足月宫颈不成熟者剖宫产后引产失败的相关因素
这项回顾性队列研究纳入2家学术医院2024年足月、单次剖宫产史且Bishop评分<8的201例剖宫产后引产患者，总体剖宫产后阴道分娩率为66.2%。既往剖宫产前有阴道分娩或剖宫产后有阴道分娩、Bishop评分较高与引产成功相关；既往因引产失败或产程停滞行剖宫产增加重复剖宫产风险，因胎位异常行剖宫产则风险较低。
要点
- 既往剖宫产后阴道分娩史和较高Bishop评分预示剖宫产后引产成功。
- 既往因引产失败或产程停滞行剖宫产者重复剖宫产风险升高。
- 既往因胎位异常行剖宫产者重复剖宫产风险较低。
核心结论
- 既往剖宫产后阴道分娩史和较高Bishop评分预示剖宫产后引产成功。
- 既往因产程停滞或引产失败行剖宫产增加宫颈不成熟者重复剖宫产风险。
研究设计与样本
- 回顾性队列研究，纳入2家学术医院2024年足月、1次剖宫产史且引产时Bishop评分<8的患者，共201例。
- 主要结局为剖宫产后引产失败，定义为重复剖宫产。
主要发现
- 总体剖宫产后阴道分娩率为66.2%。
- 既往剖宫产前有阴道分娩者引产成功可能性更高（P=.015）。
- 既往有剖宫产后阴道分娩者引产成功可能性更高（P<.001）。
- Bishop评分较高者引产成功可能性更高（P<.001）。
关键数值与推荐
- 既往因引产失败行剖宫产与重复剖宫产风险增加56.0%相关（相对风险1.56，95%CI 1.01-2.39）。
- 既往因产程停滞行剖宫产与重复剖宫产风险增加90.0%相关（相对风险1.90，95%CI 1.24-2.91）。
- 既往因胎位异常行剖宫产与重复剖宫产风险降低相关（相对风险0.51，95%CI 0.27-0.89）。
临床怎么用
- 对宫颈不成熟且有剖宫产史者，可结合既往分娩史和Bishop评分进行引产咨询。
- 既往因引产失败或产程停滞行剖宫产者应告知重复剖宫产风险升高。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
BACKGROUND: With increasing rates of induction of labor and trial of labor after cesarean, induction of labor after cesarean is becoming more common. However, the predictors of success among patients undergoing induction of labor after cesarean, particularly those with an unfavorable cervix, remain unclear. OBJECTIVE: This study aimed to identify risk factors associated with failed induction of labor after cesarean in patients with unfavorable Bishop scores. STUDY DESIGN: This retrospective cohort study of patients at 2 academic hospitals who underwent induction of labor after cesarean in 2024 included full-term patients with 1 previous cesarean delivery and an unfavorable Bishop score (<8) at the time of induction of labor. The primary outcome was failed induction of labor after cesarean, defined as repeat cesarean delivery. Associations between delivery mode and clinical characteristics were evaluated using univariate analyses and multivariate stepwise regression analyses. RESULTS: The cohort included 201 patients, with an overall vaginal birth after cesarean rate of 66.2%. Successful induction of labor after cesarean was more likely among patients with a previous vaginal delivery before cesarean (P=.015) or previous vaginal birth after cesarean (P<.001) and among those with higher Bishop scores (P<.001). Previous cesarean delivery for failed induction of labor and arrested labor were associated with a 56.0% (relative risk, 1.56 [95% confidence interval, 1.01-2.39]) and 90.0% (relative risk, 1.90 [95% confidence interval, 1.24-2.91]) increased risk of repeat cesarean delivery, respectively (relative risk, 1.56 [95% confidence interval, 1.01-2.39]). Cesarean delivery for malpresentation was associated with a lower risk of repeat cesarean delivery (relative risk, 0.51 [95% confidence interval, 0.27-0.89]). CONCLUSION: Previous vaginal birth after cesarean and higher Bishop score predict the success of induction of labor after cesarean, whereas previous cesarean delivery for labor arrest or failed induction of labor increases the risk of repeat cesarean delivery in patients with unfavorable cervices. These findings may guide counseling and future research.
引用
- Foster HS, Cummings HW, Levine LD, et al. Factors associated with failed induction of labor after cesarean delivery with an unfavorable cervix at term. Am J Obstet Gynecol MFM. 2026. PMID: 42055281. doi:10.1016/j.ajogmf.2026.101977
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。