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Mao H, Shen P. Trial of labor versus elective cesarean delivery for patients with two prior cesarean sections: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2024; 37:2326301. [PMID: 38485519 DOI: 10.1080/14767058.2024.2326301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/28/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE Cesarean section (CS) rates have been on the rise globally, leading to an increasing number of women facing the decision between a Trial of Labor after two Cesarean Sections (TOLAC-2) or opting for an Elective Repeat Cesarean Section (ERCS). This study evaluates and compares safety outcomes of TOLAC and ERCS in women with a history of two previous CS deliveries. METHODS PubMed, MEDLINE, EMbase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched for studies published until 30 June 2023. Eligible studies were included based on predetermined criteria, and a random-effects model was employed to pool data for maternal and neonatal outcomes. RESULTS Thirteen studies with a combined sample size of 101,011 women who had two prior CS were included. TOLAC-2 was associated with significantly higher maternal mortality (odds ratio (OR)=1.50, 95% confidence interval (CI)= 1.25-1.81) and higher chance of uterine rupture (OR = 7.15, 95% CI = 3.44-14.87) compared to ERCS. However, no correlation was found for other maternal outcomes, including blood transfusion, hysterectomy, or post-partum hemorrhage. Furthermore, neonatal outcomes, such as Apgar scores, NICU admissions, and neonatal mortality, were comparable in the TOLAC-2 and ERCS groups. CONCLUSION Our findings suggest an increased risk of uterine rupture and maternal mortality with TOLAC-2, emphasizing the need for personalized risk assessment and shared decision-making by healthcare professionals. Additional studies are needed to refine our understanding of these outcomes in the context of TOLAC-2.
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Affiliation(s)
- Hui Mao
- Delivery Room on the 2nd Floor of the Inpatient Department, Huzhou Maternity & Child Health Care Hospital, Huzhou City, China
| | - Pinghua Shen
- Delivery Room on the 2nd Floor of the Inpatient Department, Huzhou Maternity & Child Health Care Hospital, Huzhou City, China
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2
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Fruscalzo A, Rossetti E, Londero AP. Trial of Labor after Three or More Previous Cesarean Sections:
Systematic Review and Meta-Analysis of Observational Studies. Z Geburtshilfe Neonatol 2022; 227:96-105. [PMID: 36455615 DOI: 10.1055/a-1965-4125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Abstract
Aims To assess the success rate and prevalence of maternal or neonatal
complications in women undergoing a trial of labor after three or more
(≥3) previous cesarean sections (CSs).
Methods A systematic literature review and meta-analysis was conducted
from inception to May 2022 in Medline, Scopus, ENBASE, ClinicalTrials.gov, and
the Cochrane Central Register of Controlled Trials and Reviews. Items detailing
success rate and complications in women with a history of≥3 previous CSs
were considered. Selected articles were evaluated for quality, heterogeneity,
and publication bias. A pooled prevalence or odds ratio was calculated.
Findings Twelve articles were included for a total of 540 women with a
history of≥3 CSs, accounting for the 2% (CI 95%
1–4%) of the whole cohort of trial of labor. Our findings show a
0.67 (CI 95% 0.53–0.78) rate of successful vaginal delivery. A
higher success rate was observed in women having a history of a prior vaginal
delivery (0.90, CI 95% 0.77–0.96) and when prostaglandins,
peridural anesthesia or oxytocin were allowed (respectively 0.73, CI 95%
0.62–0.83, 0,73, CI 95% 0.57–0.85 and 0.73, CI
95% 0.64–0.81). Uterine rupture rate was 0.01 (CI 95%
0.00–0.01). No cases of fetal asphyxia or maternal or neonatal death
were registered.
Conclusions The success rate and low frequency of severe complications
observed seem to support a trial of labor in selected patients desiring a
natural birth. However, a potential underestimation of serious maternal and
neonatal complications should be considered in the decision-making process.
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Affiliation(s)
- Arrigo Fruscalzo
- Department of Obstetrics and Gynecology, HFR Fribourg,
Switzerland
- Faculty of Medicine, University of Münster,
Germany
| | - Emma Rossetti
- Department of Obstetrics and Gynecology, Brixen General Hospital,
Brixen, Italy
| | - Ambrogio P. Londero
- Academic Unit of Obstetrics and Gynaecology; Department of
Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant
Health, University of Genova, Italy
- Ennergi Research (non-profit organization), 33050 Lestizza, UD, Italy
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3
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Fruscalzo A, Elgendi M, Gantert M. Trial of Labor and Vaginal Birth after Three Previous Cesarean Sections: Report of Two Special Cases. Z Geburtshilfe Neonatol 2022; 226:205-208. [PMID: 35008110 DOI: 10.1055/a-1642-1113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Natural childbirth could represent a deeply rooted need for many women, even in exceptional situations such as after 3 previous caesarean sections. CASE PRESENTATION The first patient, a 28-year-old 6th gravida and 3rd para, first presented in the 40+3 week of pregnancy desiring a vaginal birth, after all the other hospitals in the area had refused her request. A detailed explanation of potential risks was given and, when 2 days later contractions started, she gave birth to a newborn of 4450 g spontaneously, without complications. A month later, a second woman, 42 years old, 5th gravida, 3rd para, read about the above-mentioned case on social media and decided to attempt a natural delivery after 3 caesarean sections at our hospital as well. She presented herself for the first time in the 41+1 week of pregnancy in our delivery room with an onset of labor after rupture of the membranes and gave birth on the same day, spontaneously without complications, to a 4150 g heavy healthy newborn. CONCLUSIONS The wish to attempt a spontaneous birth after 3 previous caesarean sections can be deeply anchored and should be professionally approached by obstetricians, even if counseling and management can be challenging.
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Affiliation(s)
- Arrigo Fruscalzo
- Gynecology and Obstetrics, St. Franziskus-Hospital Ahlen, Germany
| | - Marwa Elgendi
- Gynecology and Obstetrics, St. Franziskus-Hospital Ahlen, Germany
| | - Marcus Gantert
- Gynecology and Obstetrics, St. Franziskus-Hospital Ahlen, Germany
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Abstract
OBJECTIVE To provide evidence-based guidelines for the provision of a trial of labour after Caesarean section. OUTCOMES Fetal and maternal morbidity and mortality associated with vaginal birth after Caesarean and repeat Caesarean section. EVIDENCE MEDLINE database was searched for articles published from January 1, 1995, to October 31, 2017 using the key words "vaginal birth after Caesarean (Cesarean) section." The quality of evidence is described using the Evaluation of Evidence criteria outlined in the Report of the Canadian Task Force on the Periodic Health Exam. VALIDATION These guidelines were approved by the Clinical Practice Obstetrics Committee and the Board of the Society of Obstetricians and Gynaecologists of Canada. RECOMMENDATIONS
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Rotem R, Sela HY, Hirsch A, Samueloff A, Grisaru-Granovsky S, Rottenstreich M. The use of a strict protocol in the trial of labor following two previous cesarean deliveries: Maternal and neonatal results. Eur J Obstet Gynecol Reprod Biol 2020; 252:387-392. [PMID: 32683187 DOI: 10.1016/j.ejogrb.2020.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/01/2020] [Accepted: 07/10/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Over the past few decades, the rate of repeat cesarean deliveries (CD) have taken on pandemic proportions. As part of the global effort to reduce the rate of CD, trail of labor (TOL) following one and even two previous CDs is encouraged. We aimed to evaluate maternal and neonatal outcomes of parturients attempting a TOL after two previous CDs, in which a strict departmental protocol was adopted. STUDY DESIGN A retrospective cohort study of TOL following CD (TOLAC) at a single tertiary center, between 2005 and 2019. Various maternal and neonatal outcomes were assessed, in which parturients attempting TOL after two CD were compared to those after one previous CD. TOL after two CDs was permitted only to those parturients who fulfilled all the criteria of our department's protocol. A univariate analysis was initially conducted and was then followed by a multivariate analysis. RESULTS A total of 11,620 TOLAC were identified, of which 515 (4.4 %) were after two previous CDs. Overall, vaginal delivery rates were high, however, following two CDs the rate was lower than following one CD (83.1 % vs. 88.5 %, p < 0.01). Rates of uterine rupture, peripartum hysterectomy, and postpartum hemorrhage did not differ significantly between the groups. Neonatal results following two CDs were less favorable (specifically, one minute APGAR, neonatal care unit admissions and mechanical ventilation rates), yet, when controlling for potential confounders, an independent association between neonatal composite outcome and TOL following two CDs was not demonstrated. CONCLUSION For parturients with a history of two CDs, when a strict protocol for selecting appropriate candidates is followed, TOL is a reasonable alternative to repeat CD and is associated with favorable maternal and neonatal outcomes.
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Affiliation(s)
- Reut Rotem
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel.
| | - Hen Y Sela
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Ayala Hirsch
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Arnon Samueloff
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Misgav Rottenstreich
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel; Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel
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Dy J, DeMeester S, Lipworth H, Barrett J. N o 382 - Épreuve de travail après césarienne. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1012-1034. [PMID: 31227056 DOI: 10.1016/j.jogc.2019.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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7
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Doret M, Touzet S, Bourdy S, Gaucherand P. Vaginal birth after two previous c-sections: obstetricians-gynaecologists opinions and practice patterns. J Matern Fetal Neonatal Med 2010; 23:1487-92. [PMID: 20233132 DOI: 10.3109/14767051003678176] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To evaluate obstetricians' practice patterns, opinions and factors influencing decision-making about mode of delivery in women with two previous c-sections. METHODS A questionnaire was mailed to the 160 obstetricians from the Rhone-Alpes perinatal network. Questionnaires included demographic, organisational information and questions about physicians' opinion, practice patterns and patient counseling concerning vaginal birth after c-section (VBAC) after one and two caesarean sections. RESULTS Response rate was 65.6%, 100% and 23.8% would offer VBAC to women with respectively one and two previous c-sections. Uterine rupture rate was largely overestimated in both women with one (2.8%) and two prior c-sections (14.2%). Factors positively influencing obstetricians were cerebral palsy estimated rate less than 20%, a minimal decision to birth delay less than 20 min when emergency c-section would be required. Neonatal severe outcomes consecutive to trial of labour as well as placenta praevia or accreta risk and morbidity associated with multiple c-sections would be insufficiently discussed. CONCLUSION Obstetricians largely prefer a third planned c-section in women with two previous c-sections. This decision is partly based on a large overestimation of immediate maternal and neonatal serious outcomes consecutive to trial of labour as well documented serious long term outcomes of multiple c-sections are insufficiently considered.
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Affiliation(s)
- Muriel Doret
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Service d'obstétrique, F-69677 Bron, Lyon, France.
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8
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Tahseen S, Griffiths M. Vaginal birth after two caesarean sections (VBAC-2)-a systematic review with meta-analysis of success rate and adverse outcomes of VBAC-2 versus VBAC-1 and repeat (third) caesarean sections. BJOG 2009; 117:5-19. [DOI: 10.1111/j.1471-0528.2009.02351.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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9
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Landon MB, Spong CY, Thom E, Hauth JC, Bloom SL, Varner MW, Moawad AH, Caritis SN, Harper M, Wapner RJ, Sorokin Y, Miodovnik M, Carpenter M, Peaceman AM, O'sullivan MJ, Sibai BM, Langer O, Thorp JM, Ramin SM, Mercer BM, Gabbe SG. Risk of Uterine Rupture With a Trial of Labor in Women With Multiple and Single Prior Cesarean Delivery. Obstet Gynecol 2006; 108:12-20. [PMID: 16816050 DOI: 10.1097/01.aog.0000224694.32531.f3] [Citation(s) in RCA: 164] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine whether the risk for uterine rupture is increased in women attempting vaginal birth after multiple cesarean deliveries. METHODS We conducted a prospective multicenter observational study of women with prior cesarean delivery undergoing trial of labor and elective repeat operation. Maternal and perinatal outcomes were compared among women attempting vaginal birth after multiple cesarean deliveries and those with a single prior cesarean delivery. We also compared outcomes for women with multiple prior cesarean deliveries undergoing trial of labor with those electing repeat cesarean delivery. RESULTS Uterine rupture occurred in 9 of 975 (0.9%) women with multiple prior cesarean compared with 115 of 16,915 (0.7%) women with a single prior operation (P = .37). Multivariable analysis confirmed that multiple prior cesarean delivery was not associated with an increased risk for uterine rupture. The rates of hysterectomy (0.6% versus 0.2%, P = .023) and transfusion (3.2% versus 1.6%, P < .001) were increased in women with multiple prior cesarean deliveries compared with women with a single prior cesarean delivery attempting trial of labor. Similarly, a composite of maternal morbidity was increased in women with multiple prior cesarean deliveries undergoing trial of labor compared with those having elective repeat cesarean delivery (odds ratio 1.41, 95% confidence interval 1.02-1.93). CONCLUSION A history of multiple cesarean deliveries is not associated with an increased rate of uterine rupture in women attempting vaginal birth compared with those with a single prior operation. Maternal morbidity is increased with trial of labor after multiple cesarean deliveries, compared with elective repeat cesarean delivery, but the absolute risk for complications is small. Vaginal birth after multiple cesarean deliveries should remain an option for eligible women. LEVEL OF EVIDENCE II-2.
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Affiliation(s)
- Mark B Landon
- Department of Obstetrics and Gynecology, Ohio State University, Columbus, Ohio, USA.
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10
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Paré E, Quiñones JN, Macones GA. General obstetrics: Vaginal birth after caesarean section versus elective repeat caesarean section: assessment of maternal downstream health outcomes. BJOG 2005; 113:75-85. [PMID: 16398775 DOI: 10.1111/j.1471-0528.2005.00793.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the maternal implications of strategies of vaginal birth after caesarean section (VBAC) attempt versus elective repeat caesarean section in women with one previous lower segment caesarean section. DESIGN Decision model. POPULATION Women with one prior low transverse caesarean section who are eligible for trial of labour. METHODS Two decision models were built: the first one applying to women planning only one more pregnancy, the second one applying to women planning two more pregnancies. Probability estimates for VBAC success rate and risks of uterine rupture, placenta praevia, placenta accreta and hysterectomy were extracted from the available literature. MAIN OUTCOME MEASURES Hysterectomy for uterine rupture, placenta accreta or other indications. RESULTS In the first model VBAC attempt led to a higher hysterectomy rate (267/100,000) compared with repeat caesarean section (187/100,000). However, in the second model a policy of elective repeat caesarean section led to higher cumulative hysterectomy rate: 1465/100,000 versus 907/100,000 for VBAC. The first model was robust to all but one variable in sensitivity analyses. The second model was robust to all variables in sensitivity analyses. CONCLUSIONS These results indicate that long term reproductive consequences of multiple caesarean sections should be considered when making policy decisions regarding the risk-benefit ratio of VBAC.
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Affiliation(s)
- Emmanuelle Paré
- Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA
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11
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Macones GA, Cahill A, Pare E, Stamilio DM, Ratcliffe S, Stevens E, Sammel M, Peipert J. 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 1228-9. [PMID: 15846208 DOI: 10.1016/j.ajog.2004.12.082] [Citation(s) in RCA: 151] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study was undertaken to compare clinical outcomes in women with 1 versus 2 prior cesarean deliveries who attempt vaginal birth after cesarean delivery (VBAC) and also to compare clinical outcomes of women with 2 prior cesarean deliveries who attempt VBAC or opt for a repeat cesarean delivery. STUDY DESIGN We performed a secondary analysis of a retrospective cohort study, in which the medical records of more than 25,000 women with a prior cesarean delivery from 16 community and tertiary care hospitals were reviewed by trained nurse abstractors. Information on demographics, obstetric history, medical and social history, and the outcomes of the index pregnancy was obtained. Comparisons of obstetric outcomes were made between women with 1 versus 2 prior cesarean deliveries, and also between women with 2 prior cesarean deliveries who opt for VBAC attempt versus elective repeat cesarean delivery. Both bivariate and multivariate techniques were used for these comparisons. RESULTS The records of 20,175 women with one previous cesarean section and 3,970 with 2 prior cesarean sections were reviewed. The rate of VBAC success was similar in women with a single prior cesarean delivery (75.5%) compared with those with 2 prior cesarean deliveries (74.6%), though the odds of major morbidity were higher in those with 2 prior cesarean deliveries (adjusted odd ratio[OR] = 1.61 95% CI 1.11-2.33). Among women with 2 prior cesarean deliveries, those who opt for a VBAC attempt had higher odds of major complications compared with those who opt for elective repeat cesarean delivery (adjusted OR = 2.26, 95% CI 1.17-4.37). CONCLUSION The likelihood of major complications is higher with a VBAC attempt in women with 2 prior cesarean deliveries compared with those with a single prior cesarean delivery. In women with 2 prior cesarean deliveries, while major complications are increased in those who attempt VBAC relative to elective repeat cesarean delivery, the absolute risk of major complications remains low.
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Affiliation(s)
- George A Macones
- Departments of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA 19104, USA.
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12
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Guise JM, Hashima J, Osterweil P. Evidence-based vaginal birth after Caesarean section. Best Pract Res Clin Obstet Gynaecol 2005; 19:117-30. [PMID: 15749070 DOI: 10.1016/j.bpobgyn.2004.10.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Caesarean section rates are rising globally. Whether vaginal birth after Caesarean (VBAC) is safe and under what circumstances is increasingly important. This chapter reviews the literature about the risks of VBAC, patient and management factors that may alter risk, and discusses ongoing research as well as suggestions for improving future research.
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Affiliation(s)
- Jeanne-Marie Guise
- Department of Obstetrics and Gynecology, Evidence-based Practice Center, Oregon Health & Science University, UHN-50, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA.
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Dodd JM, Crowther CA, Huertas E, Guise JM, Horey D. Planned elective repeat caesarean section versus planned vaginal birth for women with a previous caesarean birth. Cochrane Database Syst Rev 2004:CD004224. [PMID: 15495090 DOI: 10.1002/14651858.cd004224.pub2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND When a woman has had a previous caesarean birth, there are two options for her care in a subsequent pregnancy: planned elective repeat caesarean or planned vaginal birth. While there are risks and benefits for both planned elective repeat caesarean birth and planned vaginal birth after caesarean, current sources of information are limited to non-randomised cohort studies. Studies designed in this way have significant potential for bias and consequently conclusions based on these results are limited in their reliability and should be interpreted with caution. OBJECTIVES To assess, using the best available evidence, the benefits and harms of a policy of planned elective repeat caesarean section with a policy of planned vaginal birth after caesarean section for women with a previous caesarean birth. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group trials register (24 June 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2004), and PubMed (1966 to 24 June 2004). SELECTION CRITERIA Randomised controlled trials with reported data that compared outcomes in mothers and babies who planned a repeat elective caesarean section with outcomes in women who planned a vaginal birth, where a previous birth had been by caesarean. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed trial quality and extracted data. MAIN RESULTS There were no randomised controlled trials identified. REVIEWERS' CONCLUSIONS Planned elective repeat caesarean section and planned vaginal birth after caesarean section for women with a prior caesarean birth are both associated with benefits and harms. Evidence for these care practices is drawn from non-randomised studies, associated with potential bias. Any results and conclusions must therefore be interpreted with caution. Randomised controlled trials are required to provide the most reliable evidence regarding the benefits and harms of both planned elective repeat caesarean section and planned vaginal birth for women with a previous caesarean birth.
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Affiliation(s)
- J M Dodd
- Department of Obstetrics and Gynaecology, University of Adelaide, Women's and Children's Hospital, 72 King William Road, Adelaide, South Australia, Australia, 5006.
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Imoh-Ita F, Williams S. Prostaglandin E2 induction of labour proceeding to vaginal delivery after two previous caesarean sections. J OBSTET GYNAECOL 2002; 22:559-60. [PMID: 12521435 DOI: 10.1080/014436102760298890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- F Imoh-Ita
- The Obstetrics Unit, Guy's Hospital, London, UK.
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15
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Wood JR, Quinlivan JA, Keirse MJ. Trial of labour after four Caesarean sections: a case report and literature review. Aust N Z J Obstet Gynaecol 2001; 41:233-5. [PMID: 11453282 DOI: 10.1111/j.1479-828x.2001.tb01219.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We present the case of a woman who requested trial of labour following four Caesarean sections and achieved a vaginal birth. We discuss the recent legal rulings pertaining to patient consent in respect to Caesarean section and published data on outcomes following trial of labour after more than 1 Caesarean section.
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Affiliation(s)
- J R Wood
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Flinders Medical Centre, Bedford Park, South Australia, Australia
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16
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Bretelle F, Cravello L, Shojai R, Roger V, D'ercole C, Blanc B. Vaginal birth following two previous cesarean sections. Eur J Obstet Gynecol Reprod Biol 2001; 94:23-6. [PMID: 11134821 DOI: 10.1016/s0301-2115(00)00328-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the management of vaginal delivery among women with two previous cesarean sections. The maternal and fetal morbidities of this attitude were studied. SETTING University hospital. DESIGN Retrospective study made over 6 years, from January 1st 1990 to December 31st 1995. PATIENTS Among 180 patients with two uterine scars, 96 patients with cephalic presentation and normal pelvic dimensions were allowed trial of labor. RESULTS The rate of vaginal birth following trial of labor was 65.6%. Three patients had an uterine scar dehiscence; among them, one hysterectomy was performed for haemorrhage with uterine atony. Neonatal issue was always favorable. Twenty-two newborns had superior birthweights compared to those born from the preceding cesarean section. CONCLUSION Trial of labor following two previous cesarean sections is acceptable in the majority of cases. It leads to a high vaginal delivery rate and low maternal and fetal morbidity.
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Affiliation(s)
- F Bretelle
- Department of Obstetrics & Gynecology B, Hôpital de La Conception, 147 Bvd Baille, 13385, Cedex 5, Marseille, France
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17
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Mozurkewich EL, Hutton EK. Elective repeat cesarean delivery versus trial of labor: a meta-analysis of the literature from 1989 to 1999. Am J Obstet Gynecol 2000; 183:1187-97. [PMID: 11084565 DOI: 10.1067/mob.2000.108890] [Citation(s) in RCA: 256] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to compare a trial of labor with elective repeat cesarean delivery among women with previous cesarean delivery. STUDY DESIGN We searched MEDLINE and EMBASE databases from 1989 through 1999 with the following terms: vaginal birth after cesarean delivery, trial of labor, trial of scar, and uterine rupture. We included all controlled trials from developed countries in which the control group had been eligible for a trial of labor. Outcomes of interest were uterine rupture, hysterectomy, maternal febrile morbidity, maternal mortality, 5-minute Apgar score <7, and fetal or neonatal mortality. We computed pooled odds ratios for each outcome. RESULTS The search strategy identified 52 controlled studies, 37 of which were excluded because many of the control subjects were not eligible for a trial of labor. Fifteen studies with a total of 47,682 women were included. Uterine rupture occurred more frequently among women undergoing a trial of labor than among those undergoing elective repeat cesarean delivery (odds ratio, 2.10; 95% confidence interval, 1.45-3.05). There was no difference in maternal mortality risk between the 2 groups (odds ratio, 1.52; 95% confidence interval, 0.36-6.38). Fetal or neonatal death (odds ratio, 1.71; 95% confidence interval, 1.28-2.28) and 5-minute Apgar scores <7 (odds ratio, 2.24; 95% confidence interval, 1.29-3.88) were more frequent in the trial of labor group than in the control group. Mothers undergoing a trial of labor were less likely to have febrile morbidity (odds ratio, 0.70; 95% confidence interval, 0.64-0.77) or to require transfusion (odds ratio, 0.57; 95% confidence interval, 0.42-0.76) or hysterectomy (odds ratio, 0.39; 95% confidence interval, 0.27-0.57). CONCLUSION A trial of labor may result in small increases in the uterine rupture rate and in fetal and neonatal mortality rates with respect to elective repeat cesarean delivery. Maternal morbidity, including febrile morbidity, and the need for transfusion or hysterectomy may be reduced with a trial of labor.
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Affiliation(s)
- E L Mozurkewich
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Caughey AB, Shipp TD, Repke JT, Zelop CM, Cohen A, Lieberman E. 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. [PMID: 10521745 DOI: 10.1016/s0002-9378(99)70317-0] [Citation(s) in RCA: 126] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We sought to determine whether there is a difference in the rate of symptomatic uterine rupture after a trial of labor in women who have had 1 versus 2 prior cesarean deliveries. STUDY DESIGN The medical records of all women with a history of either 1 or 2 prior cesarean deliveries who elected to undergo a trial of labor during a 12-year period (July 1984-June 1996) at the Brigham and Women's Hospital were reviewed. Rates of uterine rupture were compared for these 2 groups. Potential confounding variables were controlled by using logistic regression analyses. RESULTS Women with 1 prior cesarean delivery (n = 3757) had a rate of uterine rupture of 0.8%, whereas women with 2 prior cesarean deliveries (n = 134) had a rate of uterine rupture of 3.7% (P =.001). In a logistic regression analysis that was controlled for maternal age, use of epidural analgesia, oxytocin induction, oxytocin augmentation, the use of prostaglandin E(2) gel, birth weight, gestational age, type of prior hysterotomy, year of trial of labor, and prior vaginal delivery, the odds ratio for uterine rupture in those patients with 2 prior cesarean deliveries was 4.8 (95% confidence interval, 1.8-13. 2) CONCLUSIONS Women with a history of 2 prior cesarean deliveries have an almost 5-fold greater risk of uterine rupture than those with only 1 prior cesarean delivery.
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Affiliation(s)
- A B Caughey
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Martin JN, Perry KG, Roberts WE, Meydrech EF. The case for trial of labor in the patient with a prior low-segment vertical cesarean incision. Am J Obstet Gynecol 1997; 177:144-8. [PMID: 9240598 DOI: 10.1016/s0002-9378(97)70453-8] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Our purpose was to review recent obstetric literature detailing the subsequent delivery experience of patients with a prior low-segment vertical cesarean incision and to derive recommendations for practice on the basis of this information. STUDY DESIGN Ten studies that included information about pregnancy outcome in patients with prior low-segment vertical cesarean operations were retrieved and reviewed from the American obstetric literature since 1981 and from a review of all abstracts presented annually since 1981 to the Society of Perinatal Obstetricians. RESULTS Altogether, information about subsequent pregnancy outcome for 382 patients with prior low-segment vertical cesarean delivery was available for analysis. Among the 372 patients with complete patient population information, vaginal delivery was safely accomplished in 306 (82%). Four uterine ruptures (1.05%) have been reported, only one of which occurred after a single prior unextended low-segment vertical cesarean incision. Two ruptures occurred elsewhere on the lateral or posterior aspect of the uterus in subsequent pregnancies, and the fourth rupture occurred at the juncture of prior low vertical and transverse incisions. No perinatal mortality or permanent perinatal morbidity was encountered with these pregnancies. CONCLUSIONS In the otherwise uncomplicated pregnancy the patient with one previous nonextended low-segment vertical cesarean incision should be considered to have a prior low-segment scar and as such be a candidate for trial of labor in her current singleton pregnancy. The same care, counseling, and caution should be exercised for this patient as for one with a prior low-segment transverse incision.
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Affiliation(s)
- J N Martin
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, USA
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20
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Letters to the Editor. Aust N Z J Obstet Gynaecol 1996. [DOI: 10.1111/j.1479-828x.1996.tb02206.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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21
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Vaginal Birth After Cesarean Section. ACTA ACUST UNITED AC 1995. [DOI: 10.1007/978-1-4612-2482-2_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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22
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Experiment and illusion in reproductive medicine. HUMAN NATURE-AN INTERDISCIPLINARY BIOSOCIAL PERSPECTIVE 1994; 5:1-22. [DOI: 10.1007/bf02692190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/1990] [Revised: 10/15/1993] [Indexed: 10/22/2022]
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Abstract
Recent clinical attention has focused upon the rising rate of caesarean sections being performed and whether patients with a previous caesarean section should be allowed a vaginal delivery. In this paper, the worldwide trend of caesarean section and the role of trial of scar following single and multiple caesarean surgery is reviewed. The role of oxytocin and regional epidural analgesia is evaluated as well as perinatal and maternal mortality. On the basis of the available data, there is no justification for the current clinical practice of almost 99% prevalence of elective repeat caesarean section in some hospitals in the North America. Oxytocin and epidural analgesia, when carefully monitored, are safe and reasonable in these patients. Watchful waiting has always been an essential virtue in obstetric management and should not be replaced by hopeful expectancy. This aspect of the art of obstetrics would appear to require rejuvenation if we are to stem the rising tide of caesarean sections.
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Affiliation(s)
- I I Bolaji
- Academic Department of Obstetrics and Gynaecology, Newham General Hospital, Plaistow, London, UK
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24
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Klutke JJ, Klutke CG. Simultaneous bladder and uterine rupture at the time of attempted vaginal birth after Cesarean section. Int Urogynecol J 1992. [DOI: 10.1007/bf00372663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Roberts LJ. Elective section after two sections--where's the evidence? BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1991; 98:1199-202. [PMID: 1777449 DOI: 10.1111/j.1471-0528.1991.tb15388.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- L J Roberts
- Department of Obstetrics and Gynaecology, Cambridge Military Hospital, Aldershot, Hants
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