut Rotem
• Hen Y Sela
• Amihai Rottenstreich
• Arnon Samueloff
• Ori Shen
• Orna Reichman

抄録

目的:

帝王切開後の2回目の経膣分娩（VBAC）を受けた分娩患者は、帝王切開後のCDを受けた人とは対照的に、陣痛中に帝王切開分娩（CD）を受けた人に分かれる。我々は、一次帝王切開時の陣痛の段階が、その後の自然分娩（VBAC）の期間と関連しているかどうかを研究することを目的とした。

OBJECTIVE: Parturients in second delivery undergoing vaginal birth after cesarean (VBAC) are divided to those who had their cesarean delivery (CD) while in labor as opposed to those who had an elective CD. We aimed to study if the stage of labor that was present during the primary CD is associated with the duration of subsequent spontaneous VBAC.

方法:

レトロスペクティブ研究（2006-2014）。CDの既往のある二次分娩のマルチパラ（P2-VBAC）を、初産時にCDが行われた陣痛のステージ（選択分娩、潜伏分娩、第1期または第2期分娩）に基づいてサブグループ化し、陣痛期間をプリミパラ（P1）、二次分娩（P2）および三次分娩（P3）のマルチパラ（VD）と比較した。母体年齢、分娩前、局所麻酔、オキシトシン増強、出生体重、新生児の性別を含むCox回帰分析を行った。

METHODS: A retrospective study (2006-2014). Multiparas in second delivery with a history of a CD (P2-VBAC) were sub-grouped based on stage of labor at which the CD was performed in the first delivery; elective, latent, first or second stage of labor, Duration of labor was compared between P2-VBAC (as one group and further as the sub-groups) to primiparas (P1), multiparas in second (P2) and third (P3) vaginal delivery (VD). A Cox regression analysis was performed including maternal age, preterm-delivery, regional anesthesia, oxytocin augmentation, birthweight and neonatal gender.

結果:

合計58,028人の分娩患者が本研究に含まれた。平均陣痛時間は、初回分娩（P1およびP2-VBAC）の分娩患者では、リピート分娩（P2およびP3）に比べて、それぞれ6.0時間対2.5時間と有意に長かった（P<0.001）。P2-VBACのサブグループ別に陣痛時間を分析したところ、第2期CD後の自発的VDは、第1期CD後の自発的VDと比較して陣痛時間が短く、それぞれ4.2対6.3、7.0、6.9h、p<0.001であった。

RESULTS: A total of 58,028 parturients were included in the study. Mean duration of labor was significantly longer in parturients with a first VD (P1 and P2-VBAC) compared to repeat VD (P2 and P3), 6.0 versus 2.5 h, respectively, (P < 0.001). Analyzing duration of labor by the sub-groups of P2-VBAC revealed that spontaneous VD following a second-stage CD was associated with shorter duration of labor when compared with spontaneous VD following elective, latent and active first stage CD 4.2 versus 6.3, 7.0, 6.9 h respectively, p<0.001.

結論:

第二期CDは、陣痛の初期に帝王切開を受けた人と比較して、その後のVBACの持続期間を短縮する。

CONCLUSION: Second stage CD shortens duration of the following VBAC compared to those who underwent cesarean in earlier stages of labor.

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