1
|
Chen X, Mi MY. The impact of a trial of labor after cesarean versus elective repeat cesarean delivery: A meta-analysis. Medicine (Baltimore) 2024; 103:e37156. [PMID: 38363952 PMCID: PMC10869045 DOI: 10.1097/md.0000000000037156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 01/11/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND The increasing global incidence of cesarean section has prompted efforts to reduce cesarean delivery rates. A trial of labor after cesarean (TOLAC) has emerged as an alternative to elective repeat cesarean delivery (ERCD) for women with a prior cesarean delivery. However, the available evidence on the comparative outcomes of these 2 options remains inconsistent, primarily due to varying advantages and risks associated with each. Our meta-analysis aims to compare the maternal-neonatal results in TOLAC and ERCD in women with prior cesarean deliveries. METHODS A comprehensive search was performed in PubMed, Embase, Cochrane library databases up to September,2022 to identity studies evaluating perinatal outcomes in women who underwent TOLAC compared to ERCD following a previous cesarean delivery. The included studies were subjected to meta-analysis using RevMan 5.3 software to assess the overall findings. RESULTS A total of 13 articles were included in this meta-analysis. Statistically significant differences were identified in the rate of uterine rupture (OR = 2.01,95%CI = 1.48-2.74, P < .00001) and APGAR score < 7 at 5 minutes (OR = 2.17,95%CI = 1.69-2.77, P < .00001) between the TOLAC and ERCD groups. However, no significant differences were observed in the rates of hysterectomy, maternal blood transfusion, postpartum infection, postpartum hemorrhage and neonatal intensive care unit (P ≥ .05) admission between the 2 groups. CONCLUSIONS Our analysis revealed that TOLAC is associated with a higher risk of uterine rupture and lower incidence APGAR score < 7 at 5 minutes compared to ERCD. It is vital to consider predictive factors when determining the appropriate mode of delivery in order to ensure optimal pregnancy outcomes. Efforts should be made to identify the underlying causes of adverse outcomes and implement safety precautions to select suitable participants and create safe environments for TOLAC.
Collapse
Affiliation(s)
- Xiao Chen
- Department of Gynecology and Obstetrics, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei, China
| | - Mei-yan Mi
- Department of Gynecology and Obstetrics, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei, China
| |
Collapse
|
2
|
We Do Not Know How People Have Babies: an Opportunity for Epidemiologists to Have Meaningful Impact on Population-Level Health and Wellbeing. CURR EPIDEMIOL REP 2023. [DOI: 10.1007/s40471-023-00321-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
|
3
|
Fitzpatrick KE, Quigley MA, Kurinczuk JJ. Planned mode of birth after previous cesarean section: A structured review of the evidence on the associated outcomes for women and their children in high-income setting. Front Med (Lausanne) 2022; 9:920647. [PMID: 36148449 PMCID: PMC9486480 DOI: 10.3389/fmed.2022.920647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/08/2022] [Indexed: 12/05/2022] Open
Abstract
In many high-income settings policy consensus supports giving pregnant women who have had a previous cesarean section a choice between planning an elective repeat cesarean section (ERCS) or planning a vaginal birth after previous cesarean (VBAC), provided they have no contraindications to VBAC. To help women make an informed decision regarding this choice, clinical guidelines advise women should be counseled on the associated risks and benefits. The most recent and comprehensive review of the associated risks and benefits of planned VBAC compared to ERCS in high-income settings was published in 2010 by the US Agency for Healthcare Research and Quality (AHRQ). This paper describes a structured review of the evidence in high-income settings that has been published since the AHRQ review and the literature in high-income settings that has been published since 1980 on outcomes not included in the AHRQ review. Three databases (MEDLINE, EMBASE, and PsycINFO) were searched for relevant studies meeting pre-specified eligible criteria, supplemented by searching of reference lists. Forty-seven studies were identified as meeting the eligibility criteria and included in the structured review. The review suggests that while planned VBAC compared to ERCS is associated with an increased risk of various serious birth-related complications for both the mother and her baby, the absolute risk of these complications is small for either birth approach. The review also found some evidence that planned VBAC compared to ERCS is associated with benefits such as a shorter length of hospital stay and a higher likelihood of breastfeeding. The limited evidence available also suggests that planned mode of birth after previous cesarean section is not associated with the child’s subsequent risk of experiencing adverse neurodevelopmental or health problems in childhood. This information can be used to manage and counsel women with previous cesarean section about their subsequent birth choices. Collectively, the evidence supports existing consensus that there are risks and benefits associated with both planned VBAC and ERCS, and therefore women without contraindications to VBAC should be given an informed choice about planned mode of birth after previous cesarean section. However, further studies into the longer-term effects of planned mode of birth after previous cesarean section are needed along with more research to address the other key limitations and gaps that have been highlighted with the existing evidence.
Collapse
|
4
|
Jamshed S, Chien SC, Tanweer A, Asdary RN, Hardhantyo M, Greenfield D, Chien CH, Weng SF, Jian WS, Iqbal U. Correlation Between Previous Caesarean Section and Adverse Maternal Outcomes Accordingly With Robson Classification: Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 8:740000. [PMID: 35096855 PMCID: PMC8795992 DOI: 10.3389/fmed.2021.740000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/29/2021] [Indexed: 11/20/2022] Open
Abstract
Background: The increasing rates of Caesarean section (CS) beyond the WHO standards (10–15%) pose a significant global health concern. Objective: Systematic review and meta-analysis to identify an association between CS history and maternal adverse outcomes for the subsequent pregnancy and delivery among women classified in Robson classification (RC). Search Strategy: PubMed/Medline, EbscoHost, ProQuest, Embase, Web of Science, BIOSIS, MEDLINE, and Russian Science Citation Index databases were searched from 2008 to 2018. Selection Criteria: Based on Robson classification, studies reporting one or more of the 14 adverse maternal outcomes were considered eligible for this review. Data Collection: Study design data, interventions used, CS history, and adverse maternal outcomes were extracted. Main Results: From 4,084 studies, 28 (n = 1,524,695 women) met the inclusion criteria. RC group 5 showed the highest proportion among deliveries followed by RC10, RC7, and RC8 (67.71, 32.27, 0.02, and 0.001%). Among adverse maternal outcomes, hysterectomy had the highest association after preterm delivery OR = 3.39 (95% CI 1.56–7.36), followed by Severe Maternal Outcomes OR = 2.95 (95% CI 1.00–8.67). We identified over one and a half million pregnant women, of whom the majority were found to belong to RC group 5. Conclusions: Previous CS was observed to be associated with adverse maternal outcomes for the subsequent pregnancies. CS rates need to be monitored given the prospective risks which may occur for maternal and child health in subsequent births.
Collapse
Affiliation(s)
- Shazia Jamshed
- Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Sultan Zainal Abidin (UniSZA), Kuala Terengganu, Malaysia.,Qualitative Research-Methodological Application in Health Sciences Research Group, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Malaysia
| | - Shuo-Chen Chien
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan
| | - Afifa Tanweer
- Department of Nutrition Sciences, School of Health Sciences, University of Management and Technology, Lahore, Pakistan
| | - Rahma-Novita Asdary
- Masters Program in Department of Global Health & Development, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Muhammad Hardhantyo
- Graduate Program of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan.,Faculty of Health Science, Universitas Respati Yogyakarta, Depok, Indonesia.,Center for Health Policy and Management, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Depok, Indonesia
| | - David Greenfield
- The Simpson Centre for Health Services Research, South Western Sydney Clinical School, University of New South Wales (UNSW) Medicine, Sydney, NSW, Australia.,Linéaire Projects, Sydney, NSW, Australia
| | - Chia-Hui Chien
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan.,Office of Public Affairs, Taipei Medical University, Taipei, Taiwan
| | - Shuen-Fu Weng
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.,Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wen-Shan Jian
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan.,School of Health Care Administration, School of Gerontology Health Management, Graduate Institute of Data Science, Research Center for Artificial Intelligence in Medicine, Taipei Medical University, Taipei, Taiwan
| | - Usman Iqbal
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan.,Masters Program in Department of Global Health & Development, College of Public Health, Taipei Medical University, Taipei, Taiwan.,Ph.D. Program in Depatment of Global Health & Health Security, College of Public Health, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
5
|
Hill E, Chinkam S, Cardenas L, Iverson RE. Labour after caesarean counselling documentation: a quality improvement intervention on labour and delivery. BMJ Open Qual 2021; 10:e001232. [PMID: 34716182 PMCID: PMC8559118 DOI: 10.1136/bmjoq-2020-001232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 07/28/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Most women who have had previous caesareans are eligible to have labour after caesarean (LAC), but only 11.9% do so. Studies show the majority of women have already decided about future mode of birth (FMOB) before a subsequent pregnancy. Hence, providing women with LAC counselling soon after birth may help women plan for future pregnancies. Prior to our intervention, our hospital had no method of ensuring that women received LAC counselling after caesarean section. The purpose of this QI initiative was to assess whether formal LAC documentation on labour and delivery (L&D) improves rates of LAC counselling post partum. METHODS Our three-part intervention included: (1) surgeon's assessment of LAC feasibility in the operative note, (2) written LAC education for women in discharge paperwork and (3) documentation of LAC counselling in the discharge summary. We implemented these changes on L&D in January 2019. We conducted phone surveys of 40 women after caesarean preintervention and postintervention. Surveys included questions regarding three primary outcomes: whether or not they had received LAC counselling either in the hospital or at a postpartum visit, and whether or not they would pursue LAC as FMOB. Surveys also assessed two secondary outcomes: (1) women's understanding of the indications for surgery and (2) their involvement in the decision process. We used a χ2 analysis to assess primary outcomes and a Fisher's exact test to assess secondary outcomes. We also surveyed providers about the culture of LAC counselling at our hospital. RESULTS After our intervention, there was a significant difference between the number of women reporting LAC postpartum counselling (30.77% vs 53.8%, p=0.04). There was also a significant difference in the number of women feeling involved in the decision-making process (68% vs 95%, p=0.03). Providers reported improved knowledge/confidence around LAC counselling (58%-100%). Providers universally stated that LAC counselling has become more ingrained in the culture on L&D. CONCLUSIONS Documentation of LAC counselling improved the consistency with which providers incorporated LAC counselling into postpartum care. Addressing FMOB at the time of pLTCS and documenting that counselling may be an effective first step in empowering women to pursue LAC in future pregnancies.
Collapse
Affiliation(s)
- Elena Hill
- Department of Family Medicine, Department of OBGYN, Boston Medical Center, Boston, Massachusetts, USA
| | - Somphit Chinkam
- Department of Family Medicine, Department of OBGYN, Boston Medical Center, Boston, Massachusetts, USA
| | - Lilia Cardenas
- Department of Family Medicine, Department of OBGYN, Boston Medical Center, Boston, Massachusetts, USA
| | | |
Collapse
|
6
|
Baradaran K. Risk of Uterine Rupture with Vaginal Birth after Cesarean in Twin Gestations. Obstet Gynecol Int 2021; 2021:6693142. [PMID: 33868405 PMCID: PMC8032534 DOI: 10.1155/2021/6693142] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 03/24/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Women with a previous cesarean delivery may attempt a subsequent vaginal birth or repeat cesarean. Vaginal birth after cesarean carries a greater risk of uterine rupture, defined as the disruption of all uterine layers, resulting in maternal-fetal morbidity or mortality. It is unclear how the risk of uterine rupture compares in patients with twin gestations who undergo different delivery methods. OBJECTIVE The purpose of this systematic review is to determine if there is an increased risk of uterine rupture in patients with twin gestations attempting vaginal birth after cesarean (VBAC) versus planned repeat cesarean delivery (PRCD). Study Design. PubMed, Cochrane Library, and CINAHL were searched systematically. Eligible studies were prospective and retrospective studies that evaluated the incidence of uterine rupture in twin pregnancies that attempted VBAC or PRCD. Data were manually extracted from these studies, and the number of events in each group was used to calculate an odds ratio (OR) and 95% confidence interval (CI). RESULTS 4 retrospective studies were included with a total of 7699 participants, 2305 of whom attempted VBAC and 5394 underwent PRCD. The absolute risk of uterine rupture in the VBAC and PRCD groups was 0.87% and 0.09%, respectively. The rate of uterine rupture was significantly higher in the VBAC group than in the PRCD group (OR: 9.43; CI: 3.54-25.17). CONCLUSION Although VBAC is associated with higher rates of uterine rupture in twin pregnancies when compared with PRCD, the absolute risk of uterine rupture is low in both groups. Depending on individual risk factors, vaginal birth may be offered as a safe option to women with twin pregnancies and a history of cesarean delivery.
Collapse
Affiliation(s)
- Kimya Baradaran
- Master of Science in Physician Assistant Studies, Dominican University of California, San Rafael, CA 94901, USA
| |
Collapse
|
7
|
Gu N, Dai Y, Lu D, Chen T, Zhang M, Huang T, Qi Y, Han X, Xie L, Yang J, Fan C, Yan Y, Zhang A, Weng X, Zhang H, Su L, Li Y, Hu Y. Evaluation of cesarean delivery rates in different levels of hospitals in Jiangsu Province, China, using the 10-Group classification system. J Matern Fetal Neonatal Med 2021; 35:5539-5545. [PMID: 33588678 DOI: 10.1080/14767058.2021.1887124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To compare cesarean delivery (CD) rates in referral and non-referral hospitals in Maternal Safety Collaboration in Jiangsu province, China. METHODS Sixteen participants (4 referral hospitals, 12 non-referral hospitals) from Drum Tower Hospital Collaboration for Maternal Safety reported CD rates in 2019 using ten-group classification system and maternal/neonatal morbidity and mortality. RESULTS A total of 22,676 CDs were performed among 52,499 deliveries and the average CD rate was 43.2% (range 34.8-69.6%). CD rate in non-referral hospitals (44.7%) was significantly higher than it was in referral hospitals (40.4%, p < .001). Term singleton cephalic nulliparous women with spontaneous labor (Group 1) or induced labor (Group 2a) had higher CD rates if they were cared in non-referral hospitals compared with those in referral hospitals (Group 1: 11.8% vs. 4.4%, p < .001; Group 2a: 29.1% vs. 21.3%, p < .001). In non-referral hospitals, CD rate in Group 5 and the proportion of Group 5 to the overall population were also significantly higher than those in referral hospitals (98.5% vs. 92.5%, p < .001; and 21.0% vs. 14.5%, p < .001). CONCLUSION To decrease the CD rate, we need to take efforts in decreasing unnecessary operations for term singleton cephalic nulliparous women and increasing the rate of trial of labor after CD.
Collapse
Affiliation(s)
- Ning Gu
- Department of Obstetrics and Gynecology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, China
| | - Yimin Dai
- Department of Obstetrics and Gynecology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, China
| | - Dan Lu
- Department of Obstetrics and Gynecology, Yangzhou University Affiliated Northern Jiangsu People's Hospital, Yangzhou, China
| | - Tingmei Chen
- Department of Obstetrics and Gynecology, Jiangsu University Affiliated Fourth Hospital, Zhenjiang, China
| | - Muling Zhang
- Department of Obstetrics and Gynecology, Huaian First People's Hospital Affiliated to Nanjing Medical University, Huaian, China
| | - Tao Huang
- Department of Obstetrics and Gynecology, Yangzhou Maternal and Child Health Hospital, Yangzhou, China
| | - Yalan Qi
- Department of Obstetrics and Gynecology, Suqian People's Hospital of Nanjing Drum Tower Hospital Group, Suqian, China
| | - Xinning Han
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Lihua Xie
- Department of Obstetrics and Gynecology, Nanjing Gaochun People's Hospital, Nanjing, China
| | - Jishi Yang
- Department of Obstetrics and Gynecology, Taixing People's Hospital, Taizhou, China
| | - Chengling Fan
- Department of Obstetrics and Gynecology, Baoying Maternal and Child Health Hospital, Yangzhou, China
| | - Yunhua Yan
- Department of Obstetrics and Gynecology, The People's Hospital of Danyang, Zhenjiang, China
| | - Anhong Zhang
- Department of Obstetrics and Gynecology, The Affiliated Jiangning Hospital Of Nanjing Medical University, Nanjing, China
| | - Xiaoping Weng
- Department of Obstetrics and Gynecology, Luhe People's Hospital, Nanjing, China
| | - Huiling Zhang
- Department of Obstetrics and Gynecology, Nanjing Lishui District Hospital of Traditional Chinese Medicine, Nanjing, China
| | - Li Su
- Department of Obstetrics and Gynecology, Yangzhong People's Hospital, Zhenjiang, China
| | - Yingyan Li
- Department of Obstetrics and Gynecology, Gaochun Fukang Hospital, Nanjing, China
| | - Yali Hu
- Department of Obstetrics and Gynecology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, China
| |
Collapse
|
8
|
Gaudineau A, Lorthe E, Quere M, Goffinet F, Langer B, Le Ray I, Subtil D. Planned delivery route and outcomes of cephalic singletons born spontaneously at 24-31 weeks' gestation: The EPIPAGE-2 cohort study. Acta Obstet Gynecol Scand 2020; 99:1682-1690. [PMID: 32557537 DOI: 10.1111/aogs.13939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/26/2020] [Accepted: 06/05/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The objective of this study was to investigate the association between planned mode of delivery and neonatal outcomes with spontaneous very preterm birth among singletons in cephalic presentation. MATERIAL AND METHODS Etude Epidémiologique sur les Petits Ages Gestationnels 2 is a French national, prospective, population-based cohort study of preterm infants. For this study, we included women with a singleton cephalic pregnancy and spontaneous preterm labor or preterm premature rupture of membranes at 24-31 weeks' gestation. The main exposure was the planned mode of delivery (ie planned vaginal delivery or planned cesarean delivery at the initiation of labor). The primary outcome was survival at discharge and secondary outcome survival at discharge without severe morbidity. Propensity scores were used to minimize indication bias in estimating the association. RESULTS The study population consisted of 1008 women: 206 (20.4%) had planned cesarean delivery and 802 (79.6%) planned vaginal delivery. In all, 723 (90.2%) finally had a vaginal delivery. Overall, 187 (92.0%) and 681 (87.0%) neonates in the planned cesarean delivery and planned vaginal delivery groups were discharged alive, and 156 (77.6%) and 590 (76.3%) were discharged alive without severe morbidity. After matching on propensity score, planned cesarean delivery was not associated with survival (adjusted odds ratio [aOR] 1.05, 95% confidence interval [CI] 0.48-2.28) or survival without severe morbidity (aOR 0.64, 95% CI 0.36-1.16). CONCLUSIONS Planned cesarean delivery for cephalic presentation at 24-31 weeks' gestation after preterm labor or preterm premature rupture of membranes does not improve neonatal outcomes.
Collapse
Affiliation(s)
- Adrien Gaudineau
- Department of Obstetrics and Gynecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Department of Obstetrics and Gynecology, Center Hospitalier Princesse Grace, Monaco, Monaco
| | - Elsa Lorthe
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, University of Paris, Paris, France.,EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal
| | - Mathilde Quere
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, University of Paris, Paris, France
| | - François Goffinet
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, University of Paris, Paris, France.,AP-HP, Port-Royal Maternity, University Paris Descartes, Hôpitaux Universitaires Paris-Centre, Paris, France
| | - Bruno Langer
- Department of Obstetrics and Gynecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Isabelle Le Ray
- Department of Obstetrics and Gynecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Damien Subtil
- Pôle Femme Mère Nouveau-né, CHU Lille, Jeanne de Flandre Hospital, University of Lille, Lille, France
| |
Collapse
|
9
|
Keedle H, Peters L, Schmied V, Burns E, Keedle W, Dahlen HG. Women's experiences of planning a vaginal birth after caesarean in different models of maternity care in Australia. BMC Pregnancy Childbirth 2020; 20:381. [PMID: 32605586 PMCID: PMC7325036 DOI: 10.1186/s12884-020-03075-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 06/23/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Vaginal birth after caesarean (VBAC) is a safe mode of birth for most women but internationally VBAC rates remain low. In Australia women planning a VBAC may experience different models of care including continuity of care (CoC). There are a limited number of studies exploring the impact and influence of CoC on women's experiences of planning a VBAC. Continuity of care (CoC) with a midwife has been found to increase spontaneous vaginal birth and decrease some interventions. Women planning a VBAC prefer and benefit from CoC with a known care provider. This study aimed to explore the influence, and impact, of continuity of care on women's experiences when planning a VBAC in Australia. METHODS The Australian VBAC survey was designed and distributed via social media. Outcomes and experiences of women who had planned a VBAC in the past 5 years were compared by model of care. Standard fragmented maternity care was compared to continuity of care with a midwife or doctor. RESULTS In total, 490 women completed the survey and respondents came from every State and Territory in Australia. Women who had CoC with a midwife were more likely to feel in control of their decision making and feel their health care provider positively supported their decision to have a VBAC. Women who had CoC with a midwife were more likely to have been active in labour, experience water immersion and have an upright birthing position. Women who received fragmented care experienced lower autonomy and lower respect compared to CoC. CONCLUSION This study recruited a non-probability based, self-selected, sample of women using social media. Women found having a VBAC less traumatic than their previous caesarean and women planning a VBAC benefited from CoC models, particularly midwifery continuity of care. Women seeking VBAC are often excluded from these models as they are considered to have risk factors. There needs to be a focus on increasing shared belief and confidence in VBAC across professions and an expansion of midwifery led continuity of care models for women seeking a VBAC.
Collapse
Affiliation(s)
- Hazel Keedle
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Lilian Peters
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
- Amsterdam University Medical Centers, Department of Midwifery Science, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Elaine Burns
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Warren Keedle
- School of Environmental Sciences, Charles Sturt University, Bathurst, Australia
| | - Hannah Grace Dahlen
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| |
Collapse
|
10
|
Lipschuetz M, Guedalia J, Rottenstreich A, Novoselsky Persky M, Cohen SM, Kabiri D, Levin G, Yagel S, Unger R, Sompolinsky Y. Prediction of vaginal birth after cesarean deliveries using machine learning. Am J Obstet Gynecol 2020; 222:613.e1-613.e12. [PMID: 32007491 DOI: 10.1016/j.ajog.2019.12.267] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 12/30/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Efforts to reduce cesarean delivery rates to 12-15% have been undertaken worldwide. Special focus has been directed towards parturients who undergo a trial of labor after cesarean delivery to reduce the burden of repeated cesarean deliveries. Complication rates are lowest when a vaginal birth is achieved and highest when an unplanned cesarean delivery is performed, which emphasizes the need to assess, in advance, the likelihood of a successful vaginal birth after cesarean delivery. Vaginal birth after cesarean delivery calculators have been developed in different populations; however, some limitations to their implementation into clinical practice have been described. Machine-learning methods enable investigation of large-scale datasets with input combinations that traditional statistical analysis tools have difficulty processing. OBJECTIVE The aim of this study was to evaluate the feasibility of using machine-learning methods to predict a successful vaginal birth after cesarean delivery. STUDY DESIGN The electronic medical records of singleton, term labors during a 12-year period in a tertiary referral center were analyzed. With the use of gradient boosting, models that incorporated multiple maternal and fetal features were created to predict successful vaginal birth in parturients who undergo a trial of labor after cesarean delivery. One model was created to provide a personalized risk score for vaginal birth after cesarean delivery with the use of features that are available as early as the first antenatal visit; a second model was created that reassesses this score after features are added that are available only in proximity to delivery. RESULTS A cohort of 9888 parturients with 1 previous cesarean delivery was identified, of which 75.6% of parturients (n=7473) attempted a trial of labor, with a success rate of 88%. A machine-learning-based model to predict when vaginal delivery would be successful was developed. When features that are available at the first antenatal visit are used, the model showed a receiver operating characteristic curve with area under the curve of 0.745 (95% confidence interval, 0.728-0.762) that increased to 0.793 (95% confidence interval, 0.778-0.808) when features that are available in proximity to the delivery process were added. Additionally, for the later model, a risk stratification tool was built to allocate parturients into low-, medium-, and high-risk groups for failed trial of labor after cesarean delivery. The low- and medium-risk groups (42.4% and 25.6% of parturients, respectively) showed a success rate of 97.3% and 90.9%, respectively. The high-risk group (32.1%) had a vaginal delivery success rate of 73.3%. Application of the model to a cohort of parturients who elected a repeat cesarean delivery (n=2145) demonstrated that 31% of these parturients would have been allocated to the low- and medium-risk groups had a trial of labor been attempted. CONCLUSION Trial of labor after cesarean delivery is safe for most parturients. Success rates are high, even in a population with high rates of trial of labor after cesarean delivery. Application of a machine-learning algorithm to assign a personalized risk score for a successful vaginal birth after cesarean delivery may help in decision-making and contribute to a reduction in cesarean delivery rates. Parturient allocation to risk groups may help delivery process management.
Collapse
Affiliation(s)
- Michal Lipschuetz
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel; Obstetrics & Gynecology Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Joshua Guedalia
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Amihai Rottenstreich
- Obstetrics & Gynecology Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Sarah M Cohen
- Obstetrics & Gynecology Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Doron Kabiri
- Obstetrics & Gynecology Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Gabriel Levin
- Obstetrics & Gynecology Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Simcha Yagel
- Obstetrics & Gynecology Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - Ron Unger
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Yishai Sompolinsky
- Obstetrics & Gynecology Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| |
Collapse
|
11
|
Barinov SV, Tirskaya YI, Shamina IV, Medyannikova IV, Kadcyna TV, Shkabarnya LL, Lazareva OV. The use of an osmotic dilator for induction of miscarriage in patients with the second trimester missed miscarriage. J Matern Fetal Neonatal Med 2019; 34:2778-2782. [PMID: 31570024 DOI: 10.1080/14767058.2019.1671331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIM The aim of this study was to assess the outcomes of combined use of dilapan-S and pharmacological induction of miscarriage with mifepristone and misoprostol versus mifepristone and misoprostol only in patients with a second-trimester pregnancy loss. MATERIALS AND METHODS Our study included 74 patients with a second-trimester antenatal death who were randomized into two groups to receive pharmacological induction of miscarriage combined with intracervical insertion of dilapan-S (n = 37) or pharmacological induction of miscarriage only (n = 37). Efficacy endpoints included: blood loss volume, length of time between the procedure initiation and complete miscarriage, and the number of complications. RESULTS The use of dilapan-S together with mifepristone and misoprostol for induction of miscarriage in the second trimester in women with antenatal fetal death reduced the time from the start of the procedure to complete miscarriage by 1.98-fold. However, the use of dilapan-S did not significantly reduce the odds of such post-procedural complications as hematometra and retention of the products of conception in the uterus (p = .2501). CONCLUSIONS Combined management of antenatal pregnancy loss in the second trimester including intracervical insertion of dilapan-S and conventional induction with miscarriage may be considered a valuable clinical strategy. However, future studies should focus on ways to prevent postprocedural complications in this group of women.
Collapse
Affiliation(s)
- Sergey V Barinov
- 2nd Department of Obstetrics and Gynecology, Omsk State Medical University, Omsk, Russia
| | - Yuliya I Tirskaya
- 2nd Department of Obstetrics and Gynecology, Omsk State Medical University, Omsk, Russia
| | - Inna V Shamina
- 2nd Department of Obstetrics and Gynecology, Omsk State Medical University, Omsk, Russia
| | - Irina V Medyannikova
- 2nd Department of Obstetrics and Gynecology, Omsk State Medical University, Omsk, Russia
| | - Tatiana V Kadcyna
- 2nd Department of Obstetrics and Gynecology, Omsk State Medical University, Omsk, Russia
| | | | - Oksana V Lazareva
- 2nd Department of Obstetrics and Gynecology, Omsk State Medical University, Omsk, Russia
| |
Collapse
|
12
|
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] [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.
Collapse
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
| |
Collapse
|
13
|
Place K, Kruit H, Tekay A, Heinonen S, Rahkonen L. Success of trial of labor in women with a history of previous cesarean section for failed labor induction or labor dystocia: a retrospective cohort study. BMC Pregnancy Childbirth 2019; 19:176. [PMID: 31109302 PMCID: PMC6528374 DOI: 10.1186/s12884-019-2334-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 05/06/2019] [Indexed: 11/10/2022] Open
Abstract
Background The rates of cesarean section (CS) are increasing worldwide leading to an increased risk for maternal and neonatal complications in the subsequent pregnancy and labor. Previous studies have demonstrated that successful trial of labor after cesarean (TOLAC) is associated with the least maternal morbidity, but the risks of unsuccessful TOLAC exceed the risks of scheduled repeat CS. However, prediction of successful TOLAC is difficult, and only limited data on TOLAC in women with previous failed labor induction or labor dystocia exists. Our aim was to evaluate the success of TOLAC in women with a history of failed labor induction or labor dystocia, to compare the delivery outcomes according to stage of labor at time of previous CS, and to assess the risk factors for recurrent failed labor induction or labor dystocia. Methods This retrospective cohort study of 660 women with a prior CS for failed labor induction or labor dystocia undergoing TOLAC was carried out in Helsinki University Hospital, Finland, between 2013 and 2015. Data on the study population was obtained from the hospital database and analyzed using SPSS. Results The rate of vaginal delivery was 72.9% and the rate of repeat CS for failed induction or labor dystocia was 17.7%. The rate of successful TOLAC was 75.6% in women with a history of labor arrest in the first stage of labor, 73.1% in women with a history of labor arrest in the second stage of labor, and 59.0% in women with previous failed induction. The adjusted risk factors for recurrent failed induction or labor dystocia were maternal height < 160 cm (OR 1.9 95% CI 1.1–3.1), no prior vaginal delivery (OR 8.3 95% CI 3.5–19.8), type 1 or gestational diabetes (OR 1.8 95% CI 1.0–3.0), IOL for suspected non-diabetic fetal macrosomia (OR 10.8 95% CI 2.1–55.9) and birthweight ≥4500 g (OR 3.3 95% CI 1.3–7.9). Conclusions TOLAC is a feasible option to scheduled repeat CS in women with a history of failed induction or labor dystocia. However, women with no previous vaginal delivery, maternal height < 160 cm, diabetes or suspected neonatal macrosomia (≥4500 g) may be at increased risk for failed TOLAC.
Collapse
Affiliation(s)
- Katariina Place
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00029 HUS, Helsinki, Finland.
| | - Heidi Kruit
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00029 HUS, Helsinki, Finland
| | - Aydin Tekay
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00029 HUS, Helsinki, Finland
| | - Seppo Heinonen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00029 HUS, Helsinki, Finland
| | - Leena Rahkonen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00029 HUS, Helsinki, Finland
| |
Collapse
|
14
|
Pont S, Austin K, Ibiebele I, Torvaldsen S, Patterson J, Ford J. Blood transfusion following intended vaginal birth after cesarean vs elective repeat cesarean section in women with a prior primary cesarean: A population-based record linkage study. Acta Obstet Gynecol Scand 2018; 98:382-389. [PMID: 30431154 DOI: 10.1111/aogs.13504] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 11/06/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION There is a lack of evidence around the risk of transfusion following vaginal birth after cesarean (VBAC) compared with elective repeat cesarean section (ERCS); this is important for decision-making about birth options. The aim of this study was to determine transfusion rates and risk of transfusion following intended VBAC and ERCS. MATERIAL AND METHODS Women with a primary cesarean who had a subsequent birth at term (≥37 weeks) in New South Wales between 2000 and 2012, were identified from the New South Wales Perinatal Data Collection. Blood transfusions were identified from linked hospital records. Women deemed ineligible for VBAC were excluded. Modified Poisson regression was used to determine transfusion risk associated with intended VBAC compared with ERCS. Intended mode of birth was classified as: (1) intended VBAC and vaginal birth, (2) intended VBAC and cesarean, (3) intended ERCS and (4) "intention uncertain". RESULTS A total of 90 439 women were eligible for VBAC. Rates of transfusion were: 1.4% for intended VBAC and vaginal birth (n = 17 849); 1.2% for intended VBAC and cesarean (n = 7648); 0.3% for intended ERCS (n = 60 471); and 1.1% for "intention uncertain" (n = 4471). After adjusting for maternal and pregnancy characteristics, risk of transfusion was almost four times higher for women classified as intended VBAC than intended ERCS (adjusted risk ratio = 3.73, 95% confidence interval 2.90-4.78). CONCLUSIONS Following a prior primary cesarean, there was a higher risk of transfusion associated with attempting VBAC compared with ERCS. Though the absolute risk is small, it is important for women considering VBAC to choose birthing facilities with ready access to blood products.
Collapse
Affiliation(s)
- Sarah Pont
- Biostatistical Officer Training Program, NSW Ministry of Health, North Sydney, NSW, Australia
| | - Kathryn Austin
- Department of Obstetrics and Gynecology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Ibinabo Ibiebele
- Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.,The University of Sydney Northern Clinical School, St Leonards, NSW, Australia
| | - Siranda Torvaldsen
- Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.,The University of Sydney Northern Clinical School, St Leonards, NSW, Australia.,School of Public Health and Community Medicine, UNSW, Sydney, NSW, Australia
| | - Jillian Patterson
- Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.,The University of Sydney Northern Clinical School, St Leonards, NSW, Australia
| | - Jane Ford
- Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.,The University of Sydney Northern Clinical School, St Leonards, NSW, Australia
| |
Collapse
|
15
|
Lehmann S, Baghestan E, Børdahl PE, Irgens LM, Rasmussen S. Perinatal outcome in births after a previous cesarean section at high trial of labor rates. Acta Obstet Gynecol Scand 2018; 98:117-126. [DOI: 10.1111/aogs.13458] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 07/11/2018] [Accepted: 08/01/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Sjur Lehmann
- Department of Clinical Science University of Bergen Bergen Norway
| | - Elham Baghestan
- Department of Obstetrics and Gynecology Haukeland University Hospital Bergen Norway
| | - Per E. Børdahl
- Department of Clinical Science University of Bergen Bergen Norway
- Department of Obstetrics and Gynecology Haukeland University Hospital Bergen Norway
| | - Lorentz M. Irgens
- Department of Global Public Health and Primary Care University of Bergen Bergen Norway
- Medical Birth Registry of Norway Norwegian Institute of Public Health Bergen Norway
| | - Svein Rasmussen
- Department of Clinical Science University of Bergen Bergen Norway
- Department of Obstetrics and Gynecology Haukeland University Hospital Bergen Norway
| |
Collapse
|
16
|
Mu Y, Li X, Zhu J, Liu Z, Li M, Deng K, Deng C, Li Q, Kang L, Wang Y, Liang J. Prior caesarean section and likelihood of vaginal birth, 2012-2016, China. Bull World Health Organ 2018; 96:548-557. [PMID: 30104795 PMCID: PMC6083396 DOI: 10.2471/blt.17.206433] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 05/14/2018] [Accepted: 06/08/2018] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To examine the trends and safety of vaginal birth after caesarean section around the period of the one-child policy relaxation in China. METHODS We used data from China's National Maternal Near Miss Surveillance System between 2012 and 2016. To examine trends in vaginal birth after caesarean section, we used Poisson regression with a robust variance estimator. We also assessed the association between vaginal birth after caesarean section and maternal and perinatal outcomes. FINDINGS We analysed 871 636 deliveries by women with a previous caesarean section. Both in 2012 and 2016, the rate of vaginal birth after caesarean section was 9.8%. After adjusting for institutional, sociodemographic and obstetric characteristics, the rate increased by 14% between 2012 and 2016 (adjusted relative risk, aRR: 1.14; 95% confidence interval, CI: 1.07-1.21). Compared to women with a repeat caesarean section, women with a vaginal birth after caesarean section experienced lower incidence of uterine rupture (aRR: 0.26, 95% CI: 0.16-0.42), blood transfusion (aRR: 0.68, 95% CI: 0.53-0.87) and admission to the intensive care unit (aRR: 0.36, 95% CI: 0.25-0.52), but higher incidence of intrapartum stillbirths, (aRR: 7.20, 95% CI: 6.09-8.51), newborns with a 5-minute Apgar score less than 7 (aRR: 1.75, 95% CI: 1.54-1.99) and neonatal death before discharge (aRR: 1.90, 95% CI: 1.61-2.24). CONCLUSION Promotion of vaginal birth after caesarean section could increase the rate even further in China. To ensure the safety of mothers and their newborns, national policies and guidelines on vaginal birth after caesarean section are needed.
Collapse
Affiliation(s)
- Yi Mu
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xiaohong Li
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Jun Zhu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Zheng Liu
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Mingrong Li
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Kui Deng
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Changfei Deng
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Qi Li
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Leni Kang
- National Office for Maternal and Child Health Surveillance of China, Department of Paediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yanping Wang
- National Office for Maternal and Child Health Surveillance of China, Department of Paediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Juan Liang
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
17
|
Wiegerinck MMJ, van der Goes BY, Ravelli ACJ, van der Post JAM, Buist FCD, Tamminga P, Mol BW. Intrapartum and neonatal mortality among low-risk women in midwife-led versus obstetrician-led care in the Amsterdam region of the Netherlands: a propensity score matched study. BMJ Open 2018; 8:e018845. [PMID: 29306890 PMCID: PMC5781008 DOI: 10.1136/bmjopen-2017-018845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To compare intrapartum and neonatal mortality in low-risk term women starting labour in midwife-led versus obstetrician-led care. STUDY DESIGN We performed a propensity score matched study using data from our national perinatal register, completed with data from medical files. We studied women without major risk factors with singleton pregnancies who gave birth at term between 2005 and 2008 in the Amsterdam region of the Netherlands. Major risk factors comprised non-vertex position of the fetus, previous Caesarean birth, hypertension, (gestational) diabetes mellitus, post-term pregnancy (≥42 weeks), prolonged rupture of membranes (>24 hours), vaginal bleeding in the second half of pregnancy or induced labour. Groups were devided by midwife-led versus obstetrician-led care at the onset of labour. The primary outcome was intrapartum and neonatal (<28 days) mortality. Secondary outcomes included obstetric interventions, 5 min Apgar scores<7 and neonatal intensive care admittance for >24 hours. RESULTS We studied 57 396 women. Perinatal mortality occurred in 30 of 46 764 (0.64‰) women in midwife-led care and in 2 of 10 632 (0.19‰) women in obstetrician-led care (OR 3.4, 95% CI 0.82 to 14.3). A propensity score matched analysis in a 1:1 ratio with 10 632 women per group revealed an OR for perinatal mortality of 4.0 (95% CI 0.85 to 18.9). CONCLUSION Among low-risk women, midwife-led care at the onset of labour was associated with a statistically non-significant higher mortality rate.
Collapse
Affiliation(s)
- Melanie M J Wiegerinck
- Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands
| | - Birgit Y van der Goes
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anita C J Ravelli
- Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands
- Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands
| | - Joris A M van der Post
- Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands
| | - Fayette C D Buist
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
| | - Pieter Tamminga
- Neonatal Intensive Care, Emma Children's Hospital AMC, Amsterdam, The Netherlands
| | - Ben W Mol
- School of Paediatrics and Reproductive Health, The Robinson Institute, University of Adelaide, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| |
Collapse
|
18
|
Bonzon M, Gross MM, Karch A, Grylka-Baeschlin S. Deciding on the mode of birth after a previous caesarean section – An online survey investigating women's preferences in Western Switzerland. Midwifery 2017; 50:219-227. [DOI: 10.1016/j.midw.2017.04.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 04/15/2017] [Accepted: 04/17/2017] [Indexed: 12/17/2022]
|
19
|
Rogers AJ, Rogers NG, Kilgore ML, Subramaniam A, Harper LM. Economic Evaluations Comparing a Trial of Labor with an Elective Repeat Cesarean Delivery: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:163-173. [PMID: 28212958 PMCID: PMC5319694 DOI: 10.1016/j.jval.2016.08.738] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 08/01/2016] [Accepted: 08/19/2016] [Indexed: 05/16/2023]
Abstract
BACKGROUND For women who have had a previous low transverse cesarean delivery, the decision to undergo a trial of labor after cesarean (TOLAC) or an elective repeat cesarean delivery (ERCD) has important clinical and economic ramifications. OBJECTIVES To evaluate the cost-effectiveness of the alternative choices of a TOLAC and an ERCD for women with low-risk, singleton gestation pregnancies. METHODS We searched EMBASE, MEDLINE, CINAHL, Cochrane Library, EconLit, and the Cost-Effectiveness Analysis Registry with no language, publication, or date restrictions up until October 2015. Studies were included if they were primary research, compared a TOLAC with an ERCD, and provided information on the relative cost of the alternatives. Abstracts and partial economic evaluations were excluded. RESULTS Of 310 studies initially reviewed, 7 studies were included in the systematic review. In the base-case analyses, 4 studies concluded that TOLAC was dominant over ERCD, 1 study found ERCD to be dominant, and 2 studies found that although TOLAC was more costly, it offered more benefits and was thus cost-effective from a population perspective when considering societal willingness to pay for better outcomes. In sensitivity analyses, cost-effectiveness was found to be dependent on a high likelihood of TOLAC success, low risk of uterine rupture, and low relative cost of TOLAC compared with ERCD. CONCLUSIONS For women who are likely to have a successful vaginal delivery, routine ERCD may result in excess morbidity and cost from a population perspective.
Collapse
Affiliation(s)
- Anna Joy Rogers
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Nathaniel G Rogers
- Departments of Medicine and Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Meredith L Kilgore
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Akila Subramaniam
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lorie M Harper
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
20
|
Mirteymouri M, Ayati S, Pourali L, Mahmoodinia M, Mahmoodinia M. Evaluation of Maternal-Neonatal Outcomes in Vaginal Birth After Cesarean Delivery Referred to Maternity of Academic Hospitals. J Family Reprod Health 2016; 10:206-210. [PMID: 28546820 PMCID: PMC5440820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: To evaluate the maternal and neonatal complications of vaginal birth after cesarean section (VBAC). Materials and methods: This cross sectional study was conducted in Mashhad University of medical sciences. Eighty women with previous cesarean section who were candidate for VBAC were enrolled the study. Patients were followed up for 6 weeks after delivery. The complication of VBAC was compared between successful or unsuccessful VBAC cases. Data was analyzed by SPSS version 16. Results: VBAC success rate was 91%. Post-partumhemorrhage occurred in 2.7% of woman with successful VBAC and 1.3% of CS cases. Maternal and neonatal death did not happen during our study, and none of our cases experienced uterine rupture, dystocia and neonatal tachypnea. Neonatal complications include NICU admission and neonatal resuscitation frequency in VBAC and CS were 6.8% and 57.1%, respectively (p = 0.002). Birth weight of neonates in successful VBAC was 2940 ± 768 grams and 3764 ± 254 grams in unsuccessful VBAC and this difference was significant (p = 0.007). Mean maternal admission duration in VBAC and CS were 1 ± 0.1 days and 2 ± 0.4 days (p < 0.001). Successful breastfeeding rate were higher in VBAC patients (95.8%) in comparison with CS (42.9%) and this difference was statistically significant (p = 0.002). Conclusion: Our results revealed that VBAC can be considered as a safe maternal and neonatal delivery method in patients with past CS women.
Collapse
Affiliation(s)
- Masoumeh Mirteymouri
- Department of Gynecology, Women’s Health Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sedigheh Ayati
- Department of Gynecology, Women’s Health Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Leyla Pourali
- Department of Gynecology, Women’s Health Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahboubeh Mahmoodinia
- Department of Gynecology, Research Center for Patient Safety, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maliheh Mahmoodinia
- Department of Gynecology, Women’s Health Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
21
|
Landon MB, Grobman WA. What We Have Learned About Trial of Labor After Cesarean Delivery from the Maternal-Fetal Medicine Units Cesarean Registry. Semin Perinatol 2016; 40:281-6. [PMID: 27210023 PMCID: PMC4983226 DOI: 10.1053/j.semperi.2016.03.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The cesarean delivery rate in the United States has risen steadily over the past 5 decades such that approximately one in three women now undergo cesarean section. The rise in repeat operations and accompanying decline in trial of labor after cesarean (TOLAC) have been major contributors to this phenomenon. The appropriate use of TOLAC continues to be a topic of interest with the recognition that most women with a history of prior cesarean are candidates for trial of labor. The NICHD MFMU Network Cesarean Registry conducted from 1999 to 2002 provided contemporary data concerning the risks and benefits of TOLAC, which in turn have helped inform practitioners and women considering their options for childbirth following cesarean delivery.
Collapse
Affiliation(s)
- Mark B. Landon
- The Ohio State University College of Medicine, Columbus OH,
| | | | | |
Collapse
|
22
|
Monfrance MJ, Schuit E, Groenwold RH, Oudijk MA, de Graaf IM, Bax CJ, Bekedam DJ, Mol BW, Langenveld J. Pessary placement in the prevention of preterm birth in multiple pregnancies: a propensity score analysis. Eur J Obstet Gynecol Reprod Biol 2016; 197:72-7. [DOI: 10.1016/j.ejogrb.2015.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 11/12/2015] [Indexed: 11/30/2022]
|
23
|
Elective repeat cesarean delivery compared with trial of labor after a prior cesarean delivery: a propensity score analysis. Eur J Obstet Gynecol Reprod Biol 2015; 195:214-218. [PMID: 26599733 DOI: 10.1016/j.ejogrb.2015.09.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 08/19/2015] [Accepted: 09/03/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine neonatal and short term maternal outcomes according to intentional mode of delivery following a cesarean delivery (CD). STUDY DESIGN Women pregnant after CD between January 2000 and December 2007 were categorized according to whether they had an elective repeat CD (ERCD) or a Trial of Labor (TOL). Prognostically equal ERCD and TOL groups were created using the propensity score matching technique. Conditional logistic regression was performed to assess differences in neonatal and maternal outcomes. POPULATION Women in their second ongoing pregnancy with a history of CD. RESULTS After ERCD the rates of low 5min Apgar score (OR 0.3, 95%CI 0.2-0.5, p<0.001), meconium aspiration (OR 0.0, 95%CI 0-0.7, p=0.02) and birth trauma (OR 0.08, 95%CI 0.002-0.5, p<0.001) were lower compared to TOL. The rate of transient tachypnoea of the newborn (TTN) appears higher in the ERCD group (OR 1.7, 95%CI 1.0-2.8, p=0.04). Uterine rupture (OR 0.1, 95%CI 0.003-0.8, p=0.02) and hemorrhage (OR 0.6, 95%CI 0.5-0.8, p<0.001) occurred less in the ERCD group. CONCLUSION Neonatal and short term maternal morbidity appears to be lower after ERCD than after TOL. Only TTN was seen more often after ERCD.
Collapse
|
24
|
Simões R, Bernardo WM, Salomão AJ, Baracat EC. Birth route in case of cesarean section in a previous pregnancy. Rev Assoc Med Bras (1992) 2015; 61:196-202. [PMID: 26248238 DOI: 10.1590/1806-9282.61.03.196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Ricardo Simões
- Federação Brasileira das Associações de Ginecologia e Obstetrícia, Brazil
| | | | - Antônio J Salomão
- Federação Brasileira das Associações de Ginecologia e Obstetrícia, Brazil
| | - Edmund C Baracat
- Federação Brasileira das Associações de Ginecologia e Obstetrícia, Brazil
| | | | | |
Collapse
|
25
|
Aiken AR, Aiken CE, Alberry MS, Brockelsby JC, Scott JG. Management of fetal malposition in the second stage of labor: a propensity score analysis. Am J Obstet Gynecol 2015; 212:355.e1-7. [PMID: 25446659 DOI: 10.1016/j.ajog.2014.10.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 08/07/2014] [Accepted: 10/15/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We sought to determine the factors associated with selection of rotational instrumental vs cesarean delivery to manage persistent fetal malposition, and to assess differences in adverse neonatal and maternal outcomes following delivery by rotational instruments vs cesarean delivery. STUDY DESIGN We conducted a retrospective cohort study over a 5-year period in a tertiary United Kingdom obstetrics center. In all, 868 women with vertex-presenting, single, liveborn infants at term with persistent malposition in the second stage of labor were included. Propensity score stratification was used to control for selection bias: the possibility that obstetricians may systematically select more difficult cases for cesarean delivery. Linear and logistic regression models were used to compare maternal and neonatal outcomes for delivery by rotational forceps or ventouse vs cesarean delivery, adjusting for propensity scores. RESULTS Increased likelihood of rotational instrumental delivery was associated with lower maternal age (odds ratio [OR], 0.95; P < .01), lower body mass index (OR, 0.94; P < .001), lower birthweight (OR, 0.95; P < .01), no evidence of fetal compromise at the time of delivery (OR, 0.31; P < .001), delivery during the daytime (OR, 1.45; P < .05), and delivery by a more experienced obstetrician (OR, 7.21; P < .001). Following propensity score stratification, there was no difference by delivery method in the rates of delayed neonatal respiration, reported critical incidents, or low fetal arterial pH. Maternal blood loss was higher in the cesarean group (295.8 ± 48 mL, P < .001). CONCLUSION Rotational instrumental delivery is often regarded as unsafe. However, we find that neonatal outcomes are no worse once selection bias is accounted for, and that the likelihood of severe obstetric hemorrhage is reduced. More widespread training of obstetricians in rotational instrumental delivery should be considered, particularly in light of rising cesarean delivery rates.
Collapse
Affiliation(s)
- Abigail R Aiken
- Office of Population Research, Princeton University, Princeton, NJ
| | - Catherine E Aiken
- Department of Obstetrics and Gynecology, University of Cambridge, and National Institute of Health Research Cambridge Comprehensive Biomedical Research Center, England, United Kingdom.
| | - Medhat S Alberry
- Department of Obstetrics and Gynecology, University of Cambridge, and National Institute of Health Research Cambridge Comprehensive Biomedical Research Center, England, United Kingdom
| | - Jeremy C Brockelsby
- Department of Obstetrics and Gynecology, University of Cambridge, and National Institute of Health Research Cambridge Comprehensive Biomedical Research Center, England, United Kingdom
| | - James G Scott
- Red McCombs School of Business and Division of Statistics and Scientific Computation, University of Texas at Austin, Austin, TX
| |
Collapse
|
26
|
Leslie HH, Karasek DA, Harris LF, Chang E, Abdulrahim N, Maloba M, Huchko MJ. Cervical cancer precursors and hormonal contraceptive use in HIV-positive women: application of a causal model and semi-parametric estimation methods. PLoS One 2014; 9:e101090. [PMID: 24979709 PMCID: PMC4076246 DOI: 10.1371/journal.pone.0101090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 06/03/2014] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To demonstrate the application of causal inference methods to observational data in the obstetrics and gynecology field, particularly causal modeling and semi-parametric estimation. BACKGROUND Human immunodeficiency virus (HIV)-positive women are at increased risk for cervical cancer and its treatable precursors. Determining whether potential risk factors such as hormonal contraception are true causes is critical for informing public health strategies as longevity increases among HIV-positive women in developing countries. METHODS We developed a causal model of the factors related to combined oral contraceptive (COC) use and cervical intraepithelial neoplasia 2 or greater (CIN2+) and modified the model to fit the observed data, drawn from women in a cervical cancer screening program at HIV clinics in Kenya. Assumptions required for substantiation of a causal relationship were assessed. We estimated the population-level association using semi-parametric methods: g-computation, inverse probability of treatment weighting, and targeted maximum likelihood estimation. RESULTS We identified 2 plausible causal paths from COC use to CIN2+: via HPV infection and via increased disease progression. Study data enabled estimation of the latter only with strong assumptions of no unmeasured confounding. Of 2,519 women under 50 screened per protocol, 219 (8.7%) were diagnosed with CIN2+. Marginal modeling suggested a 2.9% (95% confidence interval 0.1%, 6.9%) increase in prevalence of CIN2+ if all women under 50 were exposed to COC; the significance of this association was sensitive to method of estimation and exposure misclassification. CONCLUSION Use of causal modeling enabled clear representation of the causal relationship of interest and the assumptions required to estimate that relationship from the observed data. Semi-parametric estimation methods provided flexibility and reduced reliance on correct model form. Although selected results suggest an increased prevalence of CIN2+ associated with COC, evidence is insufficient to conclude causality. Priority areas for future studies to better satisfy causal criteria are identified.
Collapse
Affiliation(s)
- Hannah H. Leslie
- Division of Epidemiology, University of California, Berkeley, California, United States of America
| | - Deborah A. Karasek
- Division of Epidemiology, University of California, Berkeley, California, United States of America
| | - Laura F. Harris
- Joint Medical Program, University of California, Berkeley, and University of California San Francisco, San Francisco, California, United States of America
| | - Emily Chang
- Pulmonary Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Naila Abdulrahim
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - May Maloba
- FACES, Family AIDS Care and Education Services, Kisumu, Kenya
| | - Megan J. Huchko
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
| |
Collapse
|
27
|
Knight HE, Gurol-Urganci I, van der Meulen JH, Mahmood TA, Richmond DH, Dougall A, Cromwell DA. Vaginal birth after caesarean section: a cohort study investigating factors associated with its uptake and success. BJOG 2013; 121:183-92. [DOI: 10.1111/1471-0528.12508] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2013] [Indexed: 11/30/2022]
Affiliation(s)
- HE Knight
- Office for Research and Clinical Audit; Lindsay Stewart R&D Centre; Royal College of Obstetricians and Gynaecologists; London UK
- Department of Health Services Research and Policy; London School of Hygiene and Tropical Medicine; London UK
| | - I Gurol-Urganci
- Office for Research and Clinical Audit; Lindsay Stewart R&D Centre; Royal College of Obstetricians and Gynaecologists; London UK
- Department of Health Services Research and Policy; London School of Hygiene and Tropical Medicine; London UK
| | - JH van der Meulen
- Office for Research and Clinical Audit; Lindsay Stewart R&D Centre; Royal College of Obstetricians and Gynaecologists; London UK
- Department of Health Services Research and Policy; London School of Hygiene and Tropical Medicine; London UK
| | - TA Mahmood
- Office for Research and Clinical Audit; Lindsay Stewart R&D Centre; Royal College of Obstetricians and Gynaecologists; London UK
| | - DH Richmond
- Office for Research and Clinical Audit; Lindsay Stewart R&D Centre; Royal College of Obstetricians and Gynaecologists; London UK
- Department of Urogynaecology; Liverpool Women's NHS Foundation Trust; Liverpool UK
| | - A Dougall
- Office for Research and Clinical Audit; Lindsay Stewart R&D Centre; Royal College of Obstetricians and Gynaecologists; London UK
| | - DA Cromwell
- Office for Research and Clinical Audit; Lindsay Stewart R&D Centre; Royal College of Obstetricians and Gynaecologists; London UK
- Department of Health Services Research and Policy; London School of Hygiene and Tropical Medicine; London UK
| |
Collapse
|
28
|
Studsgaard A, Skorstengaard M, Glavind J, Hvidman L, Uldbjerg N. Trial of labor compared to repeat cesarean section in women with no other risk factors than a prior cesarean delivery. Acta Obstet Gynecol Scand 2013; 92:1256-63. [DOI: 10.1111/aogs.12240] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 08/14/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Anne Studsgaard
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus; Denmark
| | - Malene Skorstengaard
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus; Denmark
| | - Julie Glavind
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus; Denmark
| | - Lone Hvidman
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus; Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus; Denmark
| |
Collapse
|
29
|
Einarsdóttir K, Stock S, Haggar F, Hammond G, Langridge AT, Preen DB, De Klerk N, Leonard H, Stanley FJ. Neonatal complications in public and private patients: a retrospective cohort study. BMJ Open 2013; 3:bmjopen-2013-002786. [PMID: 23793654 PMCID: PMC3669710 DOI: 10.1136/bmjopen-2013-002786] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To use propensity score methods to create similar groups of women delivering in public and private hospitals and determine any differences in mode of delivery and neonatal outcomes between the matched groups. DESIGN Population-based, retrospective cohort study. SETTING Public and private hospitals in Western Australia. PARTICIPANTS Included were 93 802 public and 66 479 private singleton, term deliveries during 1998-2008, from which 32 757 public patients were matched with 32 757 private patients on the propensity score of maternal characteristics. MAIN OUTCOME MEASURES Neonatal outcomes were compared in the propensity score-matched cohorts using conditional logistic regression, adjusted for antenatal risk factors and mode of delivery. Outcomes included Apgar score <7 at 5 min, neonatal resuscitation (endotracheal intubation or external cardiac massage) and admission to a neonatal special care unit. RESULTS No significant differences in maternal characteristics were found between the propensity score-matched groups. Private patients were more likely than their matched public counterparts to undergo prelabour caesarean section (25.2% vs 18%, p<0.0001). Public patients had lower rates of neonatal unit admission (AOR 0.67, 95% CI 0.62 to 0.73) and neonatal resuscitation (AOR 0.73, 95% CI 0.56 to 0.95), but higher rates of low Apgar scores at 5 min (AOR 1.31, 95% CI 1.06 to 1.63) despite adjustment for antenatal factors. Additional adjustment for mode of delivery reduced the resuscitation risk (AOR 0.86, 95% CI 0.63 to 1.18) but did not significantly alter the other estimates. CONCLUSIONS Propensity score methods can be used to generate comparable groups of public and private patients. Despite the rates of low Apgar scores being higher in public patients, the rates of special care admission were lower. Whether these findings stem from differences in paediatric services or clinical factors is yet to be determined.
Collapse
Affiliation(s)
- Kristjana Einarsdóttir
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
| | - Sarah Stock
- School of Women's and Infant's Health, University of Western Australia, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Fatima Haggar
- Centre for Health Services Research, School of Population Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Geoffrey Hammond
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
| | - Amanda T Langridge
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
| | - David B Preen
- Centre for Health Services Research, School of Population Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Nick De Klerk
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
| | - Helen Leonard
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
| | - Fiona J Stanley
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
30
|
Einarsdóttir K, Haggar FA, Langridge AT, Gunnell AS, Leonard H, Stanley FJ. Neonatal outcomes after preterm birth by mothers' health insurance status at birth: a retrospective cohort study. BMC Health Serv Res 2013; 13:40. [PMID: 23375105 PMCID: PMC3566968 DOI: 10.1186/1472-6963-13-40] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 01/31/2013] [Indexed: 11/10/2022] Open
Abstract
Background Publicly insured women usually have a different demographic background to privately insured women, which is related to poor neonatal outcomes after birth. Given the difference in nature and risk of preterm versus term births, it would be important to compare adverse neonatal outcomes after preterm birth between these groups of women after eliminating the demographic differences between the groups. Methods The study population included 3085 publicly insured and 3380 privately insured, singleton, preterm deliveries (32–36 weeks gestation) from Western Australia during 1998–2008. From the study population, 1016 publicly insured women were matched with 1016 privately insured women according to the propensity score of maternal demographic characteristics and pre-existing medical conditions. Neonatal outcomes were compared in the propensity score matched cohorts using conditional log-binomial regression, adjusted for antenatal risk factors. Outcomes included Apgar scores less than 7 at five minutes after birth, time until establishment of unassisted breathing (>1 minute), neonatal resuscitation (endotracheal intubation or external cardiac massage) and admission to a neonatal special care unit. Results Compared with infants of privately insured women, infants of publicly insured women were more likely to receive a low Apgar score (ARR = 2.63, 95% CI = 1.06-6.52) and take longer to establish unassisted breathing (ARR = 1.61, 95% CI = 1.25-2.07), yet, they were less likely to be admitted to a special care unit (ARR = 0.84, 95% CI = 0.80-0.87). No significant differences were evident in neonatal resuscitation between the groups (ARR = 1.20, 95% CI = 0.54-2.67). Conclusions The underlying reasons for the lower rate of special care admissions in infants of publicly insured women compared with privately insured women despite the higher rate of low Apgar scores is yet to be determined. Future research is warranted in order to clarify the meaning of our findings for future obstetric care and whether more equitable use of paediatric services should be recommended.
Collapse
Affiliation(s)
- Kristjana Einarsdóttir
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, 100 Roberts Road, Subiaco, WA 6008, Australia.
| | | | | | | | | | | |
Collapse
|
31
|
Gilbert SA, Grobman WA, Landon MB, Spong CY, Rouse DJ, Leveno KJ, Varner MW, Wapner RJ, Sorokin Y, O'Sullivan MJ, Sibai BM, Thorp JM, Ramin SM, Mercer BM. Cost-effectiveness of trial of labor after previous cesarean in a minimally biased cohort. Am J Perinatol 2013; 30:11-20. [PMID: 23292916 PMCID: PMC4049080 DOI: 10.1055/s-0032-1333206] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To estimate the cost-effectiveness of a trial of labor after one previous cesarean delivery (TOLAC). STUDY DESIGN A model comparing TOLAC with elective repeat cesarean delivery (ERCD) was developed for a hypothetical cohort with no contraindication to a TOLAC. Probabilistic estimates were obtained from women matched on their baseline characteristics using propensity scores. Cost data, quality-adjusted life-years (QALYs), and data on cerebral palsy were incorporated from the literature. RESULTS The TOLAC strategy dominated the ERCD strategy at baseline, with $138.6 million saved and 1703 QALYs gained per 100,000 women. The model was sensitive to five variables: the probability of uterine rupture, the probability of successful TOLAC, the QALY of failed TOLAC, the cost of ERCD, and the cost of successful TOLAC without complications. When the probability of TOLAC success was at the base value, 68.5%, TOLAC was preferred if the probability of uterine rupture was 4.2% or less. When the probability of uterine rupture was at the base value, 0.8%, the TOLAC strategy was preferred as long as the probability of success was 42.6% or more. CONCLUSION A TOLAC is less expensive and more effective than an ERCD in a group of women with balanced baseline characteristics.
Collapse
Affiliation(s)
- Sharon A Gilbert
- The George Washington University Biostatistics Center, Washington, District of Columbia, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Bénéfices et risques maternels de la tentative de voie basse comparée à la césarienne programmée en cas d’antécédent de césarienne. ACTA ACUST UNITED AC 2012; 41:708-26. [DOI: 10.1016/j.jgyn.2012.09.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
33
|
Lopez E, Patkai J, El Ayoubi M, Jarreau PH. [Benefits and harms to the newborn of maternal attempt at trial of labor after prior caesarean versus elective repeat caesarean delivery]. ACTA ACUST UNITED AC 2012; 41:727-34. [PMID: 23141133 DOI: 10.1016/j.jgyn.2012.09.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate neonatal outcome after elective repeat cesarean delivery (ERCD) versus trial of labor (TOL) after previous cesarean delivery. METHODS This systematic evidence review is based on Pubmed search, Cochrane library and experts recommendations. RESULTS The risks of fetal, perinatal and neonatal mortality are low after previous cesarean delivery but significantly higher for TOL as compared with ERCD. The risk of bag-and-mask ventilation and intubation for meconium-stained amniotic fluid are higher for TOL as compared with ERCD. Infants born after ERCD are more likely presented transient tachypnea. The risk of hypoxic encephalopathy/asphyxia is low after previous cesarean delivery but significantly higher for TOL as compared with ERCD. The risk of neonatal sepsis after previous cesarean delivery is significantly higher for TOL as compared with ERCD. There is no significant difference between TOL or ERCD regarding NICU admission. The strength of evidence is low to conclude about the impact of route of delivery upon birth trauma and Apgar score. CONCLUSIONS The risk of the main neonatal complications is low whatever the route of delivery after previous caesarean delivery. However, the risk of perinatal mortality, bag-and-mask ventilation, perinatal asphyxia, is higher after TOL compared with ERCD. The risk of transient tachypnea is higher after ERCD compared with TOL.
Collapse
Affiliation(s)
- E Lopez
- Service de médecine néonatale de Port-Royal, bâtiment Port-Royal, groupe hospitalier Cochin, Broca, Hôtel-Dieu, AP-HP, 53, avenue de l'Observatoire, 75014 Paris, France.
| | | | | | | |
Collapse
|