两次或以上剖宫产后阴道分娩成功与试产失败：母胎结局的系统评价和荟萃分析。
完整摘要 · 中文译文
目的：评估两次或以上剖宫产术后试产失败与成功（VBAC-2）相关的母儿结局。 数据来源：系统检索截至2025年10月的Pubmed、Embase和Cochrane数据库，并通过反向滚雪球法补充检索。 研究选择：纳入既往有两次或以上剖宫产史并尝试试产的孕妇研究，未设限制条件。 数据收集：提取母儿结局及风险和保护因素相关数据。采用DerSimonian和Laird随机效应模型，报告比值比（OR）及95%置信区间。异质性通过I²统计量和Cochran Q检验评估。方法学质量采用非随机试验偏倚风险评估工具（ROBINS-I）进行评价。 数据综合：在筛选的4065项研究中，共纳入12项研究（n=3429）。我们观察到VBAC-2失败组产后出血（OR 1.98）、母体输血（OR 3.29）、子宫破裂（OR 6.47）和新生儿重症监护病房入住（OR 6.44）的几率较高。硬膜外麻醉（OR 0.56）和既往阴道分娩史（OR 0.27）被确定为保护因素，而较高的体质指数是VBAC-2失败的危险因素。 结论：这些发现强调了在这一高危人群中开展全面患者咨询、风险评估和加强临床警惕性的迫切必要性，以优化护理策略。
完整摘要 · 英文原文
OBJECTIVE: To assess maternal and neonatal outcomes associated with a failed versus successful (VBAC-2). DATA SOURCES: A systematic search across Pubmed, Embase and Cochrane was conducted up to October 2025, supplemented by backward snowballing. STUDY SELECTION: Studies with pregnant women with a two or more previous cesarean deliveries undergoing a trial of labor were included. No restrictions were applied. DATA COLLECTION: Data on maternal and neonatal outcomes and risk and protective factors were extracted. The DerSimonian and Laird random effects model was applied, reporting Odds Ratios (OR) with 95% confidence intervals. Heterogeneity was evaluated using I2 statistics and the Cochran Q test. Methodological quality was appraised using the Cochrane Risk-of-bias tool for non-randomized trials (ROBINS-I). DATA SYNTHESIS: Out of 4065 studies screened, 12 studies (n= 3429) were included. We observed higher odds of postpartum hemorrhage (OR 1.98), maternal transfusion (OR 3.29), uterine rupture (OR 6.47), and neonatal intensive care unit admission (OR 6.44) in the VBAC-2 failure group. Epidural anesthesia (OR 0.56) and a history of previous vaginal birth (OR 0.27) were identified as protective factors, while a higher Body Mass Index was a risk factor for VBAC- 2 failure. CONCLUSIONS: These findings highlight the critical need for comprehensive patient counseling, risk assessment, and heightened clinical vigilance to optimize care strategies in this high-risk population.