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Fitzpatrick KE, Kurinczuk JJ, Bhattacharya S, Quigley MA. Planned mode of delivery after previous cesarean section and short-term maternal and perinatal outcomes: A population-based record linkage cohort study in Scotland. PLoS Med 2019; 16:e1002913. [PMID: 31550245 PMCID: PMC6759152 DOI: 10.1371/journal.pmed.1002913] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/21/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Policy consensus in high-income countries supports offering pregnant women with previous cesarean section a choice between planning an elective repeat cesarean section (ERCS) or attempting a vaginal birth, known as a planned vaginal birth after previous cesarean (VBAC), provided they do not have contraindications to planned VBAC. However, robust comprehensive information on the associated outcomes to counsel eligible women about this choice is lacking. This study investigated the short-term maternal and perinatal outcomes associated with planned mode of delivery after previous cesarean section among women delivering a term singleton and considered eligible to have a planned VBAC. METHODS AND FINDINGS A population-based cohort of 74,043 term singleton births in Scotland between 2002 and 2015 to women with one or more previous cesarean sections was conducted using linked Scottish national datasets. Logistic or modified Poisson regression, as appropriate, was used to estimate the effect of planned mode of delivery on maternal and perinatal outcomes adjusted for sociodemographic, maternal medical, and obstetric-related characteristics. A total of 45,579 women gave birth by ERCS, and 28,464 had a planned VBAC, 28.4% of whom went on to have an in-labor nonelective repeat cesarean section. Compared to women delivering by ERCS, those who had a planned VBAC were significantly more likely to have uterine rupture (0.24%, n = 69 versus 0.04%, n = 17, adjusted odds ratio [aOR] 7.3, 95% confidence interval [CI] 3.9-13.9, p < 0.001), a blood transfusion (1.14%, n = 324 versus 0.50%, n = 226, aOR 2.3, 95% CI 1.9-2.8, p < 0.001), puerperal sepsis (0.27%, n = 76 versus 0.17%, n = 78, aOR 1.8, 95% CI 1.3-2.7, p = 0.002), and surgical injury (0.17% versus 0.09%, n = 40, aOR 3.0, 95% CI 1.8-4.8, p < 0.001) and experience adverse perinatal outcomes including perinatal death, admission to a neonatal unit, resuscitation requiring drugs and/or intubation, and an Apgar score < 7 at 5 minutes (7.99%, n = 2,049 versus 6.37%, n = 2,570, aOR 1.6, 95% CI 1.5-1.7, p < 0.001). However, women who had a planned VBAC were more likely than those delivering by ERCS to breastfeed at birth or hospital discharge (63.6%, n = 14,906 versus 54.5%, n = 21,403, adjusted risk ratio [aRR] 1.2, 95% CI 1.1-1.2, p < 0.001) and were more likely to breastfeed at 6-8 weeks postpartum (43.6%, n = 10,496 versus 34.5%, n = 13,556, aRR 1.2, 95% CI 1.2-1.3, p < 0.001). The effect of planned mode of delivery on the mother's risk of having a postnatal stay greater than 5 days, an overnight readmission to hospital within 42 days of birth, and other puerperal infection varied according to whether she had any prior vaginal deliveries and, in the case of length of postnatal stay, also varied according to the number of prior cesarean sections. The study is mainly limited by the potential for residual confounding and misclassification bias. CONCLUSIONS Among women considered eligible to have a planned VBAC, planned VBAC compared to ERCS is associated with an increased risk of the mother having serious birth-related maternal and perinatal complications. Conversely, planned VBAC is associated with an increased likelihood of breastfeeding, whereas the effect on other maternal outcomes differs according to whether a woman has any prior vaginal deliveries and the number of prior cesarean sections she has had. However, the absolute risk of adverse outcomes is small for either delivery approach. This information can be used to counsel and manage the increasing number of women with previous cesarean section, but more research is needed on longer-term outcomes.
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Affiliation(s)
- Kathryn E. Fitzpatrick
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Jennifer J. Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Sohinee Bhattacharya
- The Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Maria A. Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Vandenberghe G, De Blaere M, Van Leeuw V, Roelens K, Englert Y, Hanssens M, Verstraelen H. Nationwide population-based cohort study of uterine rupture in Belgium: results from the Belgian Obstetric Surveillance System. BMJ Open 2016; 6:e010415. [PMID: 27188805 PMCID: PMC4874166 DOI: 10.1136/bmjopen-2015-010415] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 02/26/2016] [Accepted: 03/01/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We aimed to assess the prevalence of uterine rupture in Belgium and to evaluate risk factors, management and outcomes for mother and child. DESIGN Nationwide population-based prospective cohort study. SETTING Emergency obstetric care. Participation of 97% of maternity units covering 98.6% of the deliveries in Belgium. PARTICIPANTS All women with uterine rupture in Belgium between January 2012 and December 2013. 8 women were excluded because data collection forms were not returned. RESULTS Data on 90 cases of confirmed uterine rupture were obtained, of which 73 had a previous Caesarean section (CS), representing an estimated prevalence of 3.6 (95% CI 2.9 to 4.4) per 10 000 deliveries overall and of 27 (95% CI 21 to 33) and 0.7 (95% CI 0.4 to 1.2) per 10 000 deliveries in women with and without previous CS, respectively. Rupture occurred during trial of labour after caesarean section (TOLAC) in 57 women (81.4%, 95% CI 68% to 88%), with a high rate of augmented (38.5%) and induced (29.8%) labour. All patients who underwent induction of labour had an unfavourable cervix at start of induction (Bishop Score ≤7 in 100%). Other uterine surgery was reported in the history of 22 cases (24%, 95% CI 17% to 34%), including 1 case of myomectomy, 3 cases of salpingectomy and 2 cases of hysteroscopic resection of a uterine septum. 14 cases ruptured in the absence of labour (15.6%, 95% CI 9.5% to 24.7%). No mothers died; 8 required hysterectomy (8.9%, 95% CI 4.6% to 16.6%). There were 10 perinatal deaths (perinatal mortality rate 117/1000 births, 95% CI 60 to 203) and perinatal asphyxia was observed in 29 infants (34.5%, 95% CI 25.2% to 45.1%). CONCLUSIONS The prevalence of uterine rupture in Belgium is similar to that in other Western countries. There is scope for improvement through the implementation of nationally adopted guidelines on TOLAC, to prevent use of unsafe procedures, and thereby reduce avoidable morbidity and mortality.
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Affiliation(s)
- G Vandenberghe
- Department of Obstetrics & Gynaecology, Ghent University Hospital, Ghent, Belgium
| | - M De Blaere
- Department of Obstetrics & Gynaecology, Ghent University Hospital, Ghent, Belgium
| | - V Van Leeuw
- Centre d'Epidémiologie Périnatale (CEpiP), Bruxelles, Belgium
| | - K Roelens
- Department of Obstetrics & Gynaecology, Ghent University Hospital, Ghent, Belgium
| | - Y Englert
- Faculty of Medicine, Centre d'Epidémiologie Périnatale (CEpiP), Research Laboratory on Human Reproduction, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - M Hanssens
- Department of Obstetrics & Gynaecology, University Hospital Leuven, Leuven, Belgium
| | - H Verstraelen
- Department of Obstetrics & Gynaecology, Ghent University Hospital, Ghent, Belgium
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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 2013:CD004224. [PMID: 24323886 DOI: 10.1002/14651858.cd004224.pub3] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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 (VBAC), 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 VBAC for women with a previous caesarean birth. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2013) and reference lists of retrieved studies. 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 review authors independently assessed trial quality and extracted data. MAIN RESULTS Two randomised trials involving 320 women and their infants were included. However, data for maternal and infant clinical outcomes were available from one trial with very low event rates, involving 22 women only.For the primary outcomes maternal death or serious morbidity (one study; 22 women; risk ratio (RR) not estimable), and infant death or serious morbidity (one study; 22 women; RR not estimable), there were no statistically significant differences between planned caesarean birth and planned vaginal birth identified. AUTHORS' CONCLUSIONS Planned elective repeat caesarean section and planned VBAC for women with a prior caesarean birth are both associated with benefits and harms. Evidence for these care practices is largely 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)
- Jodie M Dodd
- School of Paediatrics and Reproductive Health, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Women's and Children's Hospital, 72 King William Road, Adelaide, South Australia, Australia, 5006
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Abbasi AUN. Vaginal birth after caesarean section. J Ayub Med Coll Abbottabad 2012; 24:1-2. [PMID: 24669594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Abstract
Nearly 1 in 3 pregnant women in the United States undergo cesarean. This trend is contrary to the national goal of decreasing cesarean delivery in low-risk women. The decline in vaginal birth after cesarean (VBAC) contributes to the continual increase in cesarean deliveries. Prior cesarean delivery is the most common indication for cesarean and accounts for more than one-third of all cesareans. The appropriate use and safety of cesarean and VBAC are of concern not only at the individual patient and clinician level but they also have far-reaching public health and policy implications at the national level.
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Affiliation(s)
- Yvonne W. Cheng
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 505 Parnassus Avenue, Box 0132, San Francisco, CA 94143, USA
| | - Karen B. Eden
- Department of Medical Informatics and Clinical Epidemiology, Oregon Evidence-based Practice Center, Oregon Health and Science University, Mail Code BICC, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Nicole Marshall
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Mail Code L458, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Leonardo Pereira
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Mail Code L458, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Aaron B. Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Mail Code L466, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Jeanne-Marie Guise
- Division of Maternal-Fetal Medicine, Departments of Obstetrics and Gynecology, Medical Informatics & Clinical Epidemiology, Public Health & Preventive Medicine, Oregon Evidence-based Practice Center, Oregon Health & Science University, Mail Code L466, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
- Quality & Safety for Women’s Services, Health Services & Outcomes Research, Oregon BIRCWH K12, Comparative Effectiveness K12 & KM1, Institute for Patient Centered Comparative Effectiveness, State Obstetric and Pediatric Research Collaborative (STORC), OHSU Center of Excellence in Women’s Health, OHSU Hospital, Portland, OR 97239, USA
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Katsulov A. [Method of delivery after cesarean section (review of the literature)]. Akush Ginekol (Sofiia) 2010; 49:41-48. [PMID: 21427876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The author shows, that pregnant women may give birth vaginally without compromise when they have spent one to three and more cesarean births.
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Richter R, Bergmann RL, Dudenhausen JW. Previous caesarean or vaginal delivery: which mode is a greater risk of perinatal death at the second delivery? Eur J Obstet Gynecol Reprod Biol 2006; 132:51-7. [PMID: 16846675 DOI: 10.1016/j.ejogrb.2006.06.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2005] [Revised: 05/25/2006] [Accepted: 06/03/2006] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Rolf Richter
- Department of Obstetrics, Charité-Universitaetsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
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Cohain JS. Vaginal births after C-section are not necessarily riskier in a birth center than in the hospital. Midwifery Today Int Midwife 2006:16-7, 60. [PMID: 16623142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Recent research concluded that VBACs are riskier in a birth center than in the hospital. This conclusion is only true if the woman is sure she will not have any more pregnancies and if she does not suffer from "Fear of Hospitals." Since childbirth centers offered a VBAC rate of 87%, whereas US hospitals currently offer a VBAC rate of less than 10%, the woman has a much higher risk of a repeat cesarean if she delivers in hospital, which increases her risk on subsequent pregnancies.
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Smith GCS, Pell JP, Pasupathy D, Dobbie R. Factors predisposing to perinatal death related to uterine rupture during attempted vaginal birth after caesarean section: retrospective cohort study. BMJ 2004; 329:375. [PMID: 15262772 PMCID: PMC509342 DOI: 10.1136/bmj.38160.634352.55] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the factors associated with an increased risk of perinatal death related to uterine rupture during attempted vaginal birth after caesarean section. DESIGN Population based retrospective cohort study. SETTING Data from the linked Scottish Morbidity Record and Stillbirth and Infant Death Survey of births in Scotland, 1985-98. PARTICIPANTS All women with one previous caesarean delivery who gave birth to a singleton infant at term by a means other than planned repeat caesarean section (n = 35 854). MAIN OUTCOME MEASURES All intrapartum uterine rupture and uterine rupture resulting in perinatal death (that is, death of the fetus or neonate). RESULTS The overall proportion of vaginal births was 74.2% and of uterine rupture was 0.35%. The risk of intrapartum uterine rupture was higher among women who had not previously given birth vaginally (adjusted odds ratio 2.5, 95% confidence interval 1.6 to 3.9, P < 0.001) and those whose labour was induced with prostaglandin (2.9, 2.0 to 4.3, P < 0.001). Both factors were also associated with an increased risk of perinatal death due to uterine rupture. Delivery in a hospital with < 3000 births a year did not increase the overall risk of uterine rupture (1.1, 0.8 to 1.5, P = 0.67). However, the risk of perinatal death due to uterine rupture was significantly higher in hospitals with < 3000 births a year (one per 1300 births) than in hospitals with >or= 3000 births a year (one per 4700; 3.4, 1.0 to 14.3, P = 0.04). CONCLUSION Women who have not previously given birth vaginally and those whose labour is induced with prostaglandin are at increased risk of uterine rupture when attempting vaginal birth after caesarean section. The risk of consequent death of the infant is higher in units with lower annual numbers of births.
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Affiliation(s)
- Gordon C S Smith
- Department of Obstetrics and Gynaecology, Cambridge University, Cambridge CB2 2QQ.
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Abstract
BACKGROUND Perinatal neonatal mortality is increased where there is a maternal history of cesarean section (0.45 vs. 0.31 % in deliveries after previous vaginal delivery). In this study we have analyzed the causes of the perinatal deaths. PATIENTS AND METHODS The increased risk was found by analyzing the database of the Swiss Working Group of Obstetric and Gynecological Institutions with its 29 046 deliveries with a history of previous cesarean section between 1983 and 1996. In this time period 130 perinatal neonatal deaths in deliveries after previous cesarean were recorded. RESULTS The cause of death could be established in 124 cases. In the 42 term deliveries the causes of death were the following: malformations 20, uterine rupture 5, placental abruption 5, respiratory distress syndrome 5, and other causes 7. In the 82 preterm deliveries: prematurity caused by premature contractions/rupture of membranes 38, malformations 12, chorioamnionitis 12, placental abruption 9, severe growth retardation 4, complications of placenta praevia 2, uterine rupture 1, other causes 4. DISCUSSION Preterm deliveries are more frequent (in births) after a previous c/s (7.75 vs. 5.55 % in multiparous mothers without previous cesarean) - not because of a higher frequency of preterm labor or premature rupture of membranes, but because of placental abruption, chorioamnionitis, placental insufficiency and severe growth retardation. Although some of the neonatal deaths are linked to the previous cesarean delivery, perinatal death after previous cesarean is a very rare event. A recommendation to routinely perform a repeat cesarean instead of a trial of labor seems not appropriate.
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Affiliation(s)
- C J Rageth
- Für die ASF, Spital Limmattal, Schlieren, Schweiz.
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Maouris P. Delivery-related perinatal death and vaginal birth after Caesarean section. Aust N Z J Obstet Gynaecol 2004; 43:481-2. [PMID: 14712958 DOI: 10.1046/j.0004-8666.2003.00147.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
OBJECTIVE To compare maternal and neonatal outcomes in spontaneous versus induced labor after one previous cesarean delivery. METHODS Women with one previous cesarean delivery who had spontaneous labor between January 1992 and January 2000 were compared with those whose labor was induced. RESULTS Three thousand seven hundred forty-six patients had a trial of labor (2943 spontaneous, 803 induced). Those induced had more frequent early postpartum hemorrhage (7.3% versus 5.0%; odds ratio [OR] 1.66; 95% confidence interval [CI] 1.18, 2.32), cesarean delivery (37.5% versus 24.2%; OR 1.84; 95% CI 1.51, 2.25), and neonatal intensive care unit (NICU) admission (13.3% versus 9.4%; OR 1.69; 95% CI 1.25, 2.29). There was a trend toward higher uterine rupture rates in those with induced versus spontaneous labor (0.7% versus 0.3%, P =.128) and for patients undergoing dinoprostone (prostaglandin E(2)) induction versus other methods (1.1% versus 0.6%, P =.62), although neither difference achieved statistical significance. CONCLUSION Induced labor is associated with an increased rate of early postpartum hemorrhage, cesarean delivery, and neonatal ICU admission. The higher rate of uterine rupture in those who had labor induced was not statistically significant.
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Affiliation(s)
- Tina Delaney
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Dalhousie University, Halifax, Nova Scotia, Canada.
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14
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Abstract
Prominent American and British obstetricians have been advocating for performing more Cesareans. They argue that Cesarean section is as safe or nearly as safe as vaginal birth, eliminates pelvic floor damage and the consequent symptoms caused by vaginal birth, is safer for the infant, and is desired by many women; however, abundant evidence in the medical literature refutes the validity of those claims.
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Abstract
OBJECTIVE This analysis was undertaken to better understand the costs and health consequences of a trial of labor after cesarean when compared with a policy of routine elective repeat cesarean delivery. METHODS A decision-tree model incorporating a Markov analysis was used to examine the reproductive life of a hypothetical cohort of 100,000 pregnant women whose only prior pregnancy was delivered through a low transverse cesarean incision. Using this model, the policy of performing routine elective cesarean delivery was compared with a policy of allowing a trial of labor. Main outcome measures were maternal and neonatal morbidity and mortality, total costs to the health care system, and cost per major neonatal complication avoided (death or permanent neurologic sequelae). RESULTS The consequences of routine elective cesarean delivery for a second birth are significant, with an additional 117,748 cesarean deliveries, 5500 maternal morbid events, and $179 million incurred during the reproductive life of 100,000 women. The prevention of one major adverse neonatal outcome requires 1591 cesarean deliveries and $2.4 million. Sensitivity analysis confirms the robustness of the analysis. CONCLUSION Routine elective cesarean for a second delivery for women with a prior low transverse cesarean incision results in an excess of maternal morbidity and mortality and a high cost to the medical system.
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Affiliation(s)
- W A Grobman
- Section of Maternal-Fetal Medicine and Department of Obstetrics and Gynecology, Northwestern Memorial Hospital, Northwestern University Medical School, Chicago, Illinois 60640, USA.
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Lehmann M, Hedelin G, Sorgue C, Göllner JL, Grall C, Chami A, Collin D. [Predictive factors of the delivery method in women with cesarean section scars]. J Gynecol Obstet Biol Reprod (Paris) 1999; 28:358-68. [PMID: 10480067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
OBJECTIVE To determine the independent effect of clinical and non clinical factors on the mode of delivery after previous cesarean section. METHODS We performed a retrospective multicenter study of 579 women who had previously undergone a cesarean section and who delivered between January 1995 and June 1997. Maternal and perinatal morbidity associated with trial of labor and elective repeat cesarean was assessed. Multiple logistic regression was used to identify prognostic factors for the outcome of a trial of labor. The odds ratios provided indicate the risk of cesarean section when the factor is present. RESULTS The rate of successful trial of labor was 74.5%. Overall morbidity was not increased in the trial of labor group. The variables of significant predictive value were the Bishop's score (OR = 15.2 for a score < 3; 95% CI: 5.54 to 41.9), an anomaly of the pelvis (OR = 5.89; 95% CI: 2.37 to 14.7), a previous vaginal delivery (OR = 0.27; 95% CI: 0.12 to 0.60), a fetal distress (OR = 4.11; 95% CI: 2.01 to 8.43), the weight gain during pregnancy (OR = 2.01; 95% CI: 1.10 to 3.68), a delivery between 11 p.m. and 7 a.m. (OR = 0.29; 95% CI: 0.13 to 0.66), a hypertension (OR = 3.10; 95% CI: 1.09 to 8.80) and the use of an intra-uterine pressure catheter (OR = 0.26; 95% CI: 0.11 to 0.57). CONCLUSION A trial of labor should be allowed in most of the women with previous cesarean section. The Bishop's score is the best predictor of the mode of delivery. Induction of labor and a first cesarean for dystocia do not affect the chances of vaginal birth.
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Affiliation(s)
- M Lehmann
- Service de Gynécologie-Obstétrique, Centre Hospitalier, Haguenau
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