Spontaneous versus induced labor after a previous cesarean delivery

Prevalence of uterine rupture among women with one prior low transverse cesarean and women with unscarred uterus undergoing labor induction with PGE2: A systematic review and meta-analysis

BACKGROUND

As uterine rupture may affect as many as 11/1000 women with 1 prior cesarean birth and 5/10.000 women with unscarred uterus undergoing labor induction, we intended to estimate the prevalence of such rare outcome when PGE2 is used for cervical ripening and labor induction.

METHODS

We searched MEDLINE, ClinicalTrials.gov and the Cochrane library up to September 1st 2020. Retrospective and prospective cohort studies, as well as randomized controlled trials (RCTs) on singleton viable pregnancies receiving PGE2 for cervical ripening and labor induction were reviewed. Prevalence of uterine rupture was meta-analyzed with Freeman-Tukey double arcsine transformation among women with 1 prior low transverse cesarean section and women with unscarred uterus.

RESULTS

We reviewed 956 full text articles to include 69 studies. The pooled prevalence rate of uterine rupture is estimated to range between 2 and 9 out of 1000 women with 1 prior low transverse cesarean (5/1000; 95%CI 2-9/1000, 122/9000). The prevalence of uterine rupture among women with unscarred uterus is extremely low, reaching at most 0.7/100.000 (<1/100.000.000; 95%CI <1/100.000.000-0.7/100.000, 8/17.684).

CONCLUSIONS

Uterine rupture is a rare event during cervical ripening and labor induction with PGE2.

Intracervical double-balloon catheter versus dinoprostone for cervical ripening in labor induction in pregnancies with a high risk of uterine hyperstimulation

PURPOSE

There are numerous methods for cervical ripening although not all of them are indicated in women presenting a higher risk of uterine hyperstimulation. To compare the efficacy and security of the two methods for cervical ripening in the induction of labor in these pregnancies.

METHODS

Retrospective analysis of two cohorts consisting of pregnant women who gave birth from 2016 to 2019 (112 inductions with dinoprostone and 112 with intracervical double- balloon).

RESULTS

There are statistically significant differences in favor of dinoprostone in deliveries that occurred before 12 h since the start of the induction (28.6% vs 13.4%, p = 0.005) and a higher rate of cervical ripening (55.4% vs 33.9%; p = 0.001). There were no statistically significant differences in induction time, the percentage of women delivering within 24 h or beyond, nor in the type of delivery. Additionally, a decreased need of oxytocin (60.7% vs 42.9%; p = 0.001) and a lower dose when used has been observed in the dinoprostone group. However, Dinoprostone also has a higher rate of minor maternal complications as uterine hyperstimulation (18.8% vs 3.6%; p = 0.001) and altered cardiotocography (26.8% vs 4.5%; p = 0.001). No significant difference has been found between the two groups regarding severe complications.

CONCLUSIONS

Dinoprostone presents a greater efficacy for cervical ripening and delivery in ≤ 12 h, with less need of oxytocin perfusion than inductions using an intracervical double-balloon. There is no significant difference in severe maternal complications between the two groups. In conclusion, Dinoprostone could be an effective and safe option for patients at risk of uterine hyperstimulation.

Maternal and neonatal outcomes associated with induction of labor after one previous cesarean delivery: A French retrospective study

Background

The safety of methods of labor induction in women with previous cesarean deliveries is still debated. We investigated perinatal outcomes associated with labor induction among women with a trial of labor after one cesarean delivery.

Methods

This retrospective study included 339 women with a trial of labor after one prior cesarean and a singleton term fetus in cephalic presentation in 2013–2016 in a French maternity unit. Labor induction was performed with oxytocin, artificial rupture of membranes and/or prostaglandin E2, according to the Bishop score. The primary outcome was a composite of uterine rupture, low Apgar score, neonatal resuscitation or admission to a neonatal unit. The secondary outcomes included cesarean delivery after onset of labor, postpartum hemorrhage and maternal hospital stay after delivery. We used logistic regression to estimate odds ratios adjusted (aOR) for potential confounders.

Results

In our sample, 67.3% of women had spontaneous labor and 32.7% were induced. More than half of the women received oxytocin during labor regardless of the mode of labor. The proportions of the composite outcome and of cesarean after onset of labor were higher in the induced group compared to the spontaneous group (26.1% vs 15.8%, p = 0.02 and 45.0% vs 27.6%, p<0.01, respectively). There were 9 uterine ruptures (2.6%) and this proportion was higher in the induced group compared to the spontaneous group, although this difference was not statistically significant (3.6% vs 2.2%, p = 0.48). After adjustment, labor induction was associated with higher risks of the composite outcome (aOR = 2.45, 95% CI: 1.29–4.65), cesarean after onset of labor (aOR = 2.06, 95% CI: 1.15–3.68) and maternal hospital stay after delivery ≥6 days (aOR = 6.20, 95% CI: 3.25–11.81). No association was found with postpartum hemorrhage.

Conclusion

Labor induction after one prior cesarean was associated with a higher risk of adverse perinatal outcome. Nevertheless, the higher proportion of uterine rupture did not differ significantly from that in the spontaneous labor group.

Induction of labor in women that had a previous cesarean delivery

OBJECTIVE

This study aims to evaluate factors that predict the likelihood of the success of induction of labor (IOL) in women that had a previous cesarean section (pCS).

METHODS

Pregnant women with one pCS performed more than 18 months prior were included in this retrospective observational study. Of the 242 eligible women, 234 were enrolled; 120 (51.3%) of these women delivered vaginally (VD), with the remainder receiving a repeat CS.

RESULTS

The main reasons for IOL were premature rupture of membranes (PROM) (37.1%) and post-date pregnancy (26.5%). Babies with a birth weight≥4000 g were more prevalent in women undergoing CS (21/114; 18.4%, p<0.02) and were associated with the failure of IOL. Uterine rupture during labor (1.3%) occurred in three cases. Having had a previous vaginal delivery (VD) (p=0.01), not being African (p=0.022), and receiving IOL for PROM (p=0.04) with a cervical Bishop score≥5 (p=0.015) significantly predicted the occurrence of a VD, with an 15% variance (p<0.001). An age>35 years appears to not affect the success of induction.

CONCLUSIONS

A successful IOL should be expected in Caucasian women induced for PROM with a favorable Bishop score.

Outcomes of induction of labour in women with previous caesarean delivery: a retrospective cohort study using a population database

BACKGROUND

There is evidence that induction of labour (IOL) around term reduces perinatal mortality and caesarean delivery rates when compared to expectant management of pregnancy (allowing the pregnancy to continue to await spontaneous labour or definitive indication for delivery). However, it is not clear whether IOL in women with a previous caesarean section confers the same benefits. The aim of this study was to describe outcomes of IOL at 39-41 weeks in women with one previous caesarean delivery and to compare outcomes of IOL or planned caesarean delivery to those of expectant management.

METHODS AND FINDINGS

We performed a population-based retrospective cohort study of singleton births greater than 39 weeks gestation, in women with one previous caesarean delivery, in Scotland, UK 1981-2007 (n = 46,176). Outcomes included mode of delivery, perinatal mortality, neonatal unit admission, postpartum hemorrhage and uterine rupture. 40.1% (2,969/7,401) of women who underwent IOL 39-41 weeks were ultimately delivered by caesarean. When compared to expectant management IOL was associated with lower odds of caesarean delivery (adjusted odds ratio [AOR] after IOL at 39 weeks of 0.81 [95% CI 0.71-0.91]). There was no significant effect on the odds of perinatal mortality but greater odds of neonatal unit admission (AOR after IOL at 39 weeks of 1.29 [95% CI 1.08-1.55]). In contrast, when compared with expectant management, elective repeat caesarean delivery was associated with lower perinatal mortality (AOR after planned caesarean at 39 weeks of 0.23 [95% CI 0.07-0.75]) and, depending on gestation, the same or lower neonatal unit admission (AOR after planned caesarean at 39 weeks of 0.98 [0.90-1.07] at 40 weeks of 1.08 [0.94-1.23] and at 41 weeks of 0.77 [0.60-1.00]).

CONCLUSIONS

A more liberal policy of IOL in women with previous caesarean delivery may reduce repeat caesarean delivery, but increases the risks of neonatal complications.

A review of 93 cases of ruptured uterus over a period of 2 years in a tertiary care hospital in South India

This was a retrospective descriptive study carried out on cases in JIPMER between July 2008 and June 2010 among 32,080 deliveries. The study sample included 93 women who had a ruptured uterus. Outcome variables included maternal characteristics, risk factors, management and complications of ruptured uterus. The incidence of ruptured uterus was 0.28%. Most of these women were multiparous (95%), between 20 and 30 years (82%). The majority had a scarred uterus (77%) and 83% were at term gestation. Among women with a scarred uterus, 57 women (79%) had an unknown uterine scar type and 46 women (64%) had < 18 months' duration from the last caesarean section. A total of 37 women (39.7%) presented with ruptured uterus and a dead fetus. Out of 71 women with previous caesarean section, 46 women (49.4%) were allowed trial of scar and developed a ruptured uterus in hospital. Among women with unscarred uterus, 14 presented with rupture and seven of these women were induced in hospital. Out of the 93 cases, 87% were managed with uterine repair and 12 women underwent hysterectomy. A total of 31 babies were born with good Apgar scores; 48 babies were stillborn. We conclude that the strongest association of ruptured uterus was with previous scarred uterus, multiparity and < 18 months' duration from the last caesarean section. There were no maternal deaths. Maternal morbidity was seen in 17% of cases. Perinatal mortality was 60.6%. As a result of the study, we have implemented changes to improve patients' care.

Elective repeat cesarean delivery compared with spontaneous trial of labor after a prior cesarean delivery: a propensity score analysis

OBJECTIVE

The purpose of this study was to determine outcomes, after the use of propensity score techniques, to create balanced groups according to whether a woman undergoes elective repeat cesarean delivery (ERCD) or trial of labor (TOL).

STUDY DESIGN

Women who were eligible for a TOL with 1 previous low transverse incision were categorized according to whether they underwent an ERCD or TOL. A propensity score technique was used to develop ERCD and TOL groups with comparable baseline characteristics. Outcomes were assessed with conditional logistic regression.

RESULTS

The rates of endometritis, operative injury, respiratory distress syndrome, and newborn infant infection were lower and the rates of hysterectomy and wound complication were higher in the ERCD group.

CONCLUSION

Propensity score techniques can be used to generate comparable ERCD and TOL groups. Some types of maternal morbidity (such as hysterectomy) are higher; other types (such as operative injury) are lower in the ERCD group. Although the absolute risk is low, neonatal morbidity appears to be lower in the ERCD group.

The influence of intrapartum factors on risk of uterine rupture and successful vaginal birth after cesarean delivery

Cesarean delivery is common and increasing over time. A prior cesarean birth increases the risk of both elective and emergency cesarean births and uterine rupture in a subsequent pregnancy. A range of factors, including labor characteristics, may influence the risk of these outcomes in the next pregnancy. Intrapartum factors associated with successful vaginal birth and lower risk of uterine rupture include the spontaneous onset of labor and advanced cervical dilatation. In contrast, need for induction and augmentation of labor are both factors associated with an increased likelihood of unsuccessful vaginal birth and risk of uterine rupture.

[Frequency of uterine rupture at delivery and accompanying risks for the mother and the newborn]

BACKGROUND/AIM

Uterine rupture at delivery is a severe lifethreatening complication for both mather and the newborn. The aim of the study was to determine the frequency of total number uterine rupture within the deliveries, to perceive circumstances and causes that lead to rupture, to establish perinatal and maternal mortality and to present our therapeutic procedure.

METHODS

In the group of 37 ruptures at 59 660 deliveries from the period 1991-2000 included in this retrospective study we analyzed age, level of education, gestational age, parity, previous caesarian section and other operations on uterus, time of diagnosing rupture, grade and place of rupture, use of Syntocinon and Prostaglandin at delivery, perinatal and maternal mortality, as well as therapeutic procedures at rupture that occurred.

RESULTS

The highest influence on uterine rupture in our group had been exerted by previous caesarian section and myomectomy in relation 33 : 4. Incomplete uterine ruptures were more frequent, 26 (70.27%), in relation to complete ones, 11 (29.75%). The most frequent place of uterine rupture was the front wall, 34 (91.89%), two ruptures occurred on the fundus and one on the back wall. The most frequently applied therapeutic procedures were rupture suture in 31 (83.78%) cases, and in six (16.22%) cases hysterectomy. Perinatal mortality was three times higher than average (17.78%) in that period and was 51.28%.

CONCLUSION

We emphasize that rupture frequency in the total number of deliveries was one rupture at 1 612 deliveries, whereas rupture frequency on the intact uterus was 1 : 17 269, and frequency of uterine rupture after caesarian section was one rupture at 245 deliveries. Our research as well as researches of other authors, showed that a previous caesarian section is the most frequent cause for the occurrence of uterine rupture. Therefore, caesarian section should be avoided whenever possible, not just because of a potential rupture, but also because of more frequent hysterectomy that interrupts woman's reproductive ability.

Effects of onset of labor and mode of delivery on severe postpartum hemorrhage

OBJECTIVE

Our purpose was to study the impact of labor onset and delivery mode on the risk of severe postpartum hemorrhage.

STUDY DESIGN

This was a population-based study of 307,415 mothers who were registered in the Medical Birth Registry of Norway from 1999-2004.

RESULTS

Severe postpartum hemorrhage occurred in 1.1% of all mothers and in 2.1% of those mothers with previous cesarean section delivery (CS). Compared with spontaneous labor, hemorrhage risk was higher for induction (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.56-1.88) and prelabor CS (OR, 2.05; 95% CI, 1.84-2.29). The risk was 55% higher for emergency CS and half that for vaginal deliveries (OR, 0.48; 95% CI, 0.43-0.53), compared with prelabor CS. The highest risk was for emergency CS after induction in mothers with previous CS (OR, 6.57; 95% CI, 4.25-10.13), compared with spontaneous vaginal delivery in mothers with no previous CS.

CONCLUSION

Induction and prelabor CS should be practiced with caution because of the increased risk of severe postpartum hemorrhage.

Maternal morbidity following a trial of labor after cesarean section vs elective repeat cesarean delivery: a systematic review with metaanalysis

This study reviewed maternal morbidity following trial of labor (TOL) after cesarean section, compared with elective repeat cesarean delivery (ERCS). Articles were pooled to compare women planning vaginal birth after cesarean (VBAC) with those undergoing ERCS with regard to maternal morbidity (MM), uterine rupture/dehiscence (UR/D), blood transfusion (BT), and hysterectomy. The former group was subdivided into successful VBAC (S-VBAC) and failed TOL (F-TOL). VBAC was successful in 17,905 of 24,349 patients (73%). MM, BT, and hysterectomy were similar in women planning VBAC or ERCS, whereas UR/D was different (1.3%; 0,4%). MM, UR/D, BT and hysterectomy were more common after F-TOL (17%, 4.4%, 3%; 0.5%) than after S-VBAC (3.1%, 0.2%, 1.1%; 0.1%) or ERCS (4.3%, 0.4%, 1%; 0.3%). Outcomes were more favorable in S-VBAC than ERCS. These findings show that a higher risk of UR/D in women planning VBAC than ERCS is counterbalanced by reduction of MM, UR/D. and hysterectomy when VBAC is successful.

Obstetric management and outcome of pregnancy in women with a history of caesarean section in the Netherlands

OBJECTIVE

To determine mode of delivery and occurrence of uterine rupture in women with a previous caesarean section (CS) in the Netherlands.

MATERIALS AND METHODS

During a 1-year period 38 hospitals in the Netherlands registered prospectively mode of delivery, use of prostaglandins or oxytocin and occurrence of uterine rupture in all women with a previous CS.

RESULTS

There were 4569 women with a previous CS. Trial of labour (TOL) was attempted in 71.7%, of whom 76.0% delivered vaginally. The vaginal birth after caesarean (VBAC)-rate was 54.4%. Forty-nine uterine ruptures occurred (1.1%), of which 48 occurred during a TOL (1.5%). There were four perinatal deaths (1.2/1000 TOL) and 3 hysterectomies (0.9/1000 TOL) related to the rupture. Use of prostaglandin E2 alone or combined with oxytocin was significantly associated with an increased risk of uterine rupture (OR 6.8, 95% CI 3.2-14.3, OR 4.8, 95% CI 1.6-14.6, respectively). The same held for augmentation with oxytocin (OR 2.2, 95% CI 1.04-5.0).

CONCLUSION

The success rate of TOL was 76%, resulting in a VBAC rate of 54%. Uterine rupture occurred in 1.5% during a TOL, with a risk of perinatal death of 1.2 per 1000. The risk of uterine rupture increased significantly when labour was induced with prostaglandins alone or combined with oxytocin or when labour was augmented with oxytocin.

Accuracy of birth certificate and hospital discharge data: a certified nurse-midwife and physician comparison

OBJECTIVES

Birth certificate and hospital discharge data are relied upon heavily for national surveillance and research on maternal health. Despite the great importance of these data sources, the recording accuracy in these datasets, comparing birth attendant type, has not been evaluated. The study objective was to assess the variation in chart documentation accuracy between certified nurse-midwives (CNMs) and physicians (MDs) for selected maternal variables using birth certificate and hospital discharge data.

METHODS

Data was obtained on women delivering in 10 Washington State hospitals that had both CNM and MD-attended births in 2000 (n = 2699). Using the hospital medical record as the gold standard of accuracy, the true positive rate (TPR) for selected maternal medical conditions, pregnancy complications, and intrapartum and postpartum events was calculated for CNMs and MDs using birth certificate data, hospital discharge data, and both data sources combined.

RESULTS

The magnitude of TPRs for most recorded maternal medical conditions, pregnancy complications, and intrapatum and postpartum events was higher for CNMs than for MDs. TPRs were significantly higher in birth certificate records for pregnancy-induced hypertension, premature rupture of membranes, labor augmentation, induction of labor, and vaginal birth after cesarean (VBAC) for CNM-attended births relative to MDs. Among combined data sources, CNM TPRs were significantly higher for pregnancy-induced hypertension and premature rupture of membranes.

CONCLUSIONS

CNMs had consistently higher accuracy of recorded maternal medical conditions, pregnancy complications, and intrapartum and postpartum events when compared to MDs for all data sources, with several being statistically significant. Our findings highlight discrepancies between CNM and MD hospital chart documentation, and suggest that epidemiologic researchers consider the issue of measurement error and birth attendant type.

Step 6: does not routinely employ practices, procedures unsupported by scientific evidence: the coalition for improving maternity services:

Step 6 of the Ten Steps of Mother-Friendly Care addresses two issues: 1) the routine use of interventions (shaving, enemas, intravenous drips, withholding food and fluids, early rupture of membranes, and continuous electronic fetal monitoring; and 2) the optimal rates of induction, episiotomy, cesareans, and vaginal births after cesarean. Rationales for compliance and systematic reviews are presented.

Previous caesarean or vaginal delivery: which mode is a greater risk of perinatal death at the second delivery?

OBJECTIVE

To compare the risk of perinatal death after previous caesarean versus previous vaginal delivery, and pre-labour repeat caesarean versus trial of labour after previous caesarean.

STUDY DESIGN

Using the data of the Berlin Perinatal Registry from 1993 to 1999, 7556 second parous women with a previous caesarean delivery were compared with 55142 second parous women with a previous vaginal delivery, and those 1435 women with pre-labour repeat caesarean were compared with 6121 women with a trial of labour after previous caesarean delivery. The rates of perinatal death, stillbirth and intrapartum/neonatal death were analysed using multivariable logistic regression to adjust for confounding variables and obstetric history.

RESULTS

A previous caesarean delivery was associated with a 40% excess risk of perinatal death and a 52% excess risk of stillbirth (p<0.05); the risk of intrapartum/neonatal death was not significantly increased. There were no significantly higher rates of intrapartum/neonatal death and of stillbirth in women trying a vaginal birth versus pre-labour repeat caesarean. But in most cases of antepartum death, labour was induced for that reason.

CONCLUSION

Consulting women about caesarean delivery for maternal request, the increased risk of perinatal death in further pregnancies should be discussed. After a previous caesarean delivery, a careful screening for several risk factors is necessary before recommending a trial of labour.

Induction of labour after a previous caesarean section: a retrospective study in a district general hospital

A retrospective study was undertaken in a district general hospital to identify factors associated with vaginal delivery, as opposed to caesarean section, in women undergoing induction of labour after a previous caesarean section. The study was undertaken over 9 years (April 1994 - May 2003) and included patients in their second or subsequent pregnancy who had previously had one lower segment caesarean delivery and in whom labour had been induced. Records were extracted from a database and anonymised. Vaginal delivery after induction of labour was attempted in 81 patients of whom 64 (79.0%) subsequently delivered vaginally. There were few complications and no cases of uterine rupture. Two factors had a statistical significant relationship with vaginal birth after induction of labour; occipito-anterior position (OR 10.18, 95% CI 1.42 - 112.7, Yates corrected chi2; p = 0.001) and more than one previous birth (OR 4.76, 95% CI 1.28 - 21.67, p = 0.017). Other associations were explored but were not statistically significant. This paper contributes to the literature on factors associated with vaginal delivery after induction of labour and previous caesarean section, which may inform the selection of cases, and consequent success rates for vaginal delivery.

Accuracy of reporting maternal in-hospital diagnoses and intrapartum procedures in Washington State linked birth records

While the impact of maternal morbidities and intrapartum procedures is a common topic in perinatal outcomes research, the accuracy of the reporting of these variables in the large administrative databases (birth certificates, hospital discharges) often utilised for such research is largely unknown. We conducted this study to compare maternal diagnoses and procedures listed on birth certificates, hospital discharge data, and birth certificate and hospital discharge data combined, with those documented in a stratified random sample of hospital medical records of 4541 women delivering liveborn infants in Washington State in 2000. We found that birth certificate and hospital discharge data combined had substantially higher true positive fractions (TPF, proportion of women with a positive medical record assessment who were positive using the administrative databases) than did birth certificate data alone for labour induction (86% vs. 52%), cephalopelvic disproportion (83% vs. 35%), abruptio placentae (85% vs. 68%), and forceps-assisted delivery (89% vs. 55%). For procedures available only in hospital discharge data, TPFs were generally high: episiotomy (85%) and third and fourth degree vaginal lacerations (91%). Except for repeat caesarean section without labour (TPF, 81%), delivery procedures available only in birth certificate data had low TPFs, including augmentation (34%), repeat caesarean section with labour (61%), and vaginal birth after caesarean section (62%). Our data suggest that researchers conducting perinatal epidemiological studies should not rely solely on birth certificate data to detect maternal diagnoses and intrapartum procedures accurately.

Uterine rupture after induction of labour in women with previous caesarean section

BACKGROUND

The issues related to safety of induction of labour in women with previous caesarean section remain controversial. The main adverse outcome fuelling this debate is a "small" risk of uterine rupture that is potentially devastating for both the mother and the fetus.

OBJECTIVE

To estimate the risk of uterine rupture or dehiscence in women who require induction of labour with previous caesarean sections.

DESIGN

Five year retrospective review of computerised hospital records and case note review of index cases.

SETTING

Large inner city teaching hospital.

POPULATION

Two hundred and five women who had their labour induced with history of one lower segment caesarean section.

METHODS

This study was conducted at Liverpool Women's Hospital, a tertiary referral centre, with approximately 6000 births per annum. We searched the hospital's computerised records of deliveries from June 1997 to June 2002 and reviewed all indications and outcomes of induction of labour in women with one previous caesarean section. Women with singleton pregnancy and cephalic presentation were then divided into three groups: those with one previous caesarean section and no previous vaginal deliveries, those whose last delivery was a caesarean section but had delivered vaginally before and those whose last delivery was by vaginal route, but had had one caesarean section in the past.

MAIN OUTCOME MEASURES

Uterine rupture or dehiscence, adverse neonatal outcome.

RESULTS

Two hundred and five women were included. There were four cases of uterine rupture and one dehiscence (2.4%, 95% CI 0.8-5.6%). Two babies were profoundly acidotic at birth, but all five neonates were healthy when discharged from hospital with no long term morbidity. All five cases occurred in the group of women with no previous vaginal deliveries. The intrauterine pressure catheter recordings had contributed to the diagnosis of uterine rupture/dehiscence in three out of five cases.

CONCLUSION

In women with previous caesarean section and no vaginal deliveries, induction of labour carries a relatively high risk of uterine rupture/dehiscence despite all precautions, including intrauterine pressure monitoring.

Emergency cesarean delivery in induction of labor: an evaluation of risk factors

BACKGROUND

Induction of labor has been associated with an increased risk of emergency cesarean delivery. Knowledge of factors that influence the risk of cesarean delivery in women with induced labor is limited.

METHODS

We performed a case-control study, nested within a population-based cohort of women with induced labor at term during 1991-1996 in Uppsala County, Sweden. Cases were women delivered with emergency cesarean delivery, and controls were women vaginally delivered (n = 193, respectively). Using logistic regression, analyses were performed. Odds ratio (OR) with 95% confidence intervals (CI) was used as a measure of relative risk.

RESULTS

Women with a previous cesarean delivery had high risks of cesarean delivery (adjusted OR = 10.10, 95% CI = 3.30-30.92). The risk of cesarean delivery was also increased among nulliparous (adjusted OR = 4.92, 95% CI = 2.81-8.61), short (adjusted OR = 2.20, 95% CI = 1.06-4.59), and obese women (adjusted OR = 2.03, 95% CI = 1.07-3.84). A cervix dilatation less than 1.5 cm doubled the risk of cesarean delivery (adjusted OR = 2.26, 95% CI = 1.09-4.66). Mother's age, epidural analgesia, oxytocin augmentation, gestational age, and birthweight were not significantly associated with risks of cesarean delivery.

CONCLUSIONS

Women with a previous cesarean delivery, nulliparous, short, and obese women with induced labor are at high risk of a cesarean delivery. When there is a need to deliver a woman with a previous cesarean section or a nulliparous woman with other risk factors for cesarean delivery, it may be prudent to consider an elective cesarean section.

What’s new and novel in obstetric anesthesia? Contributions from the 2003 scientific literature

THE PREGNANT PATIENT: Age; maternal disease; prophylactic antibiotics; gastroesophageal reflux; obesity; starvation; genotyping; coagulopathy; infection; substance abuse; altered drug responses in pregnancy; physiological changes of pregnancy. THE FETUS: Fetal monitoring; intrauterine surgery. THE NEWBORN: Breastfeeding; maternal infection, fever, and neonatal sepsis evaluation. OBSTETRIC COMPLICATIONS: Embolic phenomena; hemorrhage; preeclampsia; preterm delivery. OBSTETRIC MANAGEMENT: External cephalic version and cervical cerclage; elective cesarean delivery; fetal malpresentation; vaginal birth after cesarean delivery; termination of pregnancy. OBSTETRIC ANESTHESIA: Analgesia for labor and delivery; anesthesia for cesarean delivery; anesthesia for short obstetric operations; complications of anesthesia. MISCELLANEOUS: Consent; ethics; history; labor support; websites/books/leaflets/journal announcements.