Sezaryen sonras› vajinal do¤um: güvenli midir? Vaginal Birth After Cesarean Section: Is It Safe?

Emre Sinan Güngör, Egemen Ertafl, Perran Moröy, Fievki Çelen, Nuri Dan›flman, Leyla Mollamahmuto¤lu
2005 Issue: Perinatal Journal •   unpublished
Objective: Our goal was to analyse the effects of trial of labor on fetal and maternal outcomes among women with single previous lower segment cesarean delivery. Methods: 124 patients following a single prior cesarean delivery were selected prospectively for trial of labor between 1.1.2002-30.4.2004. The inclusion criterias were, single and alive fetuses with vertex presentation, estimated fetal weight lower than 4000 g and greater than 28 weeks pregnancies' and whose cervical effacement was
more » ... l effacement was 80% and dilatations over 5 cm at first examination. The patients who had cephalopelvic disproportion or classic uterine incision and whose previous indication was cephalo-pelvic disproportion were excluded from the study. During trial of labor induction was not used and the labor was followed up by continuous external cardiotocography. Results: The mean age of the cases was 27.4 ± 4.47 years, the mean gestational week was 33 ± 4 weeks, and the mean fetal weight was 2312 ± 410 g. At admission the mean servical dilatation was 4.68 ± 1.3 cm. In one case complete and in two cases partial uterine rupture from previous scar tissues occurred and immediate laparatomy was performed. The overall rate of uter-ine rupture was in %2.4 of the cases. Perinatal morbidity was established to be 13%, without any perinatal mortality. Conclusion: In view of the fact that primary cesarean rates can be reduced if their actual indications are considered, vaginal birth after single cesarean may be considered as an amenable and acceptable method in tertiary clinics with adequate facilities for the mother and the newborn in carefully selected cases. Amaç: Alt segment transvers uterin insizyon ile geçirilmifl tek sezaryen operasyonu olan olgularda, vaginal do¤umun, fetal ve maternal prognoz üzerine olan etkisinin araflt›r›lmas›. Yöntem: 1.1.2002-30.4.2004 tarihleri aras›nda geçirilmifl tek sezaryen tan›s›yla takip edilen olgulardan vaginal yoldan do¤um uy-gulanmak üzere seçilen 124 olgu üzerinde prospektif olarak yürütüldü. Çal›flmaya tek canl› bafl gelifli fetusu olan, tahmini fetal a¤›rl›¤›n 4000 g alt› olan, kemik pelvis darl›¤› olmayan, 28. gebelik haftas›ndan büyük ve ilk muayenelerinde servikal silinmesi %80, servikal dilatasyonlar› 5 cm üzerindeki olgular dahil edildi. Klasik uterin kesi operasyon kay›t notu olan ve ilk sezaryen en-dikasyonu bafl pelvis uygunsuzlu¤u olan olgular çal›flmaya dahil edilmedi. Do¤um eylemi eksternal olarak sürekli monitorize fle-kilde takip edildi ve oksitosin ile do¤um indüksiyonu uygulanmad›. Bulgular: Sezaryen sonras› vajinal do¤um (SSVD) yapt›r›lan hastalar›m›z›n yafl ortalamas› 27.4 ± 4.47, ortalama gebelik haftala-r› 33 ± 4 hafta, ortalama bebek a¤›rl›¤› 2312 ± 410 g olarak saptand›. Hastalar›n kabulü s›ras›nda pelvik muayenelerinde;ortala-ma servikal aç›kl›klar› 4.68 ±1.3 cm ve silinmeleri ise > %75 olarak gözlendi. Bir olguda alt segment eski uterin skar yerinde komp-let rüptür, 2 olguda ise parsiyel rüptür tespit edildi ve acil laparotomiye al›nd›. Post operatif takip sorunsuzdu. Tüm olgular›m›z-daki rüptür oran› %2.4 idi. 16 yenido¤an solunum s›k›nt›s› nedeniyle yenido¤an ünitemizce konsülte edildi. Perinatal morbidite %13 olarak saptand›. Perinatal mortalite gözlenmedi. Sonuç: Primer sezaryen oranlar›n›n gerçek endikasyonlar›n kullan›lmas› ile azalt›labilece¤i gerçe¤inden hareketle, 'sezaryen son-ras› vajinal do¤um'; dikkatli seçilmifl olgularda, anne ve yenido¤an için yeterli donan›m ve bak›m koflullar›n›n oldu¤u tersiyer re-ferans kliniklerinde uygulanabilir ve kabul edilebilir bir yöntem olarak görülmektedir. Anahtar Sözcükler: Vajinal do¤um, sezaryen uterus rüptürü.
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