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Thijssen KMJ, Frenken MWE, Van der Hout-van der Jagt MB, Li W, Mo Z, Westerhuis MEMH, Swan GO. A randomized controlled trial reducing cesarean delivery rates in China by introducing trial of labor after cesarean and electrohysterography. J Matern Fetal Neonatal Med 2024; 37:2376661. [PMID: 39004516 DOI: 10.1080/14767058.2024.2376661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 07/01/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVE A cesarean delivery (CD) can affect health of both mother and child and future pregnancies. Since the abandonment of the one-child policy in China, obstetricians tend to perform a repeat CD rather than a trial of labor after cesarean (TOLAC). This study aims to reduce CD rates by increasing vaginal births after cesarean (VBAC) rates and introducing electrohysterography (EHG) for accurate monitoring. METHODS In total, 82 women received counseling regarding TOLAC at the Shijiazhuang Sixth Hospital in China. Women opting for TOLAC were randomized for either external tocodynamometry (TOCO, i.e. standard care) or EHG. The primary outcome was the VBAC rate. Secondary outcomes were indications for CD, percentage of assisted vaginal deliveries, labor duration, maternal blood loss, complications and neonatal outcomes. RESULTS After accounting for preterm delivery and dropouts, all counseled women opted for a TOLAC (100%). After randomization, 42 women were included in the TOCO-group and 37 in the EHG-group. Women did not receive pain medication and labor was not augmented with oxytocin. The VBAC rate was 71.4% in the TOCO-group, versus 78.4% in the EHG-group (p = .48). Birth was assisted with forceps in 11.9% of TOCO-group versus 2.7% of EHG-group (p = .21). One secondary CD (i.e. a shift from intended vaginal delivery to surgical delivery within the same labor) was performed because of a suspicion of uterine rupture (TOCO-group). Other indications for CD were: fetal distress, labor dystocia, fetal position, cephalopelvic disproportion. There were no significant differences in secondary study outcomes. No complications were reported. CONCLUSION This study showed an average VBAC rate of 75%, without any complications, in a hospital with no previous experience with TOLAC. The VBAC rate with EHG-monitoring was higher than TOCO, although this difference was not significant. To demonstrate a significant difference, larger clinical studies are necessary. TRIAL REGISTRATION The Daily Board of the Medical Ethics Committee of The Maternal and Child Hospital of Shijiazhuang approved the study protocol (number 20171018, Dutch Trial Register NL8199).
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Affiliation(s)
- Kirsten Martine Johanna Thijssen
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands
- University MC Utrecht, Utrecht, The Netherlands
| | - Maria Wilhelmina Elisabeth Frenken
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands
| | - Marieke Beatrijs Van der Hout-van der Jagt
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands
- Faculty of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Wang Li
- Department of Obstetrics and Gynaecology, The Maternal and Child Hospital of Shijiazhuang, Shijiazhuang, Hebei Province, P.R. China
| | - Zhongfu Mo
- Department of Obstetrics and Gynaecology, The Maternal and Child Hospital of Shijiazhuang, Shijiazhuang, Hebei Province, P.R. China
| | | | - Guid Oei Swan
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands
- Faculty of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
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Tegegne GA, Rade BK, Yismaw AE, Taye W, Mengistie BA. Predictors of successful trial of labor after cesarean section (TOLAC) in women with one prior transverse cesarean section at Tertiary Hospitals in northwest Ethiopia: a multicenter study. BMC Pregnancy Childbirth 2024; 24:240. [PMID: 38580911 PMCID: PMC10996235 DOI: 10.1186/s12884-024-06432-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/18/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Trials of labor after cesarean section is the preferred strategy to decrease the cesarean delivery rate and reducing complications associated with multiple cesarean sections. The success rate of trials of labor after cesarean section and associated factors have not been well documented in Ethiopia. Hence, this study was aimed to determine the success rate and factors associated with the trial of labor after one cesarean section in five Comprehensive Specialized Hospitals located in northwest Ethiopia. METHODS An institutional-based cross-sectional study was conducted among 437 women who came for the trial of labor from December 1, 2021, to March 30, 2022. All women who fulfilled the eligibility criteria were included to this study. Data was collected using structured and pre-tested questionnaire. Then, the data was entered into Epi Data 4.6 software and exported to SPSS version 26 for analysis. To identify the variables influencing the outcome variable, bivariable and multivariable logistic regression analyses were conducted. The model's fitness was checked using the Hosmer-Lemeshow goodness of fit test, and an adjusted odds ratio with a 95% confidence interval was used to declare the predictors that are significantly associated with TOLAC. RESULTS The success rate of the trial of labor after one cesarean section was 56.3% (95% CI, 51.3%, 61.2%). Maternal age ≥ 35 years (AOR: 3.3, 95% CI 1.2, 9.3), the fetal station at admission ≤ zero (AOR: 5. 6, 95% CI 3.3, 9.5), vaginal delivery before cesarean section (AOR: 1.9, 95% CI 1.2, 3.2), and successful vaginal birth after cesarean delivery (AOR 2.2, 95% CI 1.2, 4.1) were found to have a significant association with the success rate of trial of labor after cesarean section. CONCLUSIONS In this study, the success rate of the trial of labor after a cesarean section was low as compared to the ACOG guideline and other studies in different countries. Therefore, the clinicians ought to offer counsel during antenatal and intrapartum period, encourage the women to make informed decision on the mode of delivery, and the practitioners need to follow fetal and maternal conditions strictly to minimize adverse birth outcomes.
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Affiliation(s)
| | - Bayew Kelkay Rade
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ayenew Engida Yismaw
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Worku Taye
- Department of Midwifery, Debremarkos Referral Hospital, Debremarkos, Ethiopia
| | - Berihun Agegn Mengistie
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
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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.
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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
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Yang CC, Wang CF, Lin WM, Chen SW, Hu HW. Evaluating the performance of an AI-powered VBAC prediction system within a decision-aid birth choice platform for shared decision-making. Digit Health 2024; 10:20552076241257014. [PMID: 38778867 PMCID: PMC11110514 DOI: 10.1177/20552076241257014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
Background Vaginal birth after cesarean (VBAC) is generally regarded as a safe and viable birthing option for most women with prior cesarean delivery. Nonetheless, concerns about heightened risks of adverse maternal and perinatal outcomes have often dissuaded women from considering VBAC. This study aimed to assess the performance of an artificial intelligence (AI)-powered VBAC prediction system integrated into a decision-aid birth choice platform for shared decision-making (SDM). Materials and Methods Employing a retrospective design, we collected medical records from a regional hospital in northern Taiwan from January 2019 to May 2023. To explore a suitable model for tabular data, we compared two prevailing modeling approaches: tree-based models and logistic regression models. We subjected the tree-based algorithm, CatBoost, to binary classification. Results Forty pregnant women with 347 records were included. The CatBoost model demonstrated a robust performance, boasting an accuracy rate of 0.91 (95% confidence interval (CI): 0.86-0.94) and an area under the curve of 0.89 (95% CI: 0.86-0.93), surpassing both regression models and other boosting techniques. CatBoost captured the data characteristics on the significant impact of gravidity and the positive influence of previous vaginal birth, reinforcing established clinical guidelines, as substantiated by the SHapley Additive exPlanations analysis. Conclusion Using AI techniques offers a more accurate assessment of VBAC risks, boosting women's confidence in selecting VBAC as a viable birthing option. The seamless integration of AI prediction systems with SDM platforms holds a promising potential for enhancing the effectiveness of clinical applications in the domain of women's healthcare.
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Affiliation(s)
- Cherng Chia Yang
- Department of Obstetrics and Gynecology, Saint Paul’s Hospital, Taoyuan
| | - Ching Fu Wang
- Biomedical Engineering Research and Development Center, National Yang Ming Chiao Tung University, Taipei
| | - Wei Ming Lin
- Department of Information Management, I-Shou University, Chiayi
| | - Shu Wen Chen
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei
| | - Hsiang Wei Hu
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu
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Vaajala M, Liukkonen R, Ponkilainen V, Kekki M, Mattila VM, Kuitunen I. Delivery mode and fetal outcome in attempted vaginal deliveries after previous cesarean section: a nationwide register-based cohort study in Finland. J Matern Fetal Neonatal Med 2023; 36:2198062. [PMID: 37031969 DOI: 10.1080/14767058.2023.2198062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/28/2023] [Indexed: 04/11/2023]
Abstract
PURPOSE Even though the risks and advantages of repeat Cesarean sections (CSs) and vaginal births after cesarean section (VBACs) are well studied, there is a scarcity of information on the effects of previous CS on maternal and fetal outcomes during subsequent deliveries. The aim of this study is to evaluate delivery mode and fetal outcomes in a trial of labor after cesarean section (TOLAC). METHODS In this nationwide retrospective cohort study, data from the National Medical Birth Register (MBR) were used to evaluate the outcomes of TOLACs. TOLACs were compared to the outcomes of the trial of labor after previous successful vaginal delivery. A multivariable logistic regression model was used to assess the primary outcomes (delivery mode, neonatal intensive care unit, and perinatal/neonatal mortality). Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were used for comparison. RESULTS A total of 29 352 (77.0%) women attempted vaginal delivery in the TOLAC group. In the control group, 169 377 (97.2%) women attempted vaginal delivery. The adjusted odds for urgent CS (aOR 13.05, CI 12.59-13.65) and emergency CS (aOR 3.65, CI 3.26-4.08) were notably higher in the TOLAC group when compared to the control group. The odds for neonatal intensive care unit treatment (aOR 2.05, CI 1.98-2.14), perinatal mortality (aOR 2.15, CI 1.79-2.57), and neonatal mortality (aOR 1.75, CI 1.20-2.49) were higher in the TOLAC group. CONCLUSIONS The odds for emergency CS were higher among women who underwent TOLAC. The odds for neonatal intensive care and perinatal mortality were also higher, and further research is needed to identify those expecting women who are better suited for TOLAC to minimize the risk for a neonate. The results of this study should be acknowledged by the mother and the clinician when considering the possibility of vaginal births after cesarean section.
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Affiliation(s)
- Matias Vaajala
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Rasmus Liukkonen
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Ville Ponkilainen
- Department of Surgery, Central Finland Central Hospital Nova, Jyväskylä, Finland
| | - Maiju Kekki
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
- Center for Child, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
- Department of Orthopaedics and Traumatology, Tampere University Hospital Tampere, Finland
| | - Ilari Kuitunen
- Department of Pediatrics, Mikkeli Central Hospital, Mikkeli, Finland
- Institute of Clinical Medicine and Department of Pediatrics, University of Eastern Finland, Kuopio, Finland
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Addisu D, Gebeyehu NA, Biru S, Belachew YY. Vaginal birth after cesarean section and its associated factors in Ethiopia: a systematic review and meta-analysis. Sci Rep 2023; 13:7882. [PMID: 37188702 DOI: 10.1038/s41598-023-34856-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/09/2023] [Indexed: 05/17/2023] Open
Abstract
The prevalence of cesarean sections is rising rapidly and is becoming a global issue. Vaginal birth after a cesarean section is one of the safest strategies that can be used to decrease the cesarean section rate. Different fragmented primary studies were done on the success rate of vaginal birth after cesarean section and its associated factors in Ethiopia. However, the findings were controversial and inconclusive. Therefore, this meta-analysis was intended to estimate the pooled success rate of vaginal birth after cesarean section and its associated factors in Ethiopia. Pertinent studies were searched in PubMed, Google Scholar, ScienceDirect, direct open-access journals, and Ethiopian universities' institutional repositories. The data were analyzed using Stata 17. The Newcastle-Ottawa quality assessment tool was used to assess the quality of the studies. I squared statistics and Egger's regression tests were used to assess heterogeneity and publication bias, respectively. A random effects model was selected to estimate the pooled success rate of vaginal birth after cesarean section and its associated factors. The PROSPERO registration number for this review is CRD42023413715. A total of 10 studies were included. The pooled success rate of vaginal birth after a cesarean section was found to be 48.42%. Age less than 30 years (pooled odds ratio (OR) 3.75, 95% CI 1.92, 7.33), previous history of vaginal birth (OR 3.65, 95% CI 2.64, 504), ruptured amniotic membrane at admission (OR 2.87, 95% CI 1.94, 4.26), 4 cm or more cervical dilatation at admission (OR 4, 95% CI 2.33, 6.8), a low station at admission (OR 5.07, 95% CI 2.08, 12.34), and no history of stillbirth (OR 4.93, 95% CI 1.82, 13.36) were significantly associated with successful vaginal birth after cesarean section. In conclusion, the pooled success rate of vaginal birth after a cesarean section was low in Ethiopia. Therefore, the Ministry of Health should consider those identified factors and revise the management guidelines and eligibility criteria for a trial of labor after a cesarean section.
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Affiliation(s)
- Dagne Addisu
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
| | - Natnael Atnafu Gebeyehu
- School of Midwifery, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Shimeles Biru
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yismaw Yimam Belachew
- Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Vaajala M, Liukkonen R, Ponkilainen V, Kekki M, Mattila VM, Kuitunen I. The rates of vaginal births after cesarean section have increased during the last decades: a nationwide register-based cohort study in Finland. Arch Gynecol Obstet 2023; 308:157-162. [PMID: 37016061 DOI: 10.1007/s00404-023-07010-y] [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: 10/28/2022] [Accepted: 03/12/2023] [Indexed: 04/06/2023]
Abstract
PURPOSE Epidemiological studies assessing the effects of previous cesarean section (CS) on subsequent delivery mode using large nationwide study populations. This study aims to calculate the incidence rates of trial of labors after cesarean section (TOLACs) and evaluate the annual rates of vaginal births after cesarean section (VBAC) during the last decades in Finland. METHODS Data from the National Medical Birth Register (MBR) were used to evaluate incidence rates of VABC in the Finnish population (1998-2018). All nulliparous women having their first and second pregnancy during our study period, and with the mode of delivery identified in both of these pregnancies were included in this study. Absolute annual numbers and incidence rates for TOLACs, elective CS, and VBAC were calculated. RESULTS The absolute number of TOLACs had an increasing trend during our study period, increasing up to 2118 TOLACs in 2016. The incidence rates for elective CS after the first CS had a decreasing trend, decreasing from 45% in 1999, to 28% in 2018. The absolute number of VBACs had an increasing trend during our study period, peaking in 2016 (1466 VBACs). The rates for VBAC remained relatively constant, ranging between 38 and 52%, but a slightly increasing trend at the end of the study period was seen. CONCLUSION Despite the increasing annual total number of deliveries with CS in the first pregnancy, the absolute numbers and rates for VBACs have increased towards the end of the study period in Finland. The epidemiology of TOLACs and VBACs should be better studied around the world, as with the rapidly increasing rate of CSs, these events are becoming more common challenges in health care.
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Affiliation(s)
- Matias Vaajala
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.
| | - Rasmus Liukkonen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Ville Ponkilainen
- Department of Surgery, Central Finland Central Hospital Nova, Jyväskylä, Finland
| | - Maiju Kekki
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Ilari Kuitunen
- Department of Pediatrics, Mikkeli Central Hospital, Mikkeli, Finland
- Institute of Clinical Medicine and Department of Pediatrics, University of Eastern Finland, Kuopio, Finland
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Chen SW, Shorten A, Yeh CC, Kao CH, Lu YY, Hu HW. An innovative web-based decision-aid about birth after cesarean for shared decision making in Taiwan: study protocol for a randomized control trial. Trials 2023; 24:103. [PMID: 36759893 PMCID: PMC9910264 DOI: 10.1186/s13063-023-07103-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/18/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Taiwan has a high national caesarean rate coupled with a low vaginal birth after caesarean (VBAC) rate. This study aims to develop and evaluate a web-based decision-aid with communication support tools, to increase shared decision making (SDM) about birth after caesarean. METHODS A quantitative approach will be adopted using a randomized pre-test and post-test experimental design in a medical centre in northern Taiwan. The web-based decision aid consists of five sections. Section 1 provides a two-part video to introduce SDM and how to participate in SDM. Section 2 presents an overview of functions and features of the birth decision-aid. Section 3 presents relevant VBAC information, including definitions, benefits and risks, and an artificial intelligence (AI) calculator for rate and likelihood of VBAC success. Section 4 presents the information regarding elective repeat caesarean delivery (ERCD), involving definitions, benefits, and risks. Section 5 comprises four steps of decision making to meet women's values and preferences. Pregnant women who have had one previous caesarean and are eligible for VBAC, will be recruited at 14-16 weeks. Participants will complete a baseline survey prior to random allocation to either the control group (usual care) or intervention group (usual care plus an AI-decision aid). A follow up survey at 35-38 weeks will measure change in decisional conflict, knowledge, birth mode preference, and decision-aid acceptability. Actual birth outcomes and satisfaction will be assessed one month after birth. DISCUSSION The innovative web-based decision-aid with support tools will help to promote pregnant women's decision-making engagement and communication with their providers and improve opportunities for supportive communication about VBAC SDM in Taiwan. Linking web-based AI data analysis into the medical record will also be assessed for feasibility during implementation in clinical practice. TRIAL REGISTRATION ClinicalTrials.gov identifier (NCT05091944), Registered on October 24, 2021.
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Affiliation(s)
- Shu Wen Chen
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
| | - Allison Shorten
- grid.265892.20000000106344187School of Nursing, University of Alabama at Birmingham, Birmingham, USA
| | - Chang Ching Yeh
- grid.278247.c0000 0004 0604 5314Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chien Huei Kao
- grid.412146.40000 0004 0573 0416Department of Nursing-Midwifery and Women Health, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Yu Ying Lu
- grid.412146.40000 0004 0573 0416School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Hsiang Wei Hu
- grid.64523.360000 0004 0532 3255Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
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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.
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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.
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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
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11
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Shinar S, Walsh L, Roberts N, Melamed N, Barrett J, Riddell C, Berger H. Timing of cesarean delivery in women with ≥2 previous cesarean deliveries. Am J Obstet Gynecol 2022; 226:110.e1-110.e10. [PMID: 34363783 DOI: 10.1016/j.ajog.2021.07.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND The rate of cesarean delivery is continuously increasing with the leading indication being a previous cesarean delivery. For women with 1 previous cesarean delivery, it is generally agreed that the optimal timing of delivery by elective cesarean delivery is during the 39th week of gestation, whereas for women with ≥2 previous cesarean deliveries, the optimal delivery time remains debatable. OBJECTIVE To assess the maternal and neonatal risks associated with elective delivery at different gestational ages ranging from 37 0/7 to 39 6/7 weeks' gestation and to compare it with expectant management among women with at least 2 previous cesarean deliveries. STUDY DESIGN This was a retrospective, population-based cohort study of all women with at least 2 previous cesarean deliveries who delivered after 36 6/7 weeks of gestation in Ontario, Canada, between April 2012 and March 2019. Women with multifetal pregnancies or major fetal anomalies were excluded. For each completed gestational week, outcomes of women who had an elective repeat cesarean delivery at that week solely because of 2 previous cesarean deliveries were compared with the outcomes of those who were managed expectantly and delivered at a later gestational age. The primary outcome was a composite of maternal outcomes including mortality and severe maternal morbidity. Secondary outcomes were adverse neonatal outcomes. RESULTS A total of 26,522 women met the inclusion criteria. The maternal risk was similar for elective delivery at 37 0/7 to 38 6/7 weeks of gestation compared with expectant management. However, elective delivery at 39 0/7 to 39 6/7 weeks' gestation was associated with a decreased risk for adverse outcomes when compared with expectant management (adjusted risk ratio, 0.51; 95% confidence interval, 0.29-0.91). For the neonate, elective delivery during the 37th week of gestation significantly increased the incidence of the composite adverse outcome than in an ongoing pregnancy (adjusted risk ratio, 1.68; 95% confidence interval, 1.39-2.01), but was comparable for elective delivery at 38 0/7 to 39 6/7 weeks' gestation and expectant management. The risk for an unplanned cesarean delivery increased from 6.5% before 38 weeks' gestation to 21.7% before 39 weeks' gestation and to 32.6% before 40 weeks' gestation. CONCLUSION For women with ≥2 cesarean deliveries, elective delivery at 38 0/7 to 38 6/7 weeks' gestation likely represents the optimal balance between neonatal and maternal risk while decreasing the likelihood of an unplanned cesarean delivery.
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Affiliation(s)
- Shiri Shinar
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
| | - Laura Walsh
- Better Outcomes Registry & Network (BORN), Ottawa, Ontario, Canada
| | - Nicole Roberts
- Better Outcomes Registry & Network (BORN), Ottawa, Ontario, Canada
| | - Nir Melamed
- Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jon Barrett
- Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | | | - Howard Berger
- Department of Obstetrics and Gynecology, Saint Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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12
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Vaginal delivery after caesarean section and its associated factors in Mizan Tepi University Teaching Hospital, Southwest Ethiopia. Heliyon 2021; 7:e08276. [PMID: 34765789 PMCID: PMC8571079 DOI: 10.1016/j.heliyon.2021.e08276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 11/24/2022] Open
Abstract
Background Vaginal birth after caesarean section is appropriate for a majority of women who have had a single prior lower segment caesarean section. However, little is known about vaginal birth after caesarean section in Ethiopia. Thus, this study aimed to assess the success rate of vaginal birth after caesarean section and its associated factors in Mizan-Tepi University Teaching Hospital, southwest Ethiopia in 2020. Methods An institutional-based cross-sectional study was conducted among 416 mothers who gave birth by caesarean section from 2017 to 2019. The data were entered into epidata version 3.1.0 and analysed by SPSS version 21.0. Multivariable logistic regression analysis was performed to identify the factors associated with successful vaginal birth after caesarean section. A crude and adjusted odds ratio with a 95% confidence interval was used to interpret the results. A P value of <0.05 indicated statistically significant results. Results Of 416 completed charts reviewed, the success rate of vaginal birth after cesarean section was 170 (41%), with 95% CI (36.2%, 45.6%). The factors associated with successful vaginal birth after cesarean section were: macrosomia as past indication of cesarean section delivery: AOR; 0.31, 95% CI (0.15, 0.62); prior successful vaginal birth after cesarean section: AOR; 2, 95% CI (1.18, 3.70); previous successful spontaneous vaginal delivery: AOR; 4, 95% CI (2.05, 7.83); cervical dilatation at admission: AOR; 2.7, 95% CI (1.47, 4.95), and duration of labor: AOR; 1.7, 95% CI (1.07, 2.83). Conclusion The success rate of vaginal birth after caesarean section in the study area was low. Macrosomia as past indication of caesarean section, prior vaginal birth after caesarean section, history of vaginal birth, cervical dilatation at admission, and duration of labour were significantly associated with the success rate. Emphasis should be placed on those factors that lead to a higher likelihood of successful vaginal birth.
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13
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Luo ZC, Liu X, Wang A, Li JQ, Zheng ZH, Guiyu S, Lou T, Pang J, Bai XL. Obstetricians' perspectives on trial of labor after cesarean (TOLAC) under the two-child policy in China: a cross-sectional study. BMC Pregnancy Childbirth 2021; 21:89. [PMID: 33509100 PMCID: PMC7841882 DOI: 10.1186/s12884-021-03559-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 01/13/2021] [Indexed: 11/16/2022] Open
Abstract
Background As the birth policy has been adjusted from one-child-one-couple to universal two-child-one-couple in China, there is an increasing number of women undergoing a second pregnancy after a previous cesarean section (CS). Undertaking an elective repeat CS (ERCS) has been taken for granted and has thus become a major contributor to the increasing CS rate in China. Promoting trial of labor after CS (TOLAC) can reduce the CS rate without compromising delivery outcomes. This study aimed to investigate Chinese obstetricians’ perspectives regarding TOLAC, and the factors associated with their decision-making regarding recommending TOLAC to pregnant women with a history of CS under the two-child policy. Methods A cross-sectional survey was carried out between May and July 2018. Binary logistic regression was used to determine the factors associated with the obstetricians’ intention to recommend TOLAC to pregnant women with a history of CS. The independent variables included sociodemographic factors and perceptions regarding TOLAC (selection criteria for TOLAC, basis underlying the selection criteria for TOLAC, and perceived challenges regarding promoting TOLAC). Results A total of 426 obstetricians were surveyed, with a response rate of ≥83%. The results showed that 31.0% of the obstetricians had no intention to recommend TOLAC to pregnant women with a history of CS. Their decisions were associated with the perceived lack of confidence regarding undergoing TOLAC among pregnant women with a history of CS and their families (odds ratio [OR] = 2.31; 95% CI: 1.38–1.38); obstetricians’ uncertainty about the safety of TOLAC for pregnant women with a history of CS (OR = 0.49; 95% CI: 0.27–0.96), and worries about medical lawsuits due to adverse delivery outcomes (OR = 0.14; 95% CI: 0.07–0.31). The main reported challenges regarding performing TOLAC were lack of clear guidelines for predicting or avoiding the risks associated with TOLAC (83.4%), obstetricians’ uncertainty about the safety of TOLAC for women with a history of CS (81.2%), pregnant women’s unwillingness to accept the risks associated with TOLAC (81.0%) or demand for ERCS (80.7%), and the perceived lack of confidence (77.5%) or understanding (69.7%) regarding undergoing TOLAC among pregnant women and their families. Conclusion A proportion of Chinese obstetricians did not intend to recommend TOLAC to pregnant women with a history of CS. This phenomenon was closely associated with obstetricians’ concerns about TOLAC safety and perceived attitudes of the pregnant women and their families regarding TOLAC. Effective measures are needed to help obstetricians predict and reduce the risks associated with TOLAC, clearly specify the indications for TOLAC, improve labor management, and popularize TOLAC in China. Additionally, public health education on TOLAC is necessary to improve the understanding of TOLAC among pregnant women with a history of CS and their families, and to improve their interactions with their obstetricians regarding shared decision making. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03559-1.
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Affiliation(s)
- Zhong-Chen Luo
- School of Nursing, Guizhou Medical University, Guiyang, China
| | - Xu Liu
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Anni Wang
- School of Nursing, Fudan University, Shanghai, China
| | - Jian-Qiong Li
- School of Nursing, Chongqing Three Gorges Medical College, Chongqing, China
| | - Ze-Hong Zheng
- Engineering Training Center, Guizhou Minzu University, Guiyang, China
| | - Sun Guiyu
- Nursing Department, Guizhou Provincial Peoples Hospital, Guiyang, China
| | - Ting Lou
- Nursing Department, Guizhou Provincial Peoples Hospital, Guiyang, China
| | - Jin Pang
- Nursing Department, Guizhou Provincial Peoples Hospital, Guiyang, China
| | - Xiao-Ling Bai
- Nursing Department, Guizhou Provincial Peoples Hospital, Guiyang, China. .,Guizhou Nursing Vocational College, Dazhi Road, Guiyang, 550025, China.
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14
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Anikwe C, Kalu C, Okorochukwu B, Dimejesi IO, Eleje G, Ikeoha C. Trial of labour after caesarean section in a secondary health facility in Abakaliki, Nigeria. NIGERIAN JOURNAL OF MEDICINE 2021. [DOI: 10.4103/njm.njm_71_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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15
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Asgarian A, Rahmati N, Nasiri F, Mohammadbeigi A. The Failure Rate, Related Factors, and Neonate Complications of Vaginal Delivery after Cesarean Section. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2019; 25:65-70. [PMID: 31956600 PMCID: PMC6952909 DOI: 10.4103/ijnmr.ijnmr_101_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/29/2019] [Accepted: 10/15/2019] [Indexed: 11/04/2022]
Abstract
Background The rate of Cesarean Section (CS) is high in Iran. A successful Vaginal Birth After Cesarean (VBAC) section can protect mothers against the risk of having multiple CS. This study aimed to evaluate the success rate of VBAC, related factors, and the causes of failure. Materials and Methods This cross-sectional study was conducted on 150 pregnant women who were candidates for VBAC and admitted at maternity hospitals in Qom from 2016 to 2018. The required data were collected from the patients' records and entered into the checklist. Then, the success rate of VBAC was estimated, and related factors together with the causes of failure were determined by t-test, Chi-square, and independent-samples t-tests in SPSS v. 18 software. Results The mean (SD) maternal age was 32 (5.20) years and ranged from 21 to 45 years old. The success rate of VBAC was estimated to be 85.33%, and 14.67% of the patients had to repeat a CS after failure in vaginal delivery. The mean time between previous CS and present delivery was statistically significant between successful and failure groups (t 125 = 2.32, p = 0.002). The results also revealed that the most important causes of VBAC failure were prolonged labor [odds ratio (OR) = 4.70)], full arrest (OR = 2.70), and decline fetal heart (OR = 5.31). Conclusions The success rate of VBAC in our study was high. However, VBAC was more successful when the interval between inter-deliveries was long, and lower complications were reported when the interval was 2-4 years.
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Affiliation(s)
- Azadeh Asgarian
- Department of Nursing, Qom University of Medical Sciences, Qom, Iran
| | - Nayereh Rahmati
- Department of Gynecology and Obstetrics, Qom University of Medical Sciences, Qom, Iran
| | - Farzaneh Nasiri
- Department of Midwifery, Faculty of Medicine, Qom Branch, Islamic Azad University, Qom, Iran
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16
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Choo SN, Kanneganti A, Abdul Aziz MNDB, Loh L, Hargreaves C, Gopal V, Biswas A, Chan YH, Ismail IS, Chi C, Mattar C. MEchanical DIlatation of the Cervix-- in a Scarred uterus (MEDICS): the study protocol of a randomised controlled trial comparing a single cervical catheter balloon and prostaglandin PGE2 for cervical ripening and labour induction following caesarean delivery. BMJ Open 2019; 9:e028896. [PMID: 31699720 PMCID: PMC6858154 DOI: 10.1136/bmjopen-2019-028896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 08/13/2019] [Accepted: 09/24/2019] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Labour induction in women with a previous caesarean delivery currently uses vaginal prostaglandin E2 (PGE2), which carries the risks of uterine hyperstimulation and scar rupture. We aim to compare the efficacy of mechanical labour induction using a transcervically applied Foley catheter balloon (FCB) with PGE2 in affected women attempting trial of labour after caesarean (TOLAC). METHODS AND ANALYSIS This single-centre non-inferiority prospective, randomised, open, blinded-endpoint study conducted at an academic maternity unit in Singapore will recruit a total of 100 women with one previous uncomplicated caesarean section and no contraindications to vaginal delivery. Eligible consented participants with term singleton pregnancies and unfavourable cervical scores (≤5) requiring labour induction undergo stratified randomisation based on parity and are assigned either FCB (n=50) or PGE2 (n=50). Treatments are applied for up to 12 hours with serial monitoring of the mother and the fetus and serial assessment for improved cervical scores. If the cervix is still unfavourable, participants are allowed a further 12 hours' observation for cervical ripening. Active labour is initiated by amniotomy at cervical scores of ≥6. The primary outcome is the rate of change in the cervical score, and secondary outcomes include active labour within 24 hours of induction, vaginal delivery, time-to-delivery interval and uterine hyperstimulation. All analyses will be intention-to-treat. The data generated in this trial may guide a change in practice towards mechanical labour induction if this proves efficient and safer for women attempting TOLAC compared with PGE2, to improve labour management in this high-risk population. ETHICS AND DISSEMINATION Ethical approval is granted by the Domain Specific Review Board (Domain D) of the National Healthcare Group, Singapore. All adverse events will be reported within 24 hours of notification for assessment of causality. Data will be published and will be available for future meta-analyses. TRIAL REGISTRATION NUMBER NCT03471858; Pre-results.
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Affiliation(s)
- Soe-Na Choo
- Obstetrics and Gynaecology, National University Hospital, Singapore, Singapore
| | - Abhiram Kanneganti
- Obstetrics and Gynaecology, National University Hospital, Singapore, Singapore
| | | | - Leta Loh
- Obstetrics and Gynaecology, National University Hospital, Singapore, Singapore
| | - Carol Hargreaves
- Data Analytics Consulting Centre, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Vikneswaran Gopal
- Data Analytics Consulting Centre, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Arijit Biswas
- Obstetrics and Gynaecology, National University Hospital, Singapore, Singapore
- Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University Health System, Singapore, Singapore
| | - Ida Suzani Ismail
- Obstetrics and Gynaecology, National University Hospital, Singapore, Singapore
| | - Claudia Chi
- Obstetrics and Gynaecology, National University Hospital, Singapore, Singapore
| | - Citra Mattar
- Obstetrics and Gynaecology, National University Hospital, Singapore, Singapore
- Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Wu Y, Kataria Y, Wang Z, Ming WK, Ellervik C. Factors associated with successful vaginal birth after a cesarean section: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2019; 19:360. [PMID: 31623587 PMCID: PMC6798397 DOI: 10.1186/s12884-019-2517-y] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 09/20/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Evidence for the relationship between maternal and perinatal factors and the success of vaginal birth after cesarean section (VBAC) is conflicting. We aimed to systematically analyze published data on maternal and fetal factors for successful VBAC. METHODS A comprehensive search of Medline, Embase, and the Cumulative Index to Nursing and Allied Health Literature, from each database's inception to March 16, 2018. Observational studies, identifying women with a trial of labor after one previous low-transverse cesarean section were included. Two reviewers independently abstracted the data. Meta-analysis was performed using the random-effects model. Risk of bias was assessed by the Newcastle-Ottawa Scale. RESULTS We included 94 eligible observational studies (239,006 pregnant women with 163,502 VBAC). Factors were associated with successful VBAC with the following odds ratios (OR;95%CI): age (0.92;0.86-0.98), obesity (0.50;0.39-0.64), diabetes (0.50;0.42-0.60), hypertensive disorders complicating pregnancy (HDCP) (0.54;0.44-0.67), Bishop score (3.77;2.17-6.53), labor induction (0.58;0.50-0.67), macrosomia (0.56;0.50-0.64), white race (1.39;1.26-1.54), previous vaginal birth before cesarean section (3.14;2.62-3.77), previous VBAC (4.71;4.33-5.12), the indications for the previous cesarean section (cephalopelvic disproportion (0.54;0.36-0.80), dystocia or failure to progress (0.54;0.41-0.70), failed induction (0.56;0.37-0.85), and fetal malpresentation (1.66;1.38-2.01)). Adjusted ORs were similar. CONCLUSIONS Diabetes, HDCP, Bishop score, labor induction, macrosomia, age, obesity, previous vaginal birth, and the indications for the previous CS should be considered as the factors affecting the success of VBAC.
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Affiliation(s)
- Yanxin Wu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, 510000, People's Republic of China
- Department of Laboratory Medicine, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02215, USA
| | - Yachana Kataria
- Department of Laboratory Medicine, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02215, USA
| | - Zilian Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, 510000, People's Republic of China.
| | - Wai-Kit Ming
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, 510000, People's Republic of China.
| | - Christina Ellervik
- Department of Laboratory Medicine, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02215, USA.
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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Wen J, Chen Q, Luo Q. Analysing the likelihood of caesarean birth after implementation of the two-childbirth policy in China, using the Ten Group Classification System. J OBSTET GYNAECOL 2019; 40:336-341. [PMID: 31354082 DOI: 10.1080/01443615.2019.1624949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The aim of this study was to identify the main contributor to the high Caesarean section birth rate at a regional perinatal medical centre using the Robson Ten Group Classification System (TGCS). A total of 54,085 women were surveyed and were included in our study from 2015 to 2017 at the Women's Hospital at Zhejiang University School of Medicine in Hangzhou, China. The Caesarean birth rate was similar among the three years; although, the new two-childbirth policy in China has been in implementation since 2016. According to the TGCS, Group 5 was the largest contributor to the overall Caesarean birth rate (40.79%), followed by Group 2 (21.36%). The Caesarean birth rate of Group 5 and Group 2 decreased significantly from 2015 to 2017 (p < .05). The proportion of Group 7 contributing to the overall Caesarean birth rate increased significantly (p < .05). Future efforts should focus on increasing vaginal birth after Caesarean in Group 5 and external cephalic version in Group 7 to decrease the overall Caesarean birth rate.Impact statementWhat is already known on this subject? The Ten Group Classification System (TGCS) proposed by World Health Organisation was used in some countries such as Queensland, Singapore and Japan to assess and compare Caesarean section rates. The main contributor to the high Caesarean birth rate varies in different counties. However, it is not widely used in China.What the results of this study add? It was the first study using the TGCS to analyse the Caesarean birth rate and the changes after implementation of the two-childbirth policy in China. It identified that Group 5 (multiparous mothers with a previous Caesarean birth in a singleton, cephalic full-term pregnancy) constituted the most important determinant of overall Caesarean birth rates, followed by Group 2 (nulliparous mothers with a singleton, cephalic full-term pregnancy undergoing an induction of labour or prelabour Caesarean birth). The contribution of Group 5 and Group 7 (multiparous women with a single breech pregnancy) to the overall Caesarean birth rate has increased significantly since the new childbirth policy was implemented.What the implications are of these findings for clinical practice and/or further research? Future efforts should focus on increasing vaginal birth after Caesarean in Group 5 and external cephalic version in Group 7 to decrease the overall Caesarean birth rate in China.
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Affiliation(s)
- Jie Wen
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - QinQing Chen
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiong Luo
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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19
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VBAC: Changes over Last 10 Years. J Obstet Gynaecol India 2018; 69:110-114. [PMID: 30956463 DOI: 10.1007/s13224-018-1101-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 02/22/2018] [Indexed: 10/17/2022] Open
Abstract
Introduction Vaginal birth after caesarean section (VBAC) has been historically studied to be a standard and a safe procedure with good successful results. Aims This study was conducted to determine changes in pattern of VBAC by the same author over a period of 10 years. Results Data for 1 year between 2005-2006 and 2014-2015 were compared, and successful VBAC was found to be 74.46% in 2005-2006 period compared to only 34.42% in 2014-2015. Neonatal mortality and maternal morbidity were, however, much higher 10 years ago. Conclusions It was concluded that better diagnostic techniques, awareness of patients and medico legal fear have led to safer health of mother and child and lesser incidence of VBAC over the last 10 years.
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Chen SW, Hutchinson AM, Nagle C, Bucknall TK. Women's decision-making processes and the influences on their mode of birth following a previous caesarean section in Taiwan: a qualitative study. BMC Pregnancy Childbirth 2018; 18:31. [PMID: 29343215 PMCID: PMC5773050 DOI: 10.1186/s12884-018-1661-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 01/07/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Vaginal birth after caesarean (VBAC) is an alternative option for women who have had a previous caesarean section (CS); however, uptake is limited because of concern about the risks of uterine rupture. The aim of this study was to explore women's decision-making processes and the influences on their mode of birth following a previous CS. METHODS A qualitative approach was used. The research comprised three stages. Stage I consisted of naturalistic observation at 33-34 weeks' gestation. Stage II involved interviews with pregnant women at 35-37 weeks' gestation. Stage III consisted of interviews with the same women who were interviewed postnatally, 1 month after birth. The research was conducted in a private medical centre in northern Taiwan. Using a purposive sampling, 21 women and 9 obstetricians were recruited. Data collection involved in-depth interviews, observation and field notes. Constant comparative analysis was employed for data analysis. RESULTS Ensuring the safety of mother and baby was the focus of women's decisions. Women's decisions-making influences included previous birth experience, concern about the risks of vaginal birth, evaluation of mode of birth, current pregnancy situation, information resources and health insurance. In communicating with obstetricians, some women complied with obstetricians' recommendations for repeat caesarean section (RCS) without being informed of alternatives. Others used four step decision-making processes that included searching for information, listening to obstetricians' professional judgement, evaluating alternatives, and making a decision regarding mode of birth. After birth, women reflected on their decisions in three aspects: reflection on birth choices; reflection on factors influencing decisions; and reflection on outcomes of decisions. CONCLUSIONS The health and wellbeing of mother and baby were the major concerns for women. In response to the decision-making influences, women's interactions with obstetricians regarding birth choices varied from passive decision-making to shared decision-making. All women have the right to be informed of alternative birthing options. Routine provision of explanations by obstetricians regarding risks associated with alternative birth options, in addition to financial coverage for RCS from National Health Insurance, would assist women's decision-making. Establishment of a website to provide women with reliable information about birthing options may also assist women's decision-making.
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Affiliation(s)
- Shu-Wen Chen
- Deakin University, Faculty of Health, School of Nursing and Midwifery, Geelong, Australia.
- National Taipei University of Nursing and Health Science, School of Nursing, Taipei, Taiwan.
| | - Alison M Hutchinson
- Deakin University, Faculty of Health, School of Nursing and Midwifery, Geelong, Australia
- Centre for Quality and Patient Safety Research-Monash Health Partnership, Clayton, Australia
| | - Cate Nagle
- James Cook University & Townsville Hospital and Health Service, School of Nursing and Midwifery, Townsville, Australia
| | - Tracey K Bucknall
- Deakin University, Faculty of Health, School of Nursing and Midwifery, Geelong, Australia
- Centre for Quality and Patient Safety Research- Alfred Health Partnership, Melbourne, Australia
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