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Hung MWC, Lee LTL, Chiu CPH, Ma MKT, Chan YYY, Kwong LT, Wong EJ, Lai THT, Chan OK, So PL, Lau WL, Leung TY. The use of bubble charts in analyzing second stage cesarean delivery rates. Am J Obstet Gynecol 2024:S0002-9378(24)00363-6. [PMID: 38408623 DOI: 10.1016/j.ajog.2024.02.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/05/2024] [Accepted: 02/20/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND The incidence of second stage cesarean delivery has been rising globally because of the failure or the anticipated difficulty of performing instrumental delivery. Yet, the best way to interpret the figure and its optimal rate remain to be determined. This is because it is strongly influenced by the practice of other 2 modes of birth, namely cesarean delivery performed before reaching the second stage and assisted vaginal birth during the second stage. In this regard, a bubble chart that can display 3-dimensional data through its x-axis, y-axis, and the size of each plot (presented as a bubble) may be a suitable method to evaluate the relationship between the rates of these 3 modes of births. OBJECTIVE This study aimed to conduct an epidemiologic study on the incidence of second stage cesarean deliveries rates among >300,000 singleton term births in 10 years from 8 obstetrical units and to compare their second stage cesarean delivery rates in relation to their pre-second stage cesarean delivery rates and assisted vaginal birth rates using a bubble chart. STUDY DESIGN The territory-wide birth data collected between 2009 and 2018 from all 8 public obstetrical units (labelled as A to H) were reviewed. The inclusion criteria were all singleton pregnancies with cephalic presentation that were delivered at term (≥37 weeks' gestation). Pre-second stage cesarean delivery rate was defined as all elective cesarean deliveries and those emergency cesarean deliveries that occurred before full cervical dilatation was achieved as a proportion of the total number of births. The second stage cesarean delivery rate and assisted vaginal birth rate were calculated according to the respective mode of delivery as a proportion of the number of cases that reached full cervical dilatation. The rates of these 3 modes of births were compared among the parity groups and among the 8 units. Using a bubble chart, each unit's second stage cesarean delivery rate (y-axis) was plotted against its pre-second stage cesarean delivery rate (x-axis) as a bubble. Each unit's second stage cesarean delivery to assisted vaginal birth ratio was represented by the size of the bubble. RESULTS During the study period, a total of 353,434 singleton cephalic presenting term pregnancies were delivered in the 8 units, and 180,496 (51.1%) were from nulliparous mothers. When compared with the multiparous group, the nulliparous group had a significantly lower pre-second stage cesarean delivery rate (18.58% vs 21.26%; P<.001) but a higher second stage cesarean delivery rate (0.79% vs 0.22%; P<.001) and a higher assisted vaginal birth rate (17.61% vs 3.58%; P<.001). Using the bubble of their averages as a reference point in the bubble chart, the 8 units' bubbles were clustered into 5 regions indicating their differences in practice: unit B and unit H were close to the average in the center. Unit A and unit F were at the upper right corner with a higher pre-second stage cesarean delivery rate and second stage cesarean delivery rate. Unit D and unit E were at the opposite end. Unit C was at the upper left corner with a low pre-second stage cesarean delivery rate but a high second stage cesarean delivery rate, whereas unit G was at the opposite end. Unit C and unit G were also in the extremes in terms of pre-second stage cesarean delivery to assisted vaginal birth ratio (0.09 and 0.01, respectively). Although some units seemed to have very similar second stage cesarean delivery rates, their obstetrical practices were differentiated by the bubble chart. CONCLUSION The second stage cesarean delivery rate must be evaluated in the context of the rates of pre-second stage cesarean delivery and assisted vaginal birth. A bubble chart is a useful method for analyzing the relationship among these 3 variables to differentiate the obstetrical practice between different units.
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Affiliation(s)
| | - Lin Tai Linus Lee
- Department of Obstetrics and Gynaecology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Christopher Pak Hey Chiu
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Man Kee Teresa Ma
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Yau Ma Tei, Hong Kong
| | - Yuen Yee Yannie Chan
- Department of Obstetrics and Gynaecology, Princess Margaret Hospital, Kwai Chung, Hong Kong
| | - Lee Ting Kwong
- Department of Obstetrics and Gynaecology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - Eunice Joanna Wong
- Department of Obstetrics and Gynaecology, United Christian Hospital, Kwun Tong, Hong Kong
| | - Theodora Hei Tung Lai
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Oi Ka Chan
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Po Lam So
- Department of Obstetrics and Gynaecology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - Wai Lam Lau
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Kowloon, Hong Kong
| | - Tak Yeung Leung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, New Territories, Hong Kong.
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Dereje L, Tilahun T, Markos J. Determinants of successful trial of labor after a previous cesarean delivery in East Wollega, Western Ethiopia: A case–control study. SAGE Open Med 2022; 10:20503121221097597. [PMID: 35600713 PMCID: PMC9118888 DOI: 10.1177/20503121221097597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 04/12/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: Vaginal birth after cesarean could be considered a reasonable and safe option for most women with a previous cesarean section. However, it is not easy to select pregnant mothers who are a candidate for a trial of labor after cesarean. Therefore, this study is aimed to identify determinants of successful vaginal birth after previous cesarean delivery in public hospitals in East Wollega, Western Ethiopia, 2020. Methods: A facility-based unmatched case–control study was conducted on 115 cases and 115 controls. Cases were those women who successfully delivered vaginally and controls were those women delivered by cesarean section after trial of labor. Data were collected using a pre-tested structured questionnaire and organized using Epidata version 3.1. Descriptive analysis and logistic regressions were performed. The adjusted odds ratio with a 95% confidence interval was used and statistical significance was declared at P-value < 0.05. Results: The study revealed that rural residence (adjusted odds ratio = 3, 95% confidence interval = 1.25–7.21), having no history of stillbirth (adjusted odds ratio = 4.2, 95% confidence interval = 1.20–14.62), prior vaginal birth after cesarean (adjusted odds ratio = 2.4, 95% confidence interval = 1.2–6.4), counseling about a trial of labor after cesarean during antenatal follow-up (adjusted odds ratio = 4.7, 95% confidence interval = 1.88–11.74), and birth interval of >2 years (adjusted odds ratio = 8.9, 95% confidence interval = 3.25–24.67) were found to be determinants of successful vaginal birth after cesarean. Conclusion: Place of residence, history of stillbirth, history of vaginal birth after cesarean, counseling about mode of delivery during antenatal care, and birth interval were determinants of successful trial of labor after cesarean. Given these factors, it is recommended that care providers should advocate delaying pregnancy for at least 2 years and counseling women about trial of labor after cesarean during antenatal care follow-up.
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Affiliation(s)
- Lemane Dereje
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Temesgen Tilahun
- Department of Obstetrics and Gynecology, School of Medicine, Wollega University. Nekemte, Ethiopia
| | - Jote Markos
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
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Zhang Y, Betran AP, Li X, Liu D, Yuan N, Shang L, Lin W, Tu S, Wang L, Wu X, Zhu T, Zhang Y, Lu Z, Zheng L, Gu C, Fang J, Liu Z, Ma L, Cai Z, Yang X, Li H, Zhang H, Zhao X, Yan L, Wang L, Sun X, Luo Q, Liu L, Zhu J, Qin W, Yao Q, Dong S, Yang Y, Cui Z, He Y, Feng X, He L, Zhang H, Zhang L, Wang X, Souza JP, Qi H, Duan T, Zhang J. What is an appropriate caesarean delivery rate for China: a multicentre survey. BJOG 2021; 129:138-147. [PMID: 34559941 PMCID: PMC9297886 DOI: 10.1111/1471-0528.16951] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2021] [Indexed: 11/30/2022]
Abstract
Objective To assess the current status of caesarean delivery (CD) in China, propose reference CD rates for China overall, and by regions, investigate the main indications for CDs and identify possible areas for safe reduction. Design A multicentre cross‐sectional study. Setting A total of 94 hospitals across 23 provinces in China. Population A total of 73 977 randomly selected deliveries. Methods We used a modified Robson classification to characterise CDs in subgroups and by regions, and the World Health Organization (WHO) C‐Model to calculate reference CD rates. Main outcome measures CD rates in China. Results In 2015–2016, the overall CD rate in China was 38.9% (95% CI 38.6–39.3%). Considering the obstetric characteristics of the population, the multivariable model‐based reference CD rate was estimated at 28.5% (95% CI 28.3–28.8%). Accordingly, an absolute reduction of 10.4% (or 26.7% relative reduction) may be considered. The CD rate varied substantially by region. Previous CD was the most common indication in all regions, accounting for 38.2% of all CDs, followed by maternal request (9.8%), labour dystocia (8.3%), fetal distress (7.7%) and malpresentation (7.6%). Overall, 12.7% of women had prelabour CDs, contributing to 32.8% of the total CDs. Conclusions Nearly 39% of births were delivered by caesarean in China but a reduction of this rate by a quarter may be considered attainable. Repeat CD contributed more than one‐third of the total CDs. Given the large variation in maternal characteristics, region‐specific or even hospital‐specific reference CD rates are needed for precision management of CD. Tweetable abstract The caesarean rate in 2015–2016 in China was 38.9%, whereas the reference rate was 28.5%. The caesarean rate in 2015–2016 in China was 38.9%, whereas the reference rate was 28.5%. Linked article This article is commented on by M Varner, p. 148 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.16953.
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Affiliation(s)
- Y Zhang
- Ministry of Education - Shanghai Key Laboratory of Children's Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - A P Betran
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland
| | - X Li
- Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China
| | - D Liu
- Dongguan City Maternal and Child Health Hospital, Southern Medical University, Guangdong, China
| | - N Yuan
- Department of Obstetrics and Gynaecology, The Second Hospital Affiliated to Shaanxi University of Chinese Medicine, Shaanxi, China
| | - L Shang
- Department of Obstetrics, The Maternal and Child Health Hospital of Xinxiang, Henan, China
| | - W Lin
- Department of Obstetrics, The Maternal and Child Health Hospital of Dalian, Liaoning, China
| | - S Tu
- Department of Obstetrics and Gynaecology, Southwest Medical University, Sichuan, China
| | - L Wang
- Department of Obstetrics and Gynaecology, The First Hospital Affiliated to Kunming Medical University, Yunnan, China
| | - X Wu
- Department of Obstetrics, Jiangsu Women and Child Health Hospital, Jiangsu, China
| | - T Zhu
- The First People's Hospital of Zhaotong, Kunming Medical University, Yunnan, China
| | - Y Zhang
- Department of Obstetrics, The Maternal and Child Health Hospital of Qujing, Yunnan, China
| | - Z Lu
- Suining Central Hospital, Chongqing Medical University, Sichuan, China
| | - L Zheng
- Taizhou Hospital of Zhejiang Province, Zhejiang, China
| | - C Gu
- Yangzhou Maternal and Child Care Service Centre, Jiangsu, China
| | - J Fang
- Qingdao Chengyang People's Hospital, Shandong First Medical University, Shandong, China
| | - Z Liu
- Department of Obstetrics, The Maternal and Child Health Hospital of Baoji, Shaanxi, China
| | - L Ma
- Yanshi City People's Hospital, Henan, China
| | - Z Cai
- Department of Obstetrics and Gynaecology, Aviation Hospital of Beijing, China Medical University, Beijing, China
| | - X Yang
- Department of Obstetrics, The Maternal and Child Health Hospital of Luohu District, Shenzhen, China
| | - H Li
- Yanan University Affiliated Hospital, Shaanxi, China
| | - H Zhang
- Haikou Hospital of the Maternal and Child Health, Hainan, China
| | - X Zhao
- The First People's Hospital of Taizhou, Wenzhou Medical University, Zhejiang, China
| | - L Yan
- The Second Affiliated Hospital of Hebei North University, Hebei, China
| | - L Wang
- Department of Obstetrics and Gynaecology, The 174th Hospital of the Chinese People's Liberation Army, Xiamen University, Fujian, China
| | - X Sun
- Puyang Maternal and Child Care Centres, Henan, China
| | - Q Luo
- Luzhou People's Hospital, Sichuan, China
| | - L Liu
- Affiliated Hospital of Jiangsu University, Jiangsu, China
| | - J Zhu
- The Second People's Hospital of Tongxiang, Zhejiang, China
| | - W Qin
- Department of Obstetrics and Gynaecology, Aviation Hospital of Beijing, China Medical University, Beijing, China
| | - Q Yao
- The Central Hospital of Shaoyang, University of South China, Hunan, China
| | - S Dong
- Affiliated Hospital of Zunyi Medical University, Guizhou, China
| | - Y Yang
- The First Affiliated Hospital of Anhui Medical University, Anhui, China
| | - Z Cui
- Department of Obstetrics, The Maternal and Child Health Hospital of Cangzhou, Hebei, China
| | - Y He
- The Second People's Hospital of Qingyuan City, Guangdong, China
| | - X Feng
- Department of Obstetrics and Gynaecology, Fujian Medical University Union Hospital, Fujian Medical University, Fujian, China
| | - L He
- The People's Hospital of Pengzhou, Sichuan, China
| | - H Zhang
- Department of Obstetrics, Eastern District of the Fourth Hospital of Hebei Medical University, Hebei, China
| | - L Zhang
- Ministry of Education - Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - X Wang
- Department of Obstetrics and Gynaecology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - J P Souza
- Department of Social Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, São Paulo, Brazil
| | - H Qi
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - T Duan
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - J Zhang
- Ministry of Education - Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Abdollahi S, Soltani S, de Souza RJ, Forbes SC, Toupchian O, Salehi-Abargouei A. Associations between Maternal Dietary Patterns and Perinatal Outcomes: A Systematic Review and Meta-Analysis of Cohort Studies. Adv Nutr 2021; 12:1332-1352. [PMID: 33508080 PMCID: PMC8321866 DOI: 10.1093/advances/nmaa156] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/10/2020] [Accepted: 11/10/2020] [Indexed: 02/06/2023] Open
Abstract
The aim was to systematically review and meta-analyze prospective cohort studies investigating the relation between maternal dietary patterns during pregnancy with pregnancy and birth outcomes. PubMed, Scopus, and ISI Web of Science were searched from inception until October 2019 for eligible studies. Studies reporting relative risk, ORs, or incidences (for binary data) or means ± SDs or B-coefficients (for continuous outcomes) comparing the highest and lowest adherence with maternal dietary patterns were included. Dietary patterns were categorized as "healthy," "unhealthy," or "mixed." No language restrictions were applied. Study-specific effect sizes with SEs for outcomes of interest were pooled using a random-effects model. Quality of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Sixty-six relevant publications were included. A higher maternal adherence to a healthy diet was associated with a reduced risk of gestational hypertension (14%, P < 0.001), maternal depression (40%, P = 0.004), low birth weight (28%, P = 0.001), preterm birth (56%, P < 0.001), higher gestational weight gain (Hedges' g: 0.15; P = 0.01), and birth weight (Hedges' g: 0.19; P = 0.007). Higher maternal adherence to an unhealthy or a mixed diet was associated with higher odds of gestational hypertension (23%, P < 0.001 for unhealthy, and 8%, P = 0.01 for mixed diet). In stratified analyses, a higher healthy eating index was associated with reduced odds of being large based on gestational age (31%, P = 0.02) and a higher head circumference at birth (0.23 cm, P = 0.02). The Mediterranean and "prudent" dietary patterns were related to lower odds of being small based on gestational age (46%, P = 0.04) and preterm birth (52%, P = 0.03), respectively. The overall GRADE quality of the evidence for most associations was low or very low, indicating that future high-quality research is warranted. This study was registered at http://www.crd.york.ac.uk/PROSPERO as CRD42018089756.
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Affiliation(s)
- Shima Abdollahi
- School of Public Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Sepideh Soltani
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada,Population Health Research Institute, Hamilton, Ontario, Canada
| | - Scott C Forbes
- Department of Physical Education, Faculty of Education, Brandon University, Brandon, Manitoba, Canada
| | - Omid Toupchian
- School of Public Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
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Lehmann S, Baghestan E, Børdahl PE, Irgens LM, Rasmussen S. Low risk pregnancies after a cesarean section: Determinants of trial of labor and its failure. PLoS One 2020; 15:e0226894. [PMID: 31929542 PMCID: PMC6957160 DOI: 10.1371/journal.pone.0226894] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 12/08/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction In pregnancies after a previous cesarean section (CS), a planned repeat CS delivery has been associated with excess risk of adverse outcome. However, also the alternative, a trial of labor after CS (TOLAC), has been associated with excess risks. A TOLAC failure, involving a non-planned CS, carries the highest risk of adverse outcome and a vaginal delivery the lowest. Thus, the decision regarding delivery mode is pivotal in clinical handling of these pregnancies. However, even with a high TOLAC rate, as seen in Norway, repeat CSs are regularly performed for no apparent medical reason. The objective of the present study was to assess to which extent demographic, socioeconomic, and health system factors are determinants of TOLAC and TOLAC failure in low risk pregnancies, and whether any effects observed changed with time. Materials and methods The study group comprised 24 645 second deliveries (1989–2014) after a first delivery CS. Thus, none of the women had prior vaginal deliveries or more than one CS. Included pregnancies were low risk, cephalic, single, and had gestational age ≥ 37 weeks. Data were obtained from the Medical Birth Registry of Norway (MBRN). The exposure variables were (second delivery) maternal age, length of maternal education, maternal country of origin, size of the delivery unit, health region (South-East, West, Mid, North), and maternal county of residence. The outcomes were TOLAC and TOLAC failure, as rates (%), relative risk (RR) and relative risk adjusted (ARR). Changes in determinant effects over time were assessed by comparing rates in two periods, 1989–2002 vs 2003–2014, and including these periods in an interaction model. Results The TOLAC rate was 74.9%, with a TOLAC failure rate of 16.2%, resulting in a vaginal birth rate of 62.8%. Low TOLAC rates were observed at high maternal age and in women from East Asia or Latin America. High TOLAC failure rates were observed at high maternal age, in women with less than 11 years of education, and in women of non-western origin. The effects of health system factors, i.e. delivery unit size and administrative region were considerable, on both TOLAC and TOLAC failure. The effects of several determinants changed significantly (P < 0.05) from 1989–2002 to 2003–2014: The association between non-TOLAC and maternal age > 39 years became weaker, the association between short education and TOLAC failure became stronger, and the association between TOLAC failure and small size of delivery unit became stronger. Conclusion Low maternal age, high education, and western country of origin were associated with high TOLAC rates, and low TOLAC failure rates. Maternity unit characteristics (size and region) contributed with effects on the same level as individual determinants studied. Temporal changes were observed in determinant effects.
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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
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Attanasio LB, Kozhimannil KB, Kjerulff KH. Women's preference for vaginal birth after a first delivery by cesarean. Birth 2019; 46:51-60. [PMID: 30051510 PMCID: PMC6348143 DOI: 10.1111/birt.12386] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/28/2018] [Accepted: 06/28/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nearly 90% of United States pregnant women with a prior cesarean give birth by repeat cesarean. Public health goals encourage greater use of vaginal birth after cesarean (VBAC), but there is little prospective data on predictors of women's preference for VBAC. We characterized predictors of women's preferred mode of delivery after a first cesarean and thematically categorized reasons for their preference. METHODS Data were from a cohort of 3006 women whose first childbirth was in Pennsylvania in 2009-2011. The analytic sample included women who had their first birth by cesarean and reported mode of delivery preference for their next delivery at 12 months postpartum (n = 616). Associations with future birth mode preference were assessed using multivariate logistic regression, and reasons for preference were categorized using content analysis. RESULTS At 12 months postpartum, 45% of women who delivered by cesarean in their first birth wanted to have their next delivery vaginally. Independent predictors of VBAC preference were Black race/ethnicity, nonrecurrent indication for the first cesarean, planning three or more additional children, and difficulty recovering from the first cesarean. The most common reason for preferring a vaginal birth was wanting the experience of vaginal birth; the most common reason for preferring cesarean birth was that the first birth was by cesarean. CONCLUSION Nearly half of respondents preferred VBAC in future births, but national estimates indicate that only about 12% of women with prior cesareans have a VBAC. This suggests a need to ensure greater access to VBAC for women who want it.
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Affiliation(s)
- Laura B. Attanasio
- Assistant Professor in the Department of Health Promotion and Policy, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, MA
| | - Katy B. Kozhimannil
- Associate Professor in the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN
| | - Kristen H. Kjerulff
- Professor in the Department of Public Health Sciences and Department of Obstetrics and Gynecology, College of Medicine, Penn State University, Hershey, PA
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7
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Kalisa R, Rulisa S, van Roosmalen J, van den Akker T. Maternal and perinatal outcome after previous caesarean section in rural Rwanda. BMC Pregnancy Childbirth 2017; 17:272. [PMID: 28841838 PMCID: PMC5574082 DOI: 10.1186/s12884-017-1467-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/22/2017] [Indexed: 11/29/2022] Open
Abstract
Background Offering a trial of labor (ToL) after previous caesarean section (CS) is an important strategy to reduce short- and long-term morbidity associated with repeated CS. We compared maternal and perinatal outcomes between ToL and elective repeat caesarean section (ERCS) at a district hospital in rural Rwanda. Methods Audit of women’s records with one prior CS who delivered at Ruhengeri district hospital in Rwanda between June 2013 and December 2014. Results Out of 4131 women who came for delivery, 435 (11%) had scarred uteri. ToL, which often started at home or at health centers without appropriate counseling, occurred in 297/435 women (68.3%), while 138 women (31.7%) delivered by ERCS. ToL was successful in 134/297 (45.1%) women. There were no maternal deaths. Twenty-eight out of all 435 women with a scarred uterus (6.4%) sustained severe acute maternal morbidity (puerperal sepsis, postpartum hemorrhage, uterine rupture), which was higher in women with ToL (n = 23, 7.7%) compared with women who had an ERCS (n = 5, 3.6%): adjusted odds ration (aOR) 1.4 (95% CI 1.2–5.4). There was no difference in neonatal admissions between women who underwent ToL (n = 64/297; 21.5%) and those who delivered by ERCS (n = 35/138; 25.4%: aOR 0.8; CI 0.5–1.6). The majority of admissions were due to perinatal asphyxia that occurred more often in infants whose mothers underwent ToL (n = 40, 13.4%) compared to those who delivered by ERCS (n = 15, 10.9%: aOR 1.9; CI 1.6–3.6). Perinatal mortality was similar among infants whose mothers had ToL (n = 8; 27/1000 ToLs) and infants whose mothers underwent ERCS (n = 4; 29/1000 ERCSs). Conclusions A considerable proportion of women delivering at a rural Rwandan hospital had scarred uteri. Severe acute maternal morbidity was higher in the ToL group, perinatal mortality did not differ. ToL took place under suboptimal conditions: access for women with scarred uteri into a facility with 24-h surgery should be guaranteed to increase the safety of ToL.
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Affiliation(s)
- Richard Kalisa
- Department of Obstetrics and Gynecology, Ruhengeri Hospital, Musanze, Rwanda. .,Athena Institute, VU University, Amsterdam, The Netherlands.
| | - Stephen Rulisa
- Department of Obstetrics and Gynecology, University of Rwanda, Kigali, Rwanda
| | - Jos van Roosmalen
- Athena Institute, VU University, Amsterdam, The Netherlands.,Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Thomas van den Akker
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
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Bartolo S, Goffinet F, Blondel B, Deneux-Tharaux C. Why women with previous caesarean and eligible for a trial of labour have an elective repeat caesarean delivery? A national study in France. BJOG 2016; 123:1664-73. [DOI: 10.1111/1471-0528.14056] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2016] [Indexed: 12/23/2022]
Affiliation(s)
- S Bartolo
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé); Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS); DHU Risks in pregnancy; Inserm UMR 1153; Paris Descartes University; Paris France
| | - F Goffinet
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé); Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS); DHU Risks in pregnancy; Inserm UMR 1153; Paris Descartes University; Paris France
- Port-Royal Maternity Unit; Cochin Hospital APHP; DHU Risks in pregnancy; Paris Descartes University; Paris France
| | - B Blondel
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé); Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS); DHU Risks in pregnancy; Inserm UMR 1153; Paris Descartes University; Paris France
| | - C Deneux-Tharaux
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé); Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS); DHU Risks in pregnancy; Inserm UMR 1153; Paris Descartes University; Paris France
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9
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Senturk MB, Cakmak Y, Atac H, Budak MS. Factors associated with successful vaginal birth after cesarean section and outcomes in rural area of Anatolia. Int J Womens Health 2015. [PMID: 26203286 PMCID: PMC4506034 DOI: 10.2147/ijwh.s83800] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Successful vaginal birth after cesarean section is more comfortable than repeat emergency or elective cesarean section. Antenatal examinations are important in selection for trial of labor, while birth management can be difficult when the patients present at emergency condition. But there is an increased chance of vaginal birth with advanced cervical dilation. This study attempts to evaluate factors associated with success of vaginal birth after cesarean section and to compare the maternal and perinatal outcomes between vaginal birth after cesarean section and intrapartum cesarean section in patients who were admitted to hospital during the active or second stage of labor. A retrospective evaluation was made from the results of 127 patients. Cesarean section was performed in 57 patients; 70 attempted trial of labor. The factors associated with success of vaginal birth after cesarean section were investigated. Maternal and neonatal outcomes were compared between the groups. Vaginal birth after cesarean section was successful in 55% of cases. Advanced cervical opening, effacement, gravidity, parity, and prior vaginal delivery were factors associated with successful vaginal birth. The vaginal birth group had more complications (P<0.01), but these were minor. The rate of blood transfusion and prevalence of changes in hemoglobin level were similar in both groups (P>0.05). In this study, cervical opening, effacement, gravidity, parity, and prior vaginal delivery were important factors for successful vaginal birth after cesarean section. The patients' requests influenced outcome. Trial of labor should take into consideration the patient's preference, together with the proper setting.
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Affiliation(s)
- Mehmet Baki Senturk
- Department of Obstetrics and Gynecology, Bakirkoy Dr Sadi Konuk Teaching and Research Hospital, Istanbul, Turkey
| | - Yusuf Cakmak
- Department of Obstetrics and Gynecology, Batman State Hospital, Batman, Turkey
| | - Halit Atac
- Department of Obstetrics and Gynecology, Batman State Hospital, Batman, Turkey
| | - Mehmet Sukru Budak
- Department of Obstetrics and Gynecology, Diyarbakir Research Hospital, Diyarbakir, Turkey
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10
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Lutomski JE, Murphy M, Devane D, Meaney S, Greene RA. Private health care coverage and increased risk of obstetric intervention. BMC Pregnancy Childbirth 2014; 14:13. [PMID: 24418254 PMCID: PMC3898095 DOI: 10.1186/1471-2393-14-13] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 12/24/2013] [Indexed: 11/10/2022] Open
Abstract
Background When clinically indicated, common obstetric interventions can greatly improve maternal and neonatal outcomes. However, variation in intervention rates suggests that obstetric practice may not be solely driven by case criteria. Methods Differences in obstetric intervention rates by private and public status in Ireland were examined using nationally representative hospital discharge data. A retrospective cohort study was performed on childbirth hospitalisations occurring between 2005 and 2010. Multivariate logistic regression analysis with correction for the relative risk was conducted to determine the risk of obstetric intervention (caesarean delivery, operative vaginal delivery, induction of labour or episiotomy) by private or public status while adjusting for obstetric risk factors. Results 403,642 childbirth hospitalisations were reviewed; approximately one-third of maternities (30.2%) were booked privately. After controlling for relevant obstetric risk factors, women with private coverage were more likely to have an elective caesarean delivery (RR: 1.48; 95% CI: 1.45-1.51), an emergency caesarean delivery (RR: 1.13; 95% CI: 1.12-1.16) and an operative vaginal delivery (RR: 1.25; 95% CI: 1.22-1.27). Compared to women with public coverage who had a vaginal delivery, women with private coverage were 40% more likely to have an episiotomy (RR: 1.40; 95% CI: 1.38-1.43). Conclusions Irrespective of obstetric risk factors, women who opted for private maternity care were significantly more likely to have an obstetric intervention. To better understand both clinical and non-clinical dynamics, future studies of examining health care coverage status and obstetric intervention would ideally apply mixed-method techniques.
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Affiliation(s)
- Jennifer E Lutomski
- National Perinatal Epidemiology Centre, Cork University Maternity Hospital, Wilton, Cork, Ireland.
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11
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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
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12
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Eden KB, Denman MA, Emeis CL, McDonagh MS, Fu R, Janik RK, Broman AR, Guise J. Trial of Labor and Vaginal Delivery Rates in Women with a Prior Cesarean. J Obstet Gynecol Neonatal Nurs 2012; 41:583-98. [DOI: 10.1111/j.1552-6909.2012.01388.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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13
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Cheng YW, Eden KB, Marshall N, Pereira L, Caughey AB, Guise JM. Delivery after prior cesarean: maternal morbidity and mortality. Clin Perinatol 2011; 38:297-309. [PMID: 21645797 PMCID: PMC3428794 DOI: 10.1016/j.clp.2011.03.012] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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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14
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Korst LM, Gregory KD, Fridman M, Phelan JP. Nonclinical factors affecting women's access to trial of labor after cesarean delivery. Clin Perinatol 2011; 38:193-216. [PMID: 21645789 DOI: 10.1016/j.clp.2011.03.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The use of trial of labor after cesarean (TOLAC) has declined in the last decade, and the clinical risks of TOLAC remain low. Nonclinical factors continue to affect women's access to TOLAC. This article considers 5 categories of factors that seem to be influencing rates of TOLAC and vaginal birth after cesarean: opinion leaders and professional guidelines, hospital facilities and cesarean availability, reimbursement for providing TOLAC, medical liability, and patient-level factors. An evidence base and strategies to provide guidance to create a safe environment for vaginal birth after cesarean are needed. Obstetric information systems are critical to this effort.
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Affiliation(s)
- Lisa M Korst
- Department of Obstetrics & Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
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