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Rotem R, Hirsch A, Ehrlich Z, Sela HY, Grisaru-Granovsky S, Rottenstreich M. Trial of labor following cesarean in patients with bicornuate uterus: a multicenter retrospective study. Arch Gynecol Obstet 2024; 310:253-259. [PMID: 37777621 DOI: 10.1007/s00404-023-07220-4] [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: 05/30/2023] [Accepted: 09/05/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVE This study aimed to evaluate whether a trial of labor after cesarean delivery (TOLAC) in women with a bicornuate uterus is associated with increased maternal and neonatal morbidity compared to women with a non-malformed uterus. METHODS A multicenter retrospective cohort study was conducted at two university-affiliated centers between 2005 and 2021. Parturients with a bicornuate uterus who attempted TOLAC following a single low-segment transverse cesarean delivery (CD) were included and compared to those with a non-malformed uterus. Failed TOLAC rates and the rate of adverse maternal and neonatal outcomes were compared using both univariate and multivariate analyses. RESULTS Among 20,844 eligible births following CD, 125 (0.6%) were identified as having a bicornuate uterus. The overall successful vaginal delivery rate following CD in the bicornuate uterus group was 77.4%. Failed TOLAC rates were significantly higher in the bicornuate group (22.4% vs. 10.5%, p < 0.01). Uterine rupture rates did not differ between the groups, but rates of placental abruption and retained placenta were significantly higher among parturients with a bicornuate uterus (9.8% vs. 4.4%, p < 0.01, and 9.8% vs. 4.4%, p < 0.01, respectively). Neonatal outcomes following TOLAC were less favorable in the bicornuate group, particularly in terms of neonatal intensive care unit admission and neonatal sepsis. Multivariate analysis revealed an independent association between the bicornuate uterus and failed TOLAC. CONCLUSIONS This study found that parturients with a bicornuate uterus who attempted TOLAC have a relatively high overall rate of vaginal birth after cesarean (VBAC). However, their chances of achieving VBAC are significantly lower compared to those with a non-malformed uterus. Obstetricians should be aware of these findings when providing consultation to patients.
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Affiliation(s)
- Reut Rotem
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Ayala Hirsch
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Zvi Ehrlich
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Hen Y Sela
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Misgav Rottenstreich
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel.
- Department of Obstetrics and Gynecology, McMaster University Medical Center, McMaster University, Hamilton, ON, Canada.
- Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel.
- Department of Obstetrics and Gynecology and Medical Genetics Institute, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University, 3235, Jerusalem, Israel.
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2
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Costumbrado J, Snyder L, Ghassemzadeh S, Ng D. Vaginal Bleeding Due to Iatrogenic Uterine Perforation - A Case Report. JOURNAL OF EDUCATION & TEACHING IN EMERGENCY MEDICINE 2024; 9:V6-V9. [PMID: 38707940 PMCID: PMC11068317 DOI: 10.21980/j83643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 03/16/2024] [Indexed: 05/07/2024]
Abstract
Uterine perforation is a rare but potentially life-threatening complication of gynecologic procedures. Serious complications include hemorrhage, infection, and injury to surrounding organ systems (eg, gastrointestinal, urological, vascular, etc.). Risk factors include advanced maternal age, prior gynecologic surgeries, and other anatomical features that impact the difficulty of accessing the uterine cavity. In this case report, we discuss a patient who presented to the emergency department (ED) with diffuse abdominal pain and vaginal bleeding that occurred after an elective dilation and curettage (D&C) for a termination of pregnancy. The diagnosis was suspected clinically and confirmed by imaging including ultrasound (US) and computed tomography (CT) of the abdomen and pelvis. The patient was managed operatively with a multidisciplinary approach including Gynecology, General Surgery, and Urology. The patient was stabilized and eventually discharged. Uterine perforation should be included in the differential for patients with a history of recent gynecologic instrumentation presenting with abdominal pain and vaginal bleeding. The stabilization of these patients requires aggressive volume resuscitation, controlling the source of bleeding, and emergent surgical consultation. Topics Gynecology, vaginal bleeding, ultrasound, computed tomography.
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Affiliation(s)
- John Costumbrado
- University of California, Riverside, School of Medicine, Riverside, CA
- Riverside Community Hospital, Department of Emergency Medicine, Riverside, CA
| | - Leah Snyder
- Riverside Community Hospital, Department of Emergency Medicine, Riverside, CA
| | - Sassan Ghassemzadeh
- University of California, Riverside, School of Medicine, Riverside, CA
- Riverside Community Hospital, Department of Emergency Medicine, Riverside, CA
| | - Daniel Ng
- University of California, Riverside, School of Medicine, Riverside, CA
- Riverside Community Hospital, Department of Emergency Medicine, Riverside, CA
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Leybovitz-Haleluya N, Saban A, Yariv A, Hershkovitz R. Timing of planned cesarean delivery among patients with two previous cesarean sections. Arch Gynecol Obstet 2024:10.1007/s00404-024-07456-8. [PMID: 38507091 DOI: 10.1007/s00404-024-07456-8] [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: 11/15/2023] [Accepted: 03/04/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVES The timing of planned repeat cesarean delivery (CD) is debateful in clinical practice. Planned repeat CD is typically scheduled before the spontaneous onset of labor to minimize the risk of uterine rupture during labor and the associated risk for fetal compromise. This timing should be balanced with the potential risk of delivering an infant who could benefit from additional maturation in utero. We aim to study the influence of gestational age at the time of repeat CD on maternal and fetal complications. STUDY DESIGN A population-based retrospective cohort study including all term singleton third CDs (≥ 37 weeks of gestation), between February-2020 and January-2022 at a tertiary medical center was conducted. Maternal and neonatal adverse outcomes were compared by gestational age at the time of the CD. A logistic regression models were constructed to adjust for confounders. RESULTS The study population included624 third CDs. Among them, two study groups were defined: 199 were at 37 + 0 to 37 + 6 weeks of gestation, and 44 were at ≥ 39 weeks of gestation at the time of delivery. 381 were at 38 + 0 to 38 + 6 weeks. Since our routine practice is to schedule elective CD at 38 + 0 to 38 + 6 weeks of gestation, we defined this group as the comparison group. In a multivariate analysis, both study groups were associated with significantly higher rates of emergent CDs after adjusting for maternal age, parity, ethnicity, premature rapture of membranes, spontaneous onset of labor and birthweight. After adjusting also for emergent CDs, CDs at 37 + 0 to 37 + 6 weeks of gestation were significantly associated with maternal and neonatal length of stay exceeding 4 days. Additionally, CDs at 37 + 0 to 37 + 6 weeks of gestation were also associated with composite of adverse neonatal and maternal outcomes. CONCLUSIONS Our study demonstrated that scheduling third CD at 38 + 0 to 38 + 6 weeks is associated with reduced risk of emergent CD, as well as beneficial maternal and neonatal outcomes.
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Affiliation(s)
- Noa Leybovitz-Haleluya
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Alla Saban
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Adi Yariv
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Reli Hershkovitz
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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4
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Sugai S, Yamawaki K, Haino K, Yoshihara K, Nishijima K. Incidence of Recurrent Uterine Rupture: A Systematic Review and Meta-analysis. Obstet Gynecol 2023; 142:1365-1372. [PMID: 37884008 PMCID: PMC10642701 DOI: 10.1097/aog.0000000000005418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/18/2023] [Accepted: 08/31/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVE We aimed to quantify the incidence of recurrent uterine rupture in pregnant women. DATA SOURCES A literature search of PubMed, Web of Science, Cochrane Central, and ClinicalTrials.gov for observational studies was performed from 2000 to 2023. METHODS OF STUDY SELECTION Of the 7,440 articles screened, 13 studies were included in the final review. We included studies of previous uterine ruptures that were complete uterine ruptures , defined as destruction of all uterine layers, including the serosa. The primary outcome was the pooled incidence of recurrent uterine rupture. Between-study heterogeneity was assessed with the I2 value. Subgroup analyses were conducted in terms of the country development status, year of publication, and study size (single center vs national study). The secondary outcomes comprised the following: 1) mean gestational age at which recurrent rupture occurred, 2) mean gestational age at which delivery occurred without recurrent rupture, and 3) perinatal complications (blood loss, transfusion, maternal mortality, and neonatal mortality). TABULATION, INTEGRATION, AND RESULTS A random-effects model was used to pool the incidence or mean value and the corresponding 95% CI with R software. The pooled incidence of recurrent uterine rupture was 10% (95% CI 6-17%). Developed countries had a significantly lower uterine rupture recurrence rate than less developed countries (6% vs 15%, P =.04). Year of publication and study size were not significantly associated with recurrent uterine rupture. The mean number of gestational weeks at the time of recurrent uterine rupture was 32.49 (95% CI 29.90-35.08). The mean number of gestational weeks at the time of delivery without recurrent uterine rupture was 35.77 (95% CI 34.95-36.60). The maternal mortality rate was 5% (95% CI 2-11%), and the neonatal mortality rate was 5% (95% CI 3-10%). Morbidity from hemorrhage, such as bleeding and transfusion, was not reported in any study and could not be evaluated. CONCLUSION This systematic review estimated a 10% incidence of recurrent uterine rupture. This finding will enable appropriate risk counseling in patients with prior uterine rupture. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42023395010.
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Affiliation(s)
- Shunya Sugai
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan
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Arusi TT, Zewdu Assefa D, Gutulo MG, Gensa Geta T. Predictors of Uterine Rupture After One Previous Cesarean Section: An Unmatched Case-Control Study. Int J Womens Health 2023; 15:1491-1500. [PMID: 37814706 PMCID: PMC10560464 DOI: 10.2147/ijwh.s427749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/26/2023] [Indexed: 10/11/2023] Open
Abstract
Background Uterine rupture is a rare occurrence but has catastrophic complications during pregnancy. The incidence is relatively higher in scarred uteri because there is a promotion of labor after cesarean section. There is a scarcity of evidence from low-income countries regarding the predictors of uterine rupture after trial labor. Objective To assess factors determining uterine rupture during labor after the previous cesarean section among mothers delivered at Hawassa University Comprehensive Specialized Hospital from September 2017 to September 2022. Methods A facility-based unmatched case-control study was done by reviewing 105 patients, which included 35 cases and 70 controls in a 1:2 case-to-control ratio. The association between dependent and independent variables was sought with running binary and multivariate analyses by using the cut point of a p value < 0.05 and 95% CI. Results The prevalence of uterine rupture is 1.6%. The factors significantly associated with uterine rupture after trial of labor are fetal weight >3.8 kg (AOR: 5.21), antenatal care 4 (AOR: 3.6), labor duration >15 hours (AOR: 10.7), and previous successful vaginal delivery (AOR: 3.4). Poor fetal-maternal outcomes like 91.4% fetal death, 29 hysterectomies, 22 blood transfusions, and 1 death. Conclusion The prevalence is relatively higher than in developed countries. The number of antenatal care, labor duration, and lower fetal weight are not common findings associated with uterine rupture after trial of labor across the literature, so large-scale studies are needed to develop guidelines for the Ethiopian setup. Improving the quality of obstetrics care given in each level of health system.
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Affiliation(s)
- Temesgen Tantu Arusi
- Department of Obstetrics and Gynecology, Wolkite University College of Health Science, Wolkite, Ethiopia
- Department of Obstetrics and Gynecology, Hawassa University, Hawassa City, Ethiopia
| | - Dereje Zewdu Assefa
- Department of Anesthesia, Wolkite University College of Medicine and Health Sciences, Wolkite, Ethiopia
| | - Muluken Gunta Gutulo
- Wolaita Zone Health Department, Wolaita Zone Health Bureau, Wolaita Sodo, Ethiopia
| | - Teshome Gensa Geta
- Department of Public Health, Wolkite University College of Health Science, Wolkite, Ethiopia
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Chamagne M, Richard MB, Vallee A, Tahiri J, Renevier B, Dahlhoff S, Garcia D, Vivanti A, Ayoubi JM. Trial of labour versus elective caesarean delivery for estimated large for gestational age foetuses after prior caesarean delivery: a multicenter retrospective study. BMC Pregnancy Childbirth 2023; 23:388. [PMID: 37237350 DOI: 10.1186/s12884-023-05688-1] [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: 10/18/2022] [Accepted: 05/07/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Lower rates of successful trial of labor after cesarean (TOLAC) in association with fetal macrosomia were previously reported. This study aimed to compare TOLAC to elective caesarean delivery (CD) in women with estimated fetal weight large for gestational age (eLGA) and a prior CD. Primary outcome was to analyse the mode of delivery in case of TOLAC. Secondary outcome was to compare maternal and foetal morbidity. METHODS We conducted a retrospective, descriptive, multicentric, cohort study in five maternity units between January and December 2020. Inclusion criteria were: women with a single prior CD and eLGA or neonatal weight > 90th percentile with singleton pregnancy and gestational age ≥ 37 weeks. MAIN OUTCOME MEASURES rate of vaginal delivery, maternal and fetal morbidity including: shoulder dystocia, neonatal hospitalization, fetal trauma, neonatal acidosis, uterine rupture, 3rd and 4th perineal tears, post-partum hemorrhage, and a need for blood transfusion. RESULTS Four hundred forty women met inclusion criteria, including 235 (53.4%) eLGA. 170 (72.3%) had a TOLAC (study group) and 65 (27.7%) an elective CD (control). 117 (68.82%) TOLAC had a vaginal delivery. No significant differences were found between the two groups in the rates of: postpartum haemorrhage, transfusion, Apgar score, neonatal hospitalization, and foetal trauma. Cord lactate was higher in the case of TOLAC (3.2 vs 2.2, p < 0.001). Median fetal weight was 3815 g (3597-4085) vs. 3865 g (3659-4168): p = 0.068 in the study vs. controls group respectively. CONCLUSION TOLAC for eLGA fetuses is legitimate because there is no difference in maternal-fetal morbidity, and the CD rate is acceptable.
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Affiliation(s)
- Matthieu Chamagne
- Department of Obstetrics and Gynecology, Foch Hospital, 92150, Suresnes, France.
| | - Maêva Bôle Richard
- Department of Obstetrics and Gynecology, Foch Hospital, 92150, Suresnes, France
| | - Alexandre Vallee
- Department of Clinical Research and Innovation, Foch Hospital, 92150, Suresnes, France
| | - Jellila Tahiri
- Department of Obstetrics and Gynecology Centre Hospitalier Universitaire, Hôpital Archet II, Pôle "Femme-Mère-Enfant'', Nice, France
| | - Bruno Renevier
- Department of Obstetrics and Gynecology, André Grégoire Hospital, 93100, Montreuil, France
| | - Sandra Dahlhoff
- Department of Obstetrics and Gynecology, Mercy Hospital, 57530, Ars-Laquenexy, France
| | - Diane Garcia
- Department of Obstetrics and Gynecology, Foch Hospital, 92150, Suresnes, France
| | - Alexandre Vivanti
- Division of Obstetrics and Gynecology, DMU Santé Des Femmes Et Des Nouveau-Nés, Antoine Béclère Hospital, Paris Saclay University, AP-HP, 92140, Clamart, France
| | - Jean Marc Ayoubi
- Department of Obstetrics and Gynecology, Foch Hospital, 92150, Suresnes, France
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7
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Dabi Y, Bouaziz J, Burke Y, Nicolas-Boluda A, Cordier AG, Chayo J, Cohen SB. Outcome of subsequent pregnancies post uterine rupture in previous delivery: A case series, a review, and recommendations for appropriate management. Int J Gynaecol Obstet 2023; 161:204-217. [PMID: 36087068 DOI: 10.1002/ijgo.14445] [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: 06/26/2022] [Revised: 08/20/2022] [Accepted: 08/30/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To provide clinicians with concrete solutions on the best management of and counseling for patients in a subsequent pregnancy following uterine rupture. METHODS A retrospective analysis of patients treated between 2005 and 2020 at Sheba Medical Center was conducted. All patients who had undergone a complete uterine rupture and subsequently had a full-term pregnancy were included. A literature review was conducted using Pubmed database and including previously published literature reviews. RESULTS Fifteen patients with subsequent pregnancies following uterine rupture were included in our cohort. Mean interval between rupture and subsequent pregnancy was 3.8 years (range 2.2-6.9 years). One patient had repeat uterine rupture of less than 2 cm at 36+5 weeksof pregnancy. A total of 17 studies were selected in this literature review, including a total of 774 pregnancies in 635 patients. The risk of repeated uterine rupture was 8.0% (62/774), ranging from 0% to 37.5%. Overall, the risk of maternal death was of 0.6% (4/635), with only four cases reported in three studies. CONCLUSION The risk of recurrence after uterine rupture is significant but should not prevent patients from conceiving.
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Affiliation(s)
- Yohann Dabi
- PointGyn-Gynecologic and Obstetrics Department, Paris, France.,Department of Research, One Clinic, Paris, France
| | - Jerome Bouaziz
- PointGyn-Gynecologic and Obstetrics Department, Paris, France.,Department of Research, One Clinic, Paris, France
| | - Yechiel Burke
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
| | - Alba Nicolas-Boluda
- PointGyn-Gynecologic and Obstetrics Department, Paris, France.,Department of Research, One Clinic, Paris, France
| | - Anne-Gael Cordier
- Sorbonne University, Department of Obstetrics and Gynecology, Tenon Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Jennifer Chayo
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
| | - Shlomo B Cohen
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
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Yang SW, Yoon SH, Yuk JS, Chun KC, Jeong MJ, Kim M. Rupture-mediated large uterine defect at 30th gestational week with protruded amniotic sac and fetal head without fetal compromise after laparoscopic electromyolysis: Case report and literature review. Medicine (Baltimore) 2022; 101:e32221. [PMID: 36595794 PMCID: PMC9794237 DOI: 10.1097/md.0000000000032221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND We describe a case of a rupture-mediated large uterine defect, which occurred on the 30th gestation week presenting a protruding amniotic sac sac without fetal compromise after a laparoscopic electromyolysis. CASE PRESENTATION A 28-year-old woman in her 30th week of gestation (gravida 2, para 0) presented with whole abdominal and right lower quadrant pain at Sanggye Paik Hospital. Ultrasound examination showed normal amniotic fluid and placentation but with breech presentation. She had undergone laparoscopic right ovarian cystectomy due to endometriosis 5 years earlier. Cardiotocography revealed an intermittent variable deceleration and no uterine contraction. Magnetic resonance imaging ruled out acute appendicitis. Four hours later, we observed a protrusion of the amniotic sac with the fetal head through a large uterine defect on magnetic resonance imaging, and performed emergency cesarean section. A boy was delivered without fetal compromise. During the cesarean section, multiple myometric wall defects and thinning were identified. After reconstruction of the uterine wall, the flaccid uterus bled persistently; thus, a cesarean hysterectomy was performed. Packed red cells and frozen plasma were transfused. The mother and neonate had uneventful puerperal and neonatal courses, respectively. After cesarean hysterectomy, we were informed that the mother had undergone a combined laparoscopic electromyolysis during the laparoscopic right ovarian cystectomy. Three years later, the child showed normal neural development. CONCLUSIONS Before myomectomy or electromyolysis, patients should be informed of the possibility of uterine rupture during subsequent pregnancies. If a pregnant woman has abdominal pain, clinicians should take a detailed history of uterine surgery and consider uterine rupture. Although, fortunately, the outcomes in this case were uneventful, urgent delivery is required when uterine rupture is diagnosed.
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Affiliation(s)
- Seung-Woo Yang
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of South Korea
| | - Sang-Hee Yoon
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of South Korea
| | - Jin-Sung Yuk
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of South Korea
| | - Kyoung-Chul Chun
- Department of Obstetrics and Gynecology, Inje University College of Medicine, Ilsan-Paik Hospital, Gyeonggi, South Korea
| | - Myeong Ja Jeong
- Department of Radiology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of South Korea
| | - Myounghwan Kim
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of South Korea
- * Correspondence: Myounghwan Kim, Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, 1342, Dongil-ro, Nowon-gu, Seoul 01757, Republic of South Korea (e-mail: )
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Wan S, Yang M, Pei J, Zhao X, Zhou C, Wu Y, Sun Q, Wu G, Hua X. Pregnancy outcomes and associated factors for uterine rupture: an 8 years population-based retrospective study. BMC Pregnancy Childbirth 2022; 22:91. [PMID: 35105342 PMCID: PMC8805328 DOI: 10.1186/s12884-022-04415-6] [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: 05/25/2021] [Accepted: 01/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background Uterine rupture is an obstetrical emergency with serious undesired complications for laboring mothers resulting in fatal maternal and neonatal outcomes. The aim of this study was to assess the incidence of uterine rupture, its association with previous uterine surgery and vaginal birth after caesarean section (VBAC), and the maternal and perinatal implications. Methods This is a population-based retrospective study. All pregnant women treated for ruptured uterus in one center between 2013 and 2020 were included. Their information retrieved from the medical records department were reviewed retrospectively. Results A total of 209,112 deliveries were included and 41 cases of uterine rupture were identified. The incidence of uterine rupture was 1.96/10000 births. Among the 41 cases, 16 (39.0%) had maternal and fetal complications. There were no maternal deaths secondary to uterine rupture, while perinatal fatality related to uterine rupture was 7.3%. Among all cases, 38 (92.7%) were scarred uterus and 3 (7.3%) were unscarred uterus. The most common cause of uterine rupture was previous cesarean section, while cases with a history of laparoscopic myomectomy were more likely to have serious adverse outcomes, such as fetal death. 24 (59.0%) of the ruptures occurred in anterior lower uterine segment. Changes in Fetal heart rate monitoring were the most reliable signs for rupture. Conclusions Incidence of uterine rupture in the study area, Shanghai, China was consistent with developed countries. Further improvements in obstetric care and enhanced collaboration with referring health facilities were needed to ensure maternal and perinatal safety. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04415-6.
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Affiliation(s)
- Sheng Wan
- Department of Obstetrics, Shanghai First Maternity and infant hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China
| | - Mengnan Yang
- Department of Obstetrics, Shanghai First Maternity and infant hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China
| | - Jindan Pei
- Department of Obstetrics, Shanghai First Maternity and infant hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China
| | - Xiaobo Zhao
- Department of Obstetrics, Shanghai First Maternity and infant hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China
| | - Chenchen Zhou
- Department of Obstetrics, Shanghai First Maternity and infant hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China
| | - Yuelin Wu
- Department of Obstetrics, Shanghai First Maternity and infant hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China
| | - Qianqian Sun
- Department of Obstetrics, Shanghai First Maternity and infant hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China
| | - Guizhu Wu
- Department of Gynecology, Shanghai First Maternity and infant hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China.
| | - Xiaolin Hua
- Department of Obstetrics, Shanghai First Maternity and infant hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China.
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10
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Figueiró-Filho EA, Gomez JM, Farine D. Risk Factors Associated with Uterine Rupture and Dehiscence: A Cross-Sectional Canadian Study. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:820-825. [PMID: 34872139 PMCID: PMC10183935 DOI: 10.1055/s-0041-1739461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To compare maternal and perinatal risk factors associated with complete uterine rupture and uterine dehiscence. METHODS Cross-sectional study of patients with uterine rupture/dehiscence from January 1998 to December 2017 (30 years) admitted at the Labor and Delivery Unit of a tertiary teaching hospital in Canada. RESULTS There were 174 (0.1%) cases of uterine disruption (29 ruptures and 145 cases of dehiscence) out of 169,356 deliveries. There were associations between dehiscence and multiparity (odds ratio [OR]: 3.2; p = 0.02), elevated maternal body mass index (BMI; OR: 3.4; p = 0.02), attempt of vaginal birth after a cesarian section (OR: 2.9; p = 0.05) and 5-minute low Apgar score (OR: 5.9; p < 0.001). Uterine rupture was associated with preterm deliveries (36.5 ± 4.9 versus 38.2 ± 2.9; p = 0.006), postpartum hemorrhage (OR: 13.9; p < 0.001), hysterectomy (OR: 23.0; p = 0.002), and stillbirth (OR: 8.2; p < 0.001). There were no associations between uterine rupture and maternal age, gestational age, onset of labor, spontaneous or artificial rupture of membranes, use of oxytocin, type of uterine incision, and birthweight. CONCLUSION This large cohort demonstrated that there are different risk factors associated with either uterine rupture or dehiscence. Uterine rupture still represents a great threat to fetal-maternal health and, differently from the common belief, uterine dehiscence can also compromise perinatal outcomes.
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Affiliation(s)
- Ernesto Antonio Figueiró-Filho
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Javier Mejia Gomez
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Dan Farine
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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Lazarou A, Oestergaard M, Netzl J, Siedentopf JP, Henrich W. Vaginal birth after cesarean (VBAC): fear it or dare it? An evaluation of potential risk factors. J Perinat Med 2021; 49:773-782. [PMID: 34432969 DOI: 10.1515/jpm-2020-0222] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 08/06/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The consultation of women aspiring a vaginal birth after caesarean may be improved by integrating the individual evaluation of factors that predict their chance of success. Retrospective analysis of correlating factors for all trials of labor after caesarean that were conducted at the Department of Obstetrics of Charité-Universitätsmedizin Berlin, Campus Virchow Clinic from 2014 to October 2017. METHODS Of 2,151 pregnant women with previous caesarean, 408 (19%) attempted a vaginal birth after cesarean. A total of 348 women could be included in the evaluation of factors, 60 pregnant women were excluded because they had obstetric factors (for example preterm birth, intrauterine fetal death) that required a different management. RESULTS Spontaneous delivery occurred in 180 (51.7%) women and 64 (18.4%) had a vacuum extraction. 104 (29.9%) of the women had a repeated caesarean delivery. The three groups showed significant differences in body mass index, the number of prior vaginal deliveries and the child's birth weight at cesarean section. The indication for the previous cesarean section also represents a significant influencing factor. Other factors such as maternal age, gestational age, sex, birth weight and the head circumference of the child at trial of labor after caesarean showed no significant influence. CONCLUSIONS The clear majority (70.1%) of trials of labor after caesarean resulted in vaginal delivery. High body mass index, no previous spontaneous delivery, and fetal distress as a cesarean indication correlated negatively with a successful vaginal birth after cesarean. These factors should be used for the consultation of pregnant women.
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Affiliation(s)
- Anastasia Lazarou
- Department of Obstetrics of Charité-Universitätsmedizin Berlin, Campus Virchow Clinic, Berlin, Germany
| | - Magdalena Oestergaard
- Department of Obstetrics of Charité-Universitätsmedizin Berlin, Campus Virchow Clinic, Berlin, Germany
| | - Johanna Netzl
- Department of Gynecology of Charité-Universitätsmedizin Berlin, Campus Virchow Clinic, Berlin, Germany
| | - Jan-Peter Siedentopf
- Department of Obstetrics of Charité-Universitätsmedizin Berlin, Campus Virchow Clinic, Berlin, Germany
| | - Wolfgang Henrich
- Department of Obstetrics of Charité-Universitätsmedizin Berlin, Campus Virchow Clinic, Berlin, Germany
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Kumari N, Jain N, Dhar RSG. Effect of a Locally Tailored Clinical Pathway Tool on VBAC Outcomes in a Private Hospital in India. J Obstet Gynaecol India 2021; 71:246-253. [PMID: 34408343 DOI: 10.1007/s13224-021-01446-5] [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: 08/25/2020] [Accepted: 01/12/2021] [Indexed: 11/24/2022] Open
Abstract
Background Customized clinical and administrative interventions in the form of a care pathway tool can improve VBAC outcomes and reduce the alarming rise in caesarean sections globally. Objective To determine the effect of a locally tailored clinical pathway tool on VBAC outcomes in a private hospital in India. Methods A pre- and post-implementation study was conducted in a private hospital in India. All women with one previous caesarean section term pregnancy and cephalic presentation were included at baseline from January 2013 to December 2015 (Phase 1) and from January 2016 to December 2018 (Phase 2) after ongoing implementation of a clinical pathway tool by all providers. Background characteristics and clinical outcomes in both phases were reviewed retrospectively from case files. Results Overall 223 (13.42%) women among 1661 total births and 244 (11.62%) women among 2099 total births were included in Phase 1 and Phase 2, respectively. Total number of women who underwent trial of labour (TOLAC) increased from 36.77% to 64.34% (P < 0.001) and VBAC rate increased from 23.76% to 58.19% (P < 0.001) in Phase 2. There was no significant difference in perinatal morbidity and mortality in the two phases. Conclusion A locally customized clinical care pathway tool implemented to support both mothers and care givers for TOLAC seemed to improve VBAC outcomes in a private setting in India.
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Affiliation(s)
- Nikita Kumari
- Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology, Sitaram Bhartia Institute of Science and Research, B-16 Qutab Institutional Area, New Delhi, 110016 India
| | - Neeru Jain
- Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology, Sitaram Bhartia Institute of Science and Research, B-16 Qutab Institutional Area, New Delhi, 110016 India
| | - Rinku Sen Gupta Dhar
- Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology, Sitaram Bhartia Institute of Science and Research, B-16 Qutab Institutional Area, New Delhi, 110016 India
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13
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Donati S, Fano V, Maraschini A. Uterine rupture: Results from a prospective population-based study in Italy. Eur J Obstet Gynecol Reprod Biol 2021; 264:70-75. [PMID: 34274701 DOI: 10.1016/j.ejogrb.2021.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/20/2021] [Accepted: 07/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine the incidence of uterine rupture (UR), and evaluate risk factors, management, and associated maternal and perinatal outcomes. STUDY DESIGN This multicentre prospective population-based study involved six regions in Italy accounting for 49% of national births. The study population comprised all women aged 11-59 years delivering at ≥22 gestational weeks with a diagnosis of UR from September 2014 to August 2016. Maternal and pregnancy characteristics and information on potential risk factors were collected. Unadjusted relative risks (RR) and 95% confidence intervals (CI) were computed with respect to the background population. RESULTS In total, 74 cases of UR occurred among the study population (rate 0.16/1000 pregnancies; mean age 34 years; 14 perinatal deaths, one maternal death). A significantly higher risk of UR was observed for maternal age ≥ 35 years (RR = 1.58, 95% CI 1.00-2.51), multiparity (RR = 5.71, 95% CI 3.14-10.04), previous caesarean section (RR = 20.5, 95% CI 11.11-37.74) and uterine scarring (RR = 6.44, 95% CI 2.94-14.12). A significant association was observed between UR and caesarean section as the mode of delivery (RR = 27.9, 95% CI 10.2-76.5) and gestational age < 37 weeks (RR = 11.82, 95% CI 7.46-18.71). CONCLUSIONS This study found a low rate of UR compared with other European countries, probably due to the high rate of primary caesarean sections and to resistance towards trial of labour and vaginal delivery after caesarean section among obstetricians in Italy. The unforeseen increase in caesarean sections -and, as a result, an increase in placenta accreta spectrum disorders, peripartum hysterectomy and related maternal and perinatal morbidity and mortality as a consequence of previous uterine scarring - failed to ensure better maternal and perinatal outcomes.
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Affiliation(s)
- Serena Donati
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy.
| | | | - Alice Maraschini
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
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Ma'ayeh M, Haight P, Oliver EA, Landon MB, Rood KM. Timing of Repeat Cesarean Delivery for Women with a Prior Classical Incision. Am J Perinatol 2021; 38:529-534. [PMID: 33053596 DOI: 10.1055/s-0040-1718576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aimed to compare neonatal outcomes for delivery at 36 weeks compared with 37 weeks in women with prior classical cesarean delivery (CCD). STUDY DESIGN This was a secondary analysis of the prospective observational cohort of the Eunice Kennedy National Institute for Child and Human Development's Maternal-Fetal Medicine Unit Network Cesarean Registry. Data on cases of repeat cesarean delivery (RCD) in the setting of a prior CCD were abstracted and used for analysis. This study compared outcomes of women who delivered at 360/7 to 366/7 versus 370/7 to 376/7 weeks. The primary outcome was a composite of adverse neonatal outcomes that included neonatal intensive care unit (NICU) admission, respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), hypoglycemia, mechanical ventilation, sepsis, length of stay ≥5 days, and neonatal death. A composite of maternal outcomes that included uterine rupture, blood transfusion, general anesthesia, cesarean hysterectomy, venous thromboembolism, maternal sepsis, intensive care unit admission, and surgical complications was also evaluated. RESULTS There were 436 patients included in the analysis. Women who delivered at 36 weeks (n = 176) were compared those who delivered at 37 weeks (n = 260). There were no differences in baseline characteristics. Delivery at 37 weeks was associated with a reduction in composite neonatal morbidity (24 vs. 34%, adjusted odds ratio [aOR] = 0.61 [0.31-0.94]), including a decrease in NICU admission rates (20 vs. 29%, aOR = 0.63 [0.40-0.99]), hospitalization ≥5 days (13 vs. 24%, aOR = 0.48 [0.29-0.8]), and RDS or TTN (9 vs. 19%, aOR = 0.43 [0.24-0.77]). There was no difference in adverse maternal outcomes (7 vs. 7%, aOR = 0.98 [0.46-2.09]). CONCLUSION Delivery at 37 weeks for women with a history of prior CCD is associated with a decrease in adverse neonatal outcomes, compared with delivery at 36 weeks. KEY POINTS · Classical cesarean section may have increased risk of uterine rupture in future pregnancies.. · This study compares outcomes of delivery at 370/7 to 376/7 versus 360/7 to 366/7 weeks.. · Delivery at 370/7 to 376/7 weeks was associated with decreased neonatal morbidity..
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Affiliation(s)
- Marwan Ma'ayeh
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Paulina Haight
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Emily A Oliver
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, Pennsylvania
| | - Mark B Landon
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Kara M Rood
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
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Desta M, Kassa GM, Getaneh T, Sharew Y, Alemu AA, Birhanu MY, Yeneabat T, Alamneh YM, Amha H. Maternal and perinatal mortality and morbidity of uterine rupture and its association with prolonged duration of operation in Ethiopia: A systematic review and meta-analysis. PLoS One 2021; 16:e0245977. [PMID: 33886549 PMCID: PMC8062067 DOI: 10.1371/journal.pone.0245977] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 01/11/2021] [Indexed: 11/28/2022] Open
Abstract
Background Uterine rupture is the leading cause of maternal and perinatal morbidity and it accounts for 36% of the maternal mortality in Ethiopia. The maternal and perinatal outcomes of uterine rupture were inconclusive for the country. Therefore, this systematic review and meta-analysis aimed to estimate the pooled maternal and perinatal mortality and morbidity of uterine rupture and its association with prolonged duration of operation. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used for this systematic review and meta-analysis. We systematically used PubMed, Cochrane Library, and African Journals online databases for searching. The Newcastle- Ottawa quality assessment scale was used for critical appraisal. Egger’s test and I2 statistic used to assess the check for publication bias and heterogeneity. The random-effect model was used to estimate the pooled prevalence and odds ratios with 95% confidence interval (CI). Results The pooled maternal mortality and morbidity due to uterine rupture in Ethiopia was 7.75% (95% CI: 4.14, 11.36) and 37.1% (95% CI: 8.44, 65.8), respectively. The highest maternal mortality occurred in Southern region (8.91%) and shock was the commonest maternal morbidity (24.43%) due to uterine rupture. The pooled perinatal death associated with uterine rupture was 86.1% (95% CI: 83.4, 89.9). The highest prevalence of perinatal death was observed in Amhara region (91.36%) and the lowest occurred in Tigray region (78.25%). Prolonged duration of operation was a significant predictor of maternal morbidity (OR = 1.39; 95% CI: 1.06, 1.81). Conclusions The percentage of maternal and perinatal deaths due to uterine rupture was high in Ethiopia. Uterine rupture was associated with maternal morbidity and prolonged duration of the operation was found to be associated with maternal morbidities. Therefore, birth preparedness and complication readiness plan, early referral and improving the duration of operation are recommended to improve maternal and perinatal outcomes of uterine rupture.
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Affiliation(s)
- Melaku Desta
- Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
- * E-mail:
| | - Getachew Mullu Kassa
- Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Temesgen Getaneh
- Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Yewbmirt Sharew
- Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Addisu Alehegn Alemu
- Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | | | - Tebikew Yeneabat
- Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
- Department of Midwifery, University of Technology Sydney, Sydney, Australia
| | - Yoseph Merkeb Alamneh
- Department of Biomedical Sciences, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
| | - Haile Amha
- Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
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Baradaran K. Risk of Uterine Rupture with Vaginal Birth after Cesarean in Twin Gestations. Obstet Gynecol Int 2021; 2021:6693142. [PMID: 33868405 PMCID: PMC8032534 DOI: 10.1155/2021/6693142] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 03/24/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Women with a previous cesarean delivery may attempt a subsequent vaginal birth or repeat cesarean. Vaginal birth after cesarean carries a greater risk of uterine rupture, defined as the disruption of all uterine layers, resulting in maternal-fetal morbidity or mortality. It is unclear how the risk of uterine rupture compares in patients with twin gestations who undergo different delivery methods. OBJECTIVE The purpose of this systematic review is to determine if there is an increased risk of uterine rupture in patients with twin gestations attempting vaginal birth after cesarean (VBAC) versus planned repeat cesarean delivery (PRCD). Study Design. PubMed, Cochrane Library, and CINAHL were searched systematically. Eligible studies were prospective and retrospective studies that evaluated the incidence of uterine rupture in twin pregnancies that attempted VBAC or PRCD. Data were manually extracted from these studies, and the number of events in each group was used to calculate an odds ratio (OR) and 95% confidence interval (CI). RESULTS 4 retrospective studies were included with a total of 7699 participants, 2305 of whom attempted VBAC and 5394 underwent PRCD. The absolute risk of uterine rupture in the VBAC and PRCD groups was 0.87% and 0.09%, respectively. The rate of uterine rupture was significantly higher in the VBAC group than in the PRCD group (OR: 9.43; CI: 3.54-25.17). CONCLUSION Although VBAC is associated with higher rates of uterine rupture in twin pregnancies when compared with PRCD, the absolute risk of uterine rupture is low in both groups. Depending on individual risk factors, vaginal birth may be offered as a safe option to women with twin pregnancies and a history of cesarean delivery.
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Affiliation(s)
- Kimya Baradaran
- Master of Science in Physician Assistant Studies, Dominican University of California, San Rafael, CA 94901, USA
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17
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Abstract
Uterine scarring increases the risk of uterine rupture during labour, which can result in significant maternal and fetal morbidity and mortality. There is insufficient evidence for a clear recommendation on the safety of vaginal delivery in the context of a patient with both a uterine perforation and a previous lower uterine segment caesarean section. We present the case of a woman with a history of one previous caesarean section and uterine perforation with a uterine manipulator, who subsequently had an uncomplicated normal vaginal delivery.
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Affiliation(s)
- Christine Wu
- Obstetrics and Gynaecology, Westmead Hospital, Westmead, New South Wales, Australia
| | - James Christie
- PRP Diagnostic Imaging, Sydney, New South Wales, Australia
| | - Roshini Nayyar
- Obstetrics and Gynaecology, Westmead Hospital, Westmead, New South Wales, Australia
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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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Vecchioli E, Cordier AG, Chantry A, Benachi A, Monier I. Maternal and neonatal outcomes associated with induction of labor after one previous cesarean delivery: A French retrospective study. PLoS One 2020; 15:e0237132. [PMID: 32764773 PMCID: PMC7413415 DOI: 10.1371/journal.pone.0237132] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 06/21/2020] [Indexed: 12/03/2022] Open
Abstract
Background The safety of methods of labor induction in women with previous cesarean deliveries is still debated. We investigated perinatal outcomes associated with labor induction among women with a trial of labor after one cesarean delivery. Methods This retrospective study included 339 women with a trial of labor after one prior cesarean and a singleton term fetus in cephalic presentation in 2013–2016 in a French maternity unit. Labor induction was performed with oxytocin, artificial rupture of membranes and/or prostaglandin E2, according to the Bishop score. The primary outcome was a composite of uterine rupture, low Apgar score, neonatal resuscitation or admission to a neonatal unit. The secondary outcomes included cesarean delivery after onset of labor, postpartum hemorrhage and maternal hospital stay after delivery. We used logistic regression to estimate odds ratios adjusted (aOR) for potential confounders. Results In our sample, 67.3% of women had spontaneous labor and 32.7% were induced. More than half of the women received oxytocin during labor regardless of the mode of labor. The proportions of the composite outcome and of cesarean after onset of labor were higher in the induced group compared to the spontaneous group (26.1% vs 15.8%, p = 0.02 and 45.0% vs 27.6%, p<0.01, respectively). There were 9 uterine ruptures (2.6%) and this proportion was higher in the induced group compared to the spontaneous group, although this difference was not statistically significant (3.6% vs 2.2%, p = 0.48). After adjustment, labor induction was associated with higher risks of the composite outcome (aOR = 2.45, 95% CI: 1.29–4.65), cesarean after onset of labor (aOR = 2.06, 95% CI: 1.15–3.68) and maternal hospital stay after delivery ≥6 days (aOR = 6.20, 95% CI: 3.25–11.81). No association was found with postpartum hemorrhage. Conclusion Labor induction after one prior cesarean was associated with a higher risk of adverse perinatal outcome. Nevertheless, the higher proportion of uterine rupture did not differ significantly from that in the spontaneous labor group.
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Affiliation(s)
- Emma Vecchioli
- Department of Obstetrics and Gynaecology, AP-HP, Antoine Béclère Hospital, University Paris Saclay, Clamart, France
- Midwifery School of Baudelocque, Paris-Descartes University, AP-HP, DHU Risks in Pregnancy, Paris, France
| | - Anne-Gaël Cordier
- Department of Obstetrics and Gynaecology, AP-HP, Antoine Béclère Hospital, University Paris Saclay, Clamart, France
| | - Anne Chantry
- Midwifery School of Baudelocque, Paris-Descartes University, AP-HP, DHU Risks in Pregnancy, Paris, France
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Université de Paris, Epidemiology and Statistics Research Center (CRESS), INSERM, INRA, Paris, France
| | - Alexandra Benachi
- Department of Obstetrics and Gynaecology, AP-HP, Antoine Béclère Hospital, University Paris Saclay, Clamart, France
| | - Isabelle Monier
- Department of Obstetrics and Gynaecology, AP-HP, Antoine Béclère Hospital, University Paris Saclay, Clamart, France
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Université de Paris, Epidemiology and Statistics Research Center (CRESS), INSERM, INRA, Paris, France
- * E-mail:
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Bălălău OD, Bacalbașa N, Olaru OG, Pleș L, Stănescu DA. Vaginal birth after cesarean section – literature review and modern guidelines. JOURNAL OF CLINICAL AND INVESTIGATIVE SURGERY 2020. [DOI: 10.25083/2559.5555/5.1/13.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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21
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Levy Shachar H, Wainstock T, Sheiner E, Pariente G. Uterine rupture and the risk for offspring long-term respiratory morbidity. J Matern Fetal Neonatal Med 2020; 35:699-704. [PMID: 32098531 DOI: 10.1080/14767058.2020.1731454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: Uterine rupture during labor is a life-threatening event associated with high morbidity for both mother and fetus. While the immediate maternal and neonatal outcomes of uterine rupture are well established, less is known regarding the long-term respiratory morbidity of offspring which survived uterine rupture.Aim: To assess whether a history of uterine rupture at birth, is associated with an increased risk for future offspring respiratory morbidity.Materials and methods: In this population-based retrospective cohort study, all singleton deliveries between 1991 and 2014 were included. Known offspring chromosomal or congenital anomalies and cases of perinatal mortality were excluded from the analysis. The incidence of hospitalizations with respiratory morbidities, predefined in a set of ICD-9 codes, was compared between offspring delivered with or without uterine rupture. Cox proportional hazards models were conducted, to control for each confounder separately.Results: During the study period 238,622 deliveries met the inclusion criteria, of those 127 (0.053%) were complicated by uterine rupture. Rates of respiratory related hospitalizations were 7.1 and 4.9%, among offspring delivered with or without uterine rupture, respectively (p = .22), and in the Kaplan- Meier survival curves, no significant differences were found between the groups (log rank test p = .241). While using Cox proportional hazards models and controlling for each confounder separately, uterine rupture was not found to be an independent risk factor for long-term respiratory morbidity of the offspring.Conclusion: Uterine rupture was not found as an independent risk factor for offspring long-term respiratory morbidity. The limited number of cases in the exposed group, could only demonstrate a trend with no significance, and therefore further investigation is required.
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Affiliation(s)
- Hagar Levy Shachar
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Tamar Wainstock
- Public Health Department, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Gali Pariente
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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Abstract
Trial of labor after cesarean delivery (TOLAC) refers to a planned attempt to deliver vaginally by a woman who has had a previous cesarean delivery, regardless of the outcome. This method provides women who desire a vaginal delivery the possibility of achieving that goal-a vaginal birth after cesarean delivery (VBAC). In addition to fulfilling a patient's preference for vaginal delivery, at an individual level, VBAC is associated with decreased maternal morbidity and a decreased risk of complications in future pregnancies as well as a decrease in the overall cesarean delivery rate at the population level (). However, although TOLAC is appropriate for many women, several factors increase the likelihood of a failed trial of labor, which in turn is associated with increased maternal and perinatal morbidity when compared with a successful trial of labor (ie, VBAC) and elective repeat cesarean delivery (). Therefore, assessing the likelihood of VBAC as well as the individual risks is important when determining who is an appropriate candidate for TOLAC. Thus, the purpose of this document is to review the risks and benefits of TOLAC in various clinical situations and to provide practical guidelines for counseling and management of patients who will attempt to give birth vaginally after a previous cesarean delivery.
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Martel MJ, MacKinnon CJ. No. 155-Guidelines for Vaginal Birth After Previous Caesarean Birth. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019. [PMID: 29525045 DOI: 10.1016/j.jogc.2018.01.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To provide evidence-based guidelines for the provision of a trial of labour (TOL) after Caesarean section. OUTCOME Fetal and maternal morbidity and mortality associated with vaginal birth after Caesarean (VBAC) and repeat Caesarean section. EVIDENCE MEDLINE database was searched for articles published from January 1, 1995, to February 28, 2004, using the key words "vaginal birth after Caesarean (Cesarean) section." The quality of evidence is described using the Evaluation of Evidence criteria outlined in the Report of the Canadian Task Force on the Periodic Health Exam. RECOMMENDATIONS VALIDATION: These guidelines were approved by the Clinical Practice Obstetrics and Executive Committees of the Society of Obstetricians and Gynaecologists of Canada.
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Avram CM, Greiner KS, Tilden E, Caughey AB. Point-of-care HIV viral load in pregnant women without prenatal care: a cost-effectiveness analysis. Am J Obstet Gynecol 2019; 221:265.e1-265.e9. [PMID: 31229430 DOI: 10.1016/j.ajog.2019.06.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/08/2019] [Accepted: 06/12/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Routine cesarean delivery has been shown to decrease mother-to-child-transmission of HIV in women with high viral load greater than 1000 copies/mL; however, women presenting late in pregnancy may not have viral load results before delivery. OBJECTIVE Our study investigated the costs and outcomes of using a point-of-care HIV RNA viral load test to guide delivery compared with routine cesarean delivery for all in the setting of unknown viral load. STUDY DESIGN A decision-analytic model was constructed using TreeAge software to compare HIV RNA viral load testing vs routine cesarean delivery for all in a theoretical cohort of 1275 HIV-positive women without prenatal care who presented at term for delivery, the estimated population of HIV-positive women without prenatal care in the United States annually. TreeAge Pro software is used to build decision trees modeling clinical problems and perform cost-effectiveness, sensitivity, and simulation analysis to identify the optimal outcome. The average cost per test was $15.22. To examine the downstream impact of a cesarean delivery and because most childbearing women in the United States will deliver 2 children, we incorporated a second pregnancy and delivery in the model. Primary outcomes were mother-to-child transmission, delivery mode, cesarean delivery-related complications, cost, and quality-adjusted life years. Model inputs were derived from the literature and varied in sensitivity analyses. The cost-effectiveness threshold was $100,000/quality-adjusted life year. RESULTS Measuring viral load resulted in more HIV-infected neonates than routine cesarean delivery for all due to viral exposure during more frequent vaginal births in this strategy. There were no observed maternal deaths or differences in cesarean delivery-related complications. Quantifying viral load increased cost by $3,883,371 and decreased quality-adjusted life years by 63 compared with routine cesarean delivery for all. With the threshold set at $100,000/quality-adjusted life year, the viral load test is cost-effective only when the vertical transmission rate in women with high viral load was below 0.68% (baseline: 16.8%) and when the odds ratio of vertical transmission with routine cesarean delivery for all compared with vaginal delivery was above 0.885 (baseline: 0.3). CONCLUSIONS For HIV-infected pregnant women without prenatal care, quantifying viral load to guide mode of delivery using a point-of-care test resulted in increased costs and decreased effectiveness when compared with routine cesarean delivery for all, even after including downstream complications of cesarean delivery.
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Affiliation(s)
- Carmen M Avram
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR.
| | - Karen S Greiner
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
| | - Ellen Tilden
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR; School of Nursing, Nurse-Midwifery, Oregon Health & Science University, Portland, OR
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
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Abstract
Abstract
Background
Uterine rupture is an extremely rare and unpredictable event for women undergoing trial of labor after cesarean delivery (TOLAC).
Case presentation
We present a patient with a lateral edge uterine rupture after TOLAC and our modified surgical technique for preventing complications of uterine atony.
Conclusion
Further case report studies are required in order to evaluate the effectiveness of our new-modified surgical technique in appropriate selected cases.
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Cost-Effectiveness of Continuous Support From a Layperson During a Woman's First Two Births. J Obstet Gynecol Neonatal Nurs 2019; 48:538-551. [PMID: 31325414 DOI: 10.1016/j.jogn.2019.06.002] [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] [Accepted: 06/01/2019] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To evaluate the cost-effectiveness and health outcomes related to continuous support from a layperson during a woman's first two births in a theoretical population. DESIGN Cost-effectiveness analysis. PARTICIPANTS A theoretical cohort of 1.2 million women based on an approximation of annual low-risk, nulliparous, term, singleton births in the United States with the assumption that these women have second births. This reflects the average number of births per woman in the United States. METHODS We designed a cost-effectiveness model to compare outcomes in women with continuous support from relatives, friends, or community members with minimal to no training (excluding trained doulas) during labor and birth compared with outcomes for women with no continuous support. Outcomes included mode of birth, uterine rupture, hysterectomy, maternal death, cost, and quality-adjusted life years (QALYs). We derived probabilities from the literature and set a cost-effectiveness threshold at $100,000/QALY. RESULTS In this theoretical model, continuous support by a layperson during the first birth resulted in fewer cesarean births, decreased costs, and increased QALYs for the first and subsequent births. Women with support from laypersons had 71,090 fewer cesarean births, 35 fewer uterine ruptures, 9 fewer hysterectomies, and 16 fewer maternal deaths, which saved $364 million with 2,673 increased QALYs. Sensitivity analyses showed that continuous support in the first birth was cost-effective even when varying the estimate of lost wages of the support person up to $708. CONCLUSION Continuous labor support from a layperson leads to fewer cesarean births, improved outcomes, decreased costs, and increased QALYs. This highlights the need to increase women's access to continuous layperson support during labor and birth uninhibited by financial and institutional barriers.
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Frank ZC, Lee VR, Hersh AR, Pilliod RA, Caughey AB. Timing of delivery in women with prior uterine rupture: a decision analysis. J Matern Fetal Neonatal Med 2019; 34:238-244. [PMID: 30935266 DOI: 10.1080/14767058.2019.1602825] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Uterine rupture is an obstetric complication with high rates of associated maternal and neonatal morbidity and mortality. However, limited guidance for the timing of delivery in women with a history of prior uterine rupture exists.Objective: To determine the optimal gestational age of delivery in women with prior uterine rupture.Study design: A decision-analytic model was built using TreeAge software to compare the outcomes of repeat cesarean delivery when performed at 32, 33, 34, 35, or 36 weeks gestation in a theoretical cohort of 1000 women with prior uterine rupture. Strategies involved expectant management until a later gestational age accounting for the risks of spontaneous uterine rupture, spontaneous labor, uterine rupture following spontaneous labor, and stillbirth during each successive week that a woman was still pregnant. Maternal outcomes included uterine rupture, hysterectomy, and death. Neonatal outcomes included hypoxic-ischemic encephalopathy, cerebral palsy, and death. Probabilities were derived from the literature and total quality-adjusted life years (QALYs) were calculated. Sensitivity analyses were used to vary model inputs to investigate the robustness of our baseline assumptions.Results: In our theoretical cohort of 1000 pregnant women with a history of prior uterine rupture, cesarean delivery at 34 weeks maximized maternal and neonatal QALYs. Compared to delivery at 36 weeks, delivery at 34 weeks would prevent 38.6 uterine ruptures, 0.079 maternal deaths, 6.10 hysterectomies, and 12.1 neonatal deaths but results in 4.70 more cases of cerebral palsy. Univariate sensitivity analysis found that repeat cesarean at 34 weeks remained the optimal strategy until the probability of spontaneous repeat uterine rupture (baseline estimate: 0.68%) fell below 0.2% or rose above 0.9%, at which point, a strategy of delivery at 35 or 32 weeks became optimal, respectively. However, Monte Carlo simulation demonstrated that delivery at 35 weeks was the optimal strategy 37% of the time, whereas 34 weeks was the optimal strategy 17% of the time.Conclusion: The optimal time for repeat cesarean delivery in women with prior uterine rupture appears to be between 34-0/7 and 35-6/7 weeks gestation.
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Affiliation(s)
- Zoë C Frank
- Department of Obstetrics and Gynecology, Oregon Health and Sciences University, Portland, OR, USA
| | - Vanessa R Lee
- Department of Obstetrics and Gynecology, Oregon Health and Sciences University, Portland, OR, USA
| | - Alyssa R Hersh
- Department of Obstetrics and Gynecology, Oregon Health and Sciences University, Portland, OR, USA
| | - Rachel A Pilliod
- Department of Obstetrics and Gynecology, Oregon Health and Sciences University, Portland, OR, USA
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health and Sciences University, Portland, OR, USA
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Zipori Y, Grunwald O, Ginsberg Y, Beloosesky R, Weiner Z. The impact of extending the second stage of labor to prevent primary cesarean delivery on maternal and neonatal outcomes. Am J Obstet Gynecol 2019; 220:191.e1-191.e7. [PMID: 30616966 DOI: 10.1016/j.ajog.2018.10.028] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 10/15/2018] [Accepted: 10/17/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND A low rate of primary cesarean delivery is expected to reduce some of the major complications that are associated with a repeat cesarean delivery, such as uterine rupture, adhesive placental disorders, hysterectomy, and even maternal death. Since 2014, and in alignment with the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, we changed our approach to labor dystocia, defined as abnormal progression of labor, by allowing a longer duration of the second stage of labor. OBJECTIVE To examine the effect of prolonging the second stage of labor on the rate of cesarean delivery, and maternal and neonatal outcomes. MATERIALS AND METHODS In a historical control group, we compared maternal and neonatal outcomes over 2 periods. Period I (9300 patients): from May 2011 until April 2014, when a prolonged second stage in nulliparous women was considered after 3 hours with regional anesthesia or 2 hours if no such anesthesia was provided. Second-stage arrest was defined in multiparous women after 2 hours with regional anesthesia or 1 hour without it. Period II (10,531 patients): from May 2014 until April 2017, allowed nulliparous and multiparous women continuing the second stage of labor an additional 1 hour before diagnosing second-stage arrest. Singleton deliveries at or beyond 37 weeks' gestation were initially considered for eligibility. We excluded women with high-risk pregnancies and known fetal anomalies. For comparing means, we used the t test. If variables were not normally distributed, we used the Mann-Whitney test instead. For comparing proportions, we used the χ2 test with continuity correction. RESULTS The primary cesarean delivery was decreased in nulliparous women from 23.3% (819 of 3515) in period I to 15.7% (596 of 3796) in period II (relative risk [RR], 0.67; 95% CI, 0.61-0.74), a trend that was also significant in multiparous women (10.9%, 623 of 5785, in period I vs 8.1%, 544 of 6735, in period II; RR, 0.75; 95% CI, 0.67-0.84). The rate of operative vaginal deliveries in nulliparous women was higher in period II than in period I (19.2%, 732 of 3515, vs 17.7%, 622 of 3796, P < .0001). Rates of third- and fourth-degree laceration and of shoulder dystocia were also higher in period II. The rate of arterial cord pH < 7.0 and the rate of admission to the neonatal intensive care unit were higher in period II, but the early neurological outcome was not different when comparing the 2 periods. CONCLUSION The new policy of labor management successfully decreased primary cesarean deliveries, with a small rise in instrumental deliveries. However, it also increased the other immediate maternal and neonatal complications. A higher rate of lower umbilical artery cord pH was the most significant finding; however, the early neurological outcome did not change. It is possible that the ongoing adjustment to the new labor protocol will avoid, in the future, maternal and neonatal complications. The long-term maternal and neonatal consequences of our new approach will be evaluated in future studies.
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You SH, Chang YL, Yen CF. Rupture of the scarred and unscarred gravid uterus: Outcomes and risk factors analysis. Taiwan J Obstet Gynecol 2018; 57:248-254. [PMID: 29673669 DOI: 10.1016/j.tjog.2018.02.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2017] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To study the maternal and fetal outcomes and assess the risk factors in patients with rupture at the lower-segment or non-lower-segment scarred, or unscarred gravid uterus. MATERIALS AND METHODS Gravid patients with uterine rupture were retrospectively collected in Chang-Gung Memorial Hospital from November 2004 to July 2017. The rupture timing and location in association with maternal and fetal outcomes were collected as well as the possible risk factors including surgical history and interval prior to conception were analyzed. RESULTS Thirty patients were included [mean age (±SEM), 34.4 ± 0.7 years; mean body mass index, 25.0 ± 0.6 kg/m2] with mean onset of rupture at 34.2 ± 0.9 weeks, in which, 12 occurred at term and 18 at preterm (range 20-34 weeks). Four fetal demises, 22 transferals to neonatal intensive care unit, and 17 maternal blood transfusions without maternal mortality were noted. Twenty-two patients presented with acute abdominal pain and/or abnormal fetal heart rate tracing were managed with emergent cesarean delivery. Four ruptures were found in postpartum of vaginal delivery, in which 3 were after trials of labor after cesarean delivery and 1 was unscarred uterus, and two of the four eventually underwent hysterectomy. Unscarred uterus (n = 6) without identifiable risk factor ruptured in significantly later gestation associated with higher fetal birthweights than those of the scarred uterus (n = 24) (both p < 0.05), both of which yielded morbidity. The rupture timing between patients of non-lower-segment scar (n = 14) and lower-segment scar (n = 10) were not significantly different. CONCLUSION Rupture of gravid uterus prevalently occurred after 30 weeks of gestation with remarkable morbidity. Unscarred uterus could rupture in later gestation than the scarred ones without identifiable risk factor. Alertness to the acute abdominal pain, atypical from uterine contraction or the suspicious fetal heart rate tracing is the key to the timely rescue and successful management.
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Affiliation(s)
- Shu-Han You
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan; Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Yao-Lung Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan; Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Chih-Feng Yen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan; Chang Gung University College of Medicine, Tao-Yuan, Taiwan.
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Wallstrom T, Bjorklund J, Frykman J, Jarnbert-Pettersson H, Akerud H, Darj E, Gemzell-Danielsson K, Wiberg-Itzel E. Induction of labor after one previous Cesarean section in women with an unfavorable cervix: A retrospective cohort study. PLoS One 2018; 13:e0200024. [PMID: 29965989 PMCID: PMC6028115 DOI: 10.1371/journal.pone.0200024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/17/2018] [Indexed: 11/18/2022] Open
Abstract
Objective Uterine rupture is a well-known but unusual complication in vaginal deliveries with a Cesarean section in the history. The risk of uterine rupture is at least two-fold when labor is induced. In Sweden, women are allowed to deliver vaginally after one previous Cesarean section, regardless if labor starts spontaneously or is induced. The aim of the study is to compare the proportion of uterine ruptures between the three methods (balloon catheter, Minprostin® and Cytotec®) for induction of labor in women with an unfavorable cervix and one previous Cesarean section. Material and methods Retrospective cohort study of all women with one previous Cesarean section and induction of labor with an unfavorable cervix at the four largest clinics in Stockholm during 2012–2015. Inclusion criteria: Women with a previous Cesarean section and induction of labor with a viable fetus, cephalic presentation, singleton, at ≥34 w, (n = 910). Results 3.0% (27/910) of the women with induction of labor had a uterine rupture, 91% of them had no previous vaginal delivery. The proportion of uterine ruptures was 2.0% (6/295) with orally administrated Cytotec®, 2.1% (7/335) with balloon catheter and 5.0% (14/ 281) when Minprostin® was used. Conclusions No difference in the proportion of uterine ruptures was shown when orally administrated Cytotec® and balloon catheter were compared (p = 0.64). Orally administrated Cytotec® and balloon catheter give a high success rate of vaginal deliveries (almost 70%) despite an unfavorable cervix.
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Affiliation(s)
- Tove Wallstrom
- Department of Clinical Science and Education Karolinska Institute, Women’s Clinic, Sodersjukhuset, Sweden
- * E-mail:
| | - Jenny Bjorklund
- Department of Clinical Science and Education Karolinska Institute, Women’s Clinic, Sodersjukhuset, Sweden
| | - Joanna Frykman
- Department of Clinical Science and Education Karolinska Institute, Women’s Clinic, Sodersjukhuset, Sweden
| | - Hans Jarnbert-Pettersson
- Department of Clinical Science and Education Karolinska Institute, Women’s Clinic, Sodersjukhuset, Sweden
| | - Helena Akerud
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Elisabeth Darj
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Oslo, Norway
| | - Kristina Gemzell-Danielsson
- Department of Women’s and Children’s Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Wiberg-Itzel
- Department of Clinical Science and Education Karolinska Institute, Women’s Clinic, Sodersjukhuset, Sweden
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32
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Vandenberghe G, Bloemenkamp K, Berlage S, Colmorn L, Deneux-Tharaux C, Gissler M, Knight M, Langhoff-Roos J, Lindqvist PG, Oberaigner W, Van Roosmalen J, Zwart J, Roelens K. The International Network of Obstetric Survey Systems study of uterine rupture: a descriptive multi-country population-based study. BJOG 2018; 126:370-381. [PMID: 29727918 DOI: 10.1111/1471-0528.15271] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE International comparison of complete uterine rupture. DESIGN Descriptive multi-country population-based study. SETTING International. POPULATION International Network of Obstetric Survey Systems (INOSS). METHODS We merged individual data, collected prospectively in nine population-based studies, of women with complete uterine rupture, defined as complete disruption of the uterine muscle and the uterine serosa, regardless of symptoms and rupture of fetal membranes. MAIN OUTCOME MEASURES Prevalence of complete uterine rupture, regional variation and correlation with rates of caesarean section (CS) and trial of labour after CS (TOLAC). Severe maternal and perinatal morbidity and mortality. RESULTS We identified 864 complete uterine ruptures in 2 625 017 deliveries. Overall prevalence was 3.3 (95% CI 3.1-3.5) per 10 000 deliveries, 22 (95% CI 21-24) in women with and 0.6 (95% CI 0.5-0.7) in women without previous CS. Prevalence in women with previous CS was negatively correlated with previous CS rate (ρ = -0.917) and positively correlated with TOLAC rate of the background population (ρ = 0.600). Uterine rupture resulted in peripartum hysterectomy in 87 of 864 women (10%, 95% CI 8-12%) and in a perinatal death in 116 of 874 infants (13.3%, 95% CI 11.2-15.7) whose mother had uterine rupture. Overall rate of neonatal asphyxia was 28% in neonates who survived. CONCLUSIONS Higher prevalence of complete uterine ruptures per TOLAC was observed in countries with low previous CS and high TOLAC rates. Rates of hysterectomy and perinatal death are about 10% following complete uterine rupture, but in women undergoing TOLAC the rates are extremely low (only 2.2 and 3.2 per 10 000 TOLACs, respectively.) TWEETABLE ABSTRACT: Prevalence of complete uterine rupture is higher in countries with low previous CS and high TOLAC rates.
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Affiliation(s)
- G Vandenberghe
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium
| | - K Bloemenkamp
- Department of Obstetrics and Gynaecology, Birth Centre Wilhelmina's Children Hospital, Devision Woman and Baby, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - S Berlage
- Centre for Quality and Management in Health Care, Medical Association of Lower Saxony, Hannover, Germany
| | - L Colmorn
- Department of Obstetrics, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - C Deneux-Tharaux
- Obstetrical, Perinatal and Paediatric Epidemiology Research Team, Centre for Epidemiology and Statistics Sorbonne Paris Cité, Inserm U1153, Paris Descartes University, Paris, France
| | - M Gissler
- Information Services Department, THL National Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institute, Stockholm, Sweden
| | - M Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - J Langhoff-Roos
- Department of Obstetrics, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - P G Lindqvist
- Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden.,Department of Obstetrics and Gynecology, Sodersjukhuset, Stockholm, Sweden
| | - W Oberaigner
- Department of Clinical Epidemiology, Tirol Kliniken Ltd., Innsbruck, Austria.,Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - J Van Roosmalen
- Athena Institute, VU University Amsterdam, Amsterdam, the Netherlands.,Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands
| | - J Zwart
- Department of Obstetrics and Gynaecology, Deventer Hospital, Deventer, the Netherlands
| | - K Roelens
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium
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Atia H, Ellaithy M, Altraigey A, Kolkailah M, Alserehi A, Ashfaq S. Mechanical induction of labor and ecbolic-less vaginal birth after cesarean section: A cohort study. Taiwan J Obstet Gynecol 2018; 57:421-426. [DOI: 10.1016/j.tjog.2018.04.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2018] [Indexed: 11/16/2022] Open
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Hawkins L, Robertson D, Frecker H, Berger H, Satkunaratnam A. Spontaneous uterine rupture and surgical repair at 21 weeks gestation with progression to live birth: a case report. BMC Pregnancy Childbirth 2018; 18:132. [PMID: 29728141 PMCID: PMC5935985 DOI: 10.1186/s12884-018-1761-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 04/23/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Uterine rupture in the non-laboring uterus is a rare occurrence, which can lead to significant morbidity and mortality for the mother and fetus. Management of this presentation is complex at pre-viable gestations. CASE PRESENTATION A 35 year old primigravid woman with multiple previous myomectomies presented with spontaneous complete thickness uterine rupture at 21 weeks gestation. A 10 cm myometrial defect and iatrogenic amniotomy were surgically corrected with fetal preservation. This led to pregnancy continuation to 32 weeks gestation when elective cesarean delivery resulted in excellent neonatal outcome. CONCLUSIONS Early surgical diagnosis, multidisciplinary team approach, iatrogenic amniotomy and continuous two-layer myometrial closure were factors that contributed to pregnancy prolongation in this large myometrial rupture.
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Affiliation(s)
- Lesley Hawkins
- Department of Obstetrics and Gynaecology, University of Toronto, 123 Edward St, 12th Floor, Toronto, ON, M5G1E2, Canada
| | - Deborah Robertson
- Department of Obstetrics and Gynaecology, University of Toronto, 123 Edward St, 12th Floor, Toronto, ON, M5G1E2, Canada.,Department of Obstetrics and Gynaecology, St Michael's Hospital, 308-55 Queen St East, Toronto, ON, M5C1R6, Canada
| | - Helena Frecker
- Department of Obstetrics and Gynaecology, University of Toronto, 123 Edward St, 12th Floor, Toronto, ON, M5G1E2, Canada.,Department of Obstetrics and Gynaecology, Michael Garron Hospital, Suite 311, 658 Danforth Avenue, M4J5B9, Toronto, Ontario, Canada
| | - Howard Berger
- Department of Obstetrics and Gynaecology, University of Toronto, 123 Edward St, 12th Floor, Toronto, ON, M5G1E2, Canada.,Department of Obstetrics and Gynaecology, St Michael's Hospital, 308-55 Queen St East, Toronto, ON, M5C1R6, Canada
| | - Abheha Satkunaratnam
- Department of Obstetrics and Gynaecology, University of Toronto, 123 Edward St, 12th Floor, Toronto, ON, M5G1E2, Canada. .,Department of Obstetrics and Gynaecology, St Michael's Hospital, 308-55 Queen St East, Toronto, ON, M5C1R6, Canada.
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Abbas AM, A. Shehata M, M. Fathalla M. Maternal and perinatal outcomes of uterine rupture in a tertiary care hospital: a cross-sectional study. J Matern Fetal Neonatal Med 2018; 32:3352-3356. [DOI: 10.1080/14767058.2018.1463369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Ahmed M. Abbas
- Department of Obstetrics and Gynecology, Woman’s Health Hospital, Assiut University, Assiut, Egypt
| | | | - Mohamed M. Fathalla
- Department of Obstetrics and Gynecology, Woman’s Health Hospital, Assiut University, Assiut, Egypt
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Archivée: N° 155-Directive clinique sur l'accouchement vaginal chez les patientes ayant déjà subi une césarienne. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018. [DOI: 10.1016/j.jogc.2018.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Accordino F, Algeri P, Petrova PV, Mariani EM, Vergani P. Comment on "Contemporary epidemiology and novel predictors of uterine rupture: a nationwide population-based study". Arch Gynecol Obstet 2018; 297:811-812. [PMID: 29349554 DOI: 10.1007/s00404-018-4670-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 01/12/2018] [Indexed: 10/18/2022]
Affiliation(s)
- F Accordino
- Department of Obstetrics and Gynecology, San Gerardo Hospital, MBBM Foundation, University of Milano-Bicocca, via Pergolesi 33, Monza, Monza e Brianza, Italy
| | - P Algeri
- Department of Obstetrics and Gynecology, San Gerardo Hospital, MBBM Foundation, University of Milano-Bicocca, via Pergolesi 33, Monza, Monza e Brianza, Italy.
| | - P V Petrova
- Department of Obstetrics and Gynecology, San Gerardo Hospital, MBBM Foundation, University of Milano-Bicocca, via Pergolesi 33, Monza, Monza e Brianza, Italy
| | - E M Mariani
- Department of Obstetrics and Gynecology, San Gerardo Hospital, MBBM Foundation, University of Milano-Bicocca, via Pergolesi 33, Monza, Monza e Brianza, Italy
| | - P Vergani
- Department of Obstetrics and Gynecology, San Gerardo Hospital, MBBM Foundation, University of Milano-Bicocca, via Pergolesi 33, Monza, Monza e Brianza, Italy
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38
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Seo SY, Kim DW, Kim BM, Chun SW. Spontaneous uterine rupture due to placenta percreta in the second trimester of pregnancy: a case report. KOSIN MEDICAL JOURNAL 2017. [DOI: 10.7180/kmj.2017.32.2.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
A 32-year-old multiparous woman (gravida 2, para 2) with a history of previous cesarean section had acute abdominal pain and collapsed at 21 weeks of gestation. Exploratory laparotomy was performed because of the patient's worsening condition; ultrasound examination results were suggestive of massive hemoperitoneum, and fetus in vertex presentation with bradycardia. Uterine rupture between the left lower segment and borderline of the cervix in the anterior wall with active bleeding was confirmed. An uncomplicated classical cesarean section was performed, but the fetus was stillborn due to preterm birth. Hysterectomy was performed after the cesarean section. The patient was admitted to intensive care units for 3 days and was discharged in 12 days following delivery. Placenta percreta at the anterior lower segment of the uterus was confirmed in the pathology report.
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Abstract
Trial of labor after cesarean delivery (TOLAC) refers to a planned attempt to deliver vaginally by a woman who has had a previous cesarean delivery, regardless of the outcome. This method provides women who desire a vaginal delivery the possibility of achieving that goal-a vaginal birth after cesarean delivery (VBAC). In addition to fulfilling a patient's preference for vaginal delivery, at an individual level, VBAC is associated with decreased maternal morbidity and a decreased risk of complications in future pregnancies as well as a decrease in the overall cesarean delivery rate at the population level (1-3). However, although TOLAC is appropriate for many women, several factors increase the likelihood of a failed trial of labor, which in turn is associated with increased maternal and perinatal morbidity when compared with a successful trial of labor (ie, VBAC) and elective repeat cesarean delivery (4-6). Therefore, assessing the likelihood of VBAC as well as the individual risks is important when determining who is an appropriate candidate for TOLAC. Thus, the purpose of this document is to review the risks and benefits of TOLAC in various clinical situations and to provide practical guidelines for counseling and management of patients who will attempt to give birth vaginally after a previous cesarean delivery.
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Markou GA, Muray JM, Poncelet C. Risk factors and symptoms associated with maternal and neonatal complications in women with uterine rupture. A 16 years multicentric experience. Eur J Obstet Gynecol Reprod Biol 2017; 217:126-130. [PMID: 28892762 DOI: 10.1016/j.ejogrb.2017.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/29/2017] [Accepted: 09/05/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE high maternal and fetal morbidity and mortality levels have been associated with uterine ruptures. The aims of our study were to determine risk factors and signs for maternal and fetal complications in patients with uterine rupture. STUDY DESIGN retrospective, population-based study, in all Val d'Oise public obstetrics departments, France, between 2000 and 2015. All patients with uterine rupture were analyzed using medical records. To identify risk factors and signs for maternal and fetal complications, patients were divided into two groups according to adverse maternal and fetal outcomes or not, and compared. RESULTS During the study period, 126 patients with complete uterine rupture were identified. In all, 74 (58.7%) had maternal and fetal complications, and these were more frequently observed in patients with unscarred uterus (N=18; p<0.001 and OR 5.52, 95% CI 2.09-14.55), lateral injured uterus (N=21; p<0.001), after labour induction (N=21, p=0.01 and OR 3.69, 95% CI 1.22-13.53), and when a sudden onset of abdominal pain, in patients with previous successful epidural analgesia, occurred (75.9% vs 39.2%, p<0.001 and OR 4.88, 95% CI 1.9-12.13). CONCLUSION Unscarred and lateral ruptures of uterus were associated with maternal vascular injuries, and higher maternal and fetal complications. Sudden onset of abdominal pain in woman with previous successful epidural analgesia might be predictive of complicated uterine rupture.
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Affiliation(s)
- G A Markou
- Department of Obstetrics and Gynecology, Rene DUBOS Hospital, 6, avenue de l'Ile-de-France, 95303, Cergy-Pontoise cedex, France.
| | - J-M Muray
- Department of Obstetrics and Gynecology, Rene DUBOS Hospital, 6, avenue de l'Ile-de-France, 95303, Cergy-Pontoise cedex, France.
| | - C Poncelet
- Department of Obstetrics and Gynecology, Rene DUBOS Hospital, 6, avenue de l'Ile-de-France, 95303, Cergy-Pontoise cedex, France; Université Paris 13, Sorbonne Paris Cité, UFR SMBH, 93000, Bobigny, France.
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Contemporary epidemiology and novel predictors of uterine rupture: a nationwide population-based study. Arch Gynecol Obstet 2017; 296:869-875. [PMID: 28864930 DOI: 10.1007/s00404-017-4508-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 08/23/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE In spite of several policies aiming to decrease cesarean rates and related complications such as uterine rupture, data show that uterine rupture and associated morbidity are increasing along the years. Whether previously unidentified risk factors are currently playing an important role on these trends is unknown. We analyze current risks of uterine rupture and main preceding factors from more recent years compared to former data. METHODS All uterine rupture cases in the US from 2011-2012 were selected, with matched non-uterine rupture cases selected as controls. Variables considered for analysis included demographics, maternal morbidity, and obstetric complications. Likelihood forward selection was used to identify main risk factors of uterine rupture. Medians of main factors identified were used to simulate groups at risk and calculate odds ratios of uterine rupture. RESULTS From ~8 million births, 1925 presented uterine rupture. In patients with no prior cesarean delivery, multiple gestation, chronic hypertension and chorioamnionitis presented the highest odds of uterine rupture, with the combination of these factors increasing the odds of rupture 59 times (~1%). In women with prior cesarean delivery, induction/augmentation and chorioamnionitis were the most significant predictors, with the combination increasing the odds 33 times (~3%). CONCLUSIONS Despite policies implemented and changes in clinical practice, uterine rupture remains an important issue. Previously unidentified risk factors are playing now an important role, information that should be considered during patient counseling and clinical practice. Combinations of some of these factors may increase the risk of uterine rupture significantly enough to modify clinical care.
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Nguyen MT, McCullough LB, Chervenak FA. The importance of clinically and ethically fine-tuning decision-making about cesarean delivery. J Perinat Med 2017; 45:551-557. [PMID: 27780155 DOI: 10.1515/jpm-2016-0262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 09/29/2016] [Indexed: 11/15/2022]
Abstract
In obstetric practice, each pregnant woman presents with a composite of maternal and fetal characteristics that can alter the risk of significant harm without cesarean intervention. The hospital's availability of resources and the obstetrician's training, experience, and skill level can also alter the risk of significant harm without cesarean intervention. This paper proposes a clinical ethical framework that takes these clinical and organizational factors into account, to promote a deliberative rather than simplistic approach to decision-making and counseling about cesarean delivery. The result is a clinical ethical framework that should guide the obstetrician in fine-tuning his or her evidence-based, beneficence-based analysis of specific clinical and organizational factors that can affect the strength of the beneficence-based clinical judgment about cesarean delivery. We illustrate the clinical application of this framework for three common obstetric conditions: Category II fetal heart rate tracing, prior non-classical cesarean delivery, and breech presentation.
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Yang XJ, Sun SS. Comparison of maternal and fetal complications in elective and emergency cesarean section: a systematic review and meta-analysis. Arch Gynecol Obstet 2017; 296:503-512. [PMID: 28681107 DOI: 10.1007/s00404-017-4445-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 06/22/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Though the same types of complication were found in both elective cesarean section (ElCS) and emergence cesarean section (EmCS), the aim of this study is to compare the rates of maternal and fetal morbidity and mortality between ElCS and EmCS. METHODS Full-text articles involved in the maternal and fetal complications and outcomes of ElCS and EmCS were searched in multiple database. Review Manager 5.0 was adopted for meta-analysis, sensitivity analysis, and bias analysis. Funnel plots and Egger's tests were also applied with STATA 10.0 software to assess possible publication bias. RESULTS Totally nine articles were included in this study. Among these articles, seven, three, and four studies were involved in the maternal complication, fetal complication, and fetal outcomes, respectively. The combined analyses showed that both rates of maternal complication and fetal complication in EmCS were higher than those in ElCS. The rates of infection, fever, UTI (urinary tract infection), wound dehiscence, DIC (disseminated intravascular coagulation), and reoperation of postpartum women with EmCS were much higher than those with ElCS. Larger infant mortality rate of EmCS was also observed. CONCLUSION Emergency cesarean sections showed significantly more maternal and fetal complications and mortality than elective cesarean sections in this study. Certain plans should be worked out by obstetric practitioners to avoid the post-operative complications.
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Affiliation(s)
- Xiao-Jing Yang
- Department of Obstetrics, Tai'an Central Hospital, No. 29 Longtan Road, Tai'an, 271000, China.
| | - Shan-Shan Sun
- Department of Obstetrics, Tai'an Central Hospital, No. 29 Longtan Road, Tai'an, 271000, China
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Abstract
BACKGROUND Women with a prior caesarean delivery have an increased risk of uterine rupture and for women subsequently requiring induction of labour it is unclear which method is preferable to avoid adverse outcomes. This is an update of a review that was published in 2013. OBJECTIVES To assess the benefits and harms associated with different methods used to induce labour in women who have had a previous caesarean birth. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register (31 August 2016) and reference lists of retrieved studies. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing any method of third trimester cervical ripening or labour induction, with placebo/no treatment or other methods in women with prior caesarean section requiring labour induction in a subsequent pregnancy. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion and trial quality, extracted data, and checked them for accuracy. MAIN RESULTS Eight studies (data from 707 women and babies) are included in this updated review. Meta-analysis was not possible because studies compared different methods of labour induction. All included studies had at least one design limitation (i.e. lack of blinding, sample attrition, other bias, or reporting bias). One study stopped prematurely due to safety concerns. Vaginal PGE2 versus intravenous oxytocin (one trial, 42 women): no clear differences for caesarean section (risk ratio (RR) 0.67, 95% confidence interval (CI) 0.22 to 2.03, evidence graded low), serious neonatal morbidity or perinatal death (RR 3.00, 95% CI 0.13 to 69.70, evidence graded low), serious maternal morbidity or death (RR 3.00, 95% CI 0.13 to 69.70, evidence graded low). Also no clear differences between groups for the reported secondary outcomes. The GRADE outcomes vaginal delivery not achieved within 24 hours, and uterine hyperstimulation with fetal heart rate changes were not reported. Vaginal misoprostol versus intravenous oxytocin (one trial, 38 women): this trial stopped early because one woman who received misoprostol had a uterine rupture (RR 3.67, 95% CI 0.16 to 84.66) and one had uterine dehiscence. No other outcomes (including GRADE outcomes) were reported. Foley catheter versus intravenous oxytocin (one trial, subgroup of 53 women): no clear difference between groups for vaginal delivery not achieved within 24 hours (RR 1.47, 95% CI 0.89 to 2.44, evidence graded low), uterine hyperstimulation with fetal heart rate changes (RR 3.11, 95% CI 0.13 to 73.09, evidence graded low), and caesarean section (RR 0.93, 95% CI 0.45 to 1.92, evidence graded low). There were also no clear differences between groups for the reported secondary outcomes. The following GRADE outcomes were not reported: serious neonatal morbidity or perinatal death, and serious maternal morbidity or death. Double-balloon catheter versus vaginal PGE2 (one trial, subgroup of 26 women): no clear difference in caesarean section (RR 0.97, 95% CI 0.41 to 2.32, evidence graded very low). Vaginal delivery not achieved within 24 hours, uterine hyperstimulation with fetal heart rate changes, serious neonatal morbidity or perinatal death, and serious maternal morbidity or death were not reported. Oral mifepristone versus Foley catheter (one trial, 107 women): no primary/GRADE outcomes were reported. Fewer women induced with mifepristone required oxytocin augmentation (RR 0.54, 95% CI 0.38 to 0.76). There were slightly fewer cases of uterine rupture among women who received mifepristone, however this was not a clear difference between groups (RR 0.29, 95% CI 0.08 to 1.02). No other secondary outcomes were reported. Vaginal isosorbide mononitrate (IMN) versus Foley catheter (one trial, 80 women): fewer women induced with IMN achieved a vaginal delivery within 24 hours (RR 2.62, 95% CI 1.32 to 5.21, evidence graded low). There was no difference between groups in the number of women who had a caesarean section (RR 1.00, 95% CI 0.39 to 2.59, evidence graded very low). More women induced with IMN required oxytocin augmentation (RR 1.65, 95% CI 1.17 to 2.32). There were no clear differences in the other reported secondary outcomes. The following GRADE outcomes were not reported: uterine hyperstimulation with fetal heart rate changes, serious neonatal morbidity or perinatal death, and serious maternal morbidity or death. 80 mL versus 30 mL Foley catheter (one trial, 154 women): no clear difference between groups for the primary outcomes: vaginal delivery not achieved within 24 hours (RR 1.05, 95% CI 0.91 to 1.20, evidence graded moderate) and caesarean section (RR 1.05, 95% CI 0.89 to 1.24, evidence graded moderate). However, more women induced using a 30 mL Foley catheter required oxytocin augmentation (RR 0.81, 95% CI 0.66 to 0.98). There were no clear differences between groups for other secondary outcomes reported. Several GRADE outcomes were not reported: uterine hyperstimulation with fetal heart rate changes, serious neonatal morbidity or perinatal death, and serious maternal morbidity or death. Vaginal PGE2 pessary versus vaginal PGE2 tablet (one trial, 200 women): no difference between groups for caesarean section (RR 1.09, 95% CI 0.74 to 1.60, evidence graded very low), or any of the reported secondary outcomes. Several GRADE outcomes were not reported: vaginal delivery not achieved within 24 hours, uterine hyperstimulation with fetal heart rate changes, serious neonatal morbidity or perinatal death, and serious maternal morbidity or death. AUTHORS' CONCLUSIONS RCT evidence on methods of induction of labour for women with a prior caesarean section is inadequate, and studies are underpowered to detect clinically relevant differences for many outcomes. Several studies reported few of our prespecified outcomes and reporting of infant outcomes was especially scarce. The GRADE level for quality of evidence was moderate to very low, due to imprecision and study design limitations.High-quality, adequately-powered RCTs would be the best approach to determine the optimal method for induction of labour in women with a prior caesarean birth. However, such trials are unlikely to be undertaken due to the very large numbers needed to investigate the risk of infrequent but serious adverse outcomes (e.g. uterine rupture). Observational studies (cohort studies), including different methods of cervical ripening, may be the best alternative. Studies could compare methods believed to provide effective induction of labour with low risk of serious harm, and report the outcomes listed in this review.
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Affiliation(s)
- Helen M West
- The University of LiverpoolInstitute of Psychology, Health and SocietyLiverpoolUK
| | | | - Jodie M Dodd
- The University of Adelaide, Women's and Children's HospitalSchool of Paediatrics and Reproductive Health, Discipline of Obstetrics and Gynaecology72 King William RoadAdelaideSouth AustraliaAustralia5006
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Litwin CE, Czuzoj-Shulman N, Zakhari A, Abenhaim HA. Neonatal outcomes following a trial of labor after Caesarean delivery: a population-based study. J Matern Fetal Neonatal Med 2017; 31:2148-2154. [PMID: 28573941 DOI: 10.1080/14767058.2017.1337740] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the neonatal effects of trial of labor after Caesarean (TOLAC) births. METHODS We conducted a retrospective population-based cohort study using the CDC's Period Linked Birth/Infant Death Public Use File (2011-2013) on women with a live singleton pregnancy and prior Caesarean delivery. Multivariate logistic regression compared neonatal outcomes between women who underwent a TOLAC with women who did not. Secondary analysis compared outcomes of birth with uterine rupture to those without. RESULTS A total of 1,036,554 births met inclusion criteria, of which 17.5% underwent TOLAC. Women who had a TOLAC were more likely to deliver infants requiring neonatal intensive care unit (NICU) admission (odds ratios (OR) 1.12, 95%CI 1.09-1.16) and assisted ventilation (OR 1.07, 95%CI 1.03-1.12). Among women with TOLAC, 0.18% of births were in context of a uterine rupture and those neonates had an increased risk of NICU admissions (OR 5.95, 95%CI 4.56-7.76), assisted ventilation (OR 8.89, 95%CI 6.73-11.75), seizures (OR 91.66, 95%CI 42.23-198.93), and death (OR 16.28, 95%CI 5.09-52.08). CONCLUSIONS Neonatal morbidity appears slightly increased among women with a TOLAC. However, morbidity and mortality are considerably increased in cases of uterine rupture. Appropriate selection and counseling of women for TOLAC should be undertaken as to minimize uterine rupture risk.
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Affiliation(s)
- Charles Edward Litwin
- a Department of Obstetrics and Gynecology , Jewish General Hospital, McGill University , Montreal , Canada
| | - Nicholas Czuzoj-Shulman
- b Centre for Clinical Epidemiology and Community Studies , Jewish General Hospital , Montreal , Canada
| | - Andrew Zakhari
- a Department of Obstetrics and Gynecology , Jewish General Hospital, McGill University , Montreal , Canada
| | - Haim Arie Abenhaim
- a Department of Obstetrics and Gynecology , Jewish General Hospital, McGill University , Montreal , Canada.,b Centre for Clinical Epidemiology and Community Studies , Jewish General Hospital , Montreal , Canada
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Yao R, Goetzinger KR, Crimmins SD, Kopelman JN, Contag SA. Association of Maternal Obesity With Maternal and Neonatal Outcomes in Cases of Uterine Rupture. Obstet Gynecol 2017; 129:683-688. [DOI: 10.1097/aog.0000000000001930] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Krispin E, Hiersch L, Wilk Goldsher Y, Wiznitzer A, Yogev Y, Ashwal E. Association between prior vaginal birth after cesarean and subsequent labor outcome. J Matern Fetal Neonatal Med 2017; 31:1066-1072. [PMID: 28285573 DOI: 10.1080/14767058.2017.1306513] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To estimate the effect of prior successful vaginal birth after cesarean (VBAC) on the rate of uterine rupture and delivery outcome in women undergoing labor after cesarean. METHODS A retrospective cohort study of all women attempting labor after cesarean delivery in a university-affiliated tertiary-hospital (2007-2014) was conducted. Study group included women attempting vaginal delivery with a history of cesarean delivery and at least one prior VBAC. Control group included women attempting first vaginal delivery following cesarean delivery. Primary outcome was defined as the rate of uterine rupture. Secondary outcomes were delivery and maternal outcomes. RESULTS Of 62,463 deliveries during the study period, 3256 met inclusion criteria. One thousand two hundred and eleven women had VBAC prior to the index labor and 2045 underwent their first labor after cesarean. Women in the study group had a significantly lower rate of uterine rupture 9 (0.7%) in respect to control 33 (1.6%), p = .036, and had a higher rate of successful vaginal birth (96 vs. 84.9%, p < .001). In multivariate analysis, previous VBAC was associated with decreased risk of uterine rupture (OR = 0.46, 95% CI 0.21-0.97, p = .04). CONCLUSIONS In women attempting labor after cesarean, prior VBAC appears to be associated with lower rate of uterine rupture and higher rate of successful vaginal birth.
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Affiliation(s)
- Eyal Krispin
- a Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva , Israel.,b Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Liran Hiersch
- b Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel.,c Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv , Israel
| | - Yulia Wilk Goldsher
- a Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva , Israel.,b Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Arnon Wiznitzer
- a Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva , Israel.,b Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Yariv Yogev
- b Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel.,c Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv , Israel
| | - Eran Ashwal
- b Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel.,c Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv , Israel
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Vilchez G, Dai J, Kumar K, Lagos M, Sokol RJ. Contemporary analysis of maternal and neonatal morbidity after uterine rupture: A nationwide population-based study. J Obstet Gynaecol Res 2017; 43:834-838. [PMID: 28188975 DOI: 10.1111/jog.13300] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/19/2016] [Accepted: 12/22/2016] [Indexed: 11/27/2022]
Abstract
AIM Uterine rupture is a rare but feared perinatal event. Despite abundant research and changes to guidelines implemented to reduce this complication, evaluation of whether uterine rupture still engenders significant maternal/neonatal morbidity has not been conducted. We analyzed recent cases of maternal/neonatal morbidity after uterine rupture. METHODS Deliveries complicated by uterine rupture from 2011 to 2012 in the United States were selected. Comparison cases without uterine rupture were used as controls. Measures of maternal/neonatal complications were compared with χ2 test, and relative risks were calculated. Logistic regression was used to identify the most significant complications. P < 0.05 indicated statistical significance. RESULTS From 7 922 016 births, 1925 cases of uterine rupture and 3765 controls were identified. Regression models retained four maternal outcomes; blood transfusion was the most common (~15%) and unplanned hysterectomy had the highest odds (~97-fold). For newborns, the model retained three measures of morbidity; neonatal intensive care unit admission was the most common (~35%) and seizures had the highest odds (~20-fold). CONCLUSIONS Despite efforts to reduce complications, mothers remain at significant risk of unplanned hysterectomy and intensive care unit admission. Neonates are at sizeable risk for neonatal intensive care unit admission and seizures, recognized markers of long-term neurobehavioral abnormality. Uterine rupture remains a major risk for mothers and babies.
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Affiliation(s)
- Gustavo Vilchez
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Jing Dai
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Komal Kumar
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Moraima Lagos
- School of Biomedical Sciences, Federico Villarreal National University, Lima, Peru
| | - Robert J Sokol
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
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Belihu FB, Small R, Davey MA. Trial of labour and vaginal birth after previous caesarean section: A population based study of Eastern African immigrants in Victoria, Australia. Midwifery 2017; 46:8-16. [PMID: 28104545 DOI: 10.1016/j.midw.2017.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 11/04/2016] [Accepted: 01/02/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Variations in caesarean section (CS) between some immigrant groups and receiving country populations have been widely reported. Often, African immigrant women are at higher risk of CS than the receiving population in developed countries. However, evidence about subsequent mode of birth following CS for African women post-migration is lacking. The objective of this study was to examine differences in attempted and successful vaginal birth after previous caesarean (VBAC) for Eastern African immigrants (Eritrea, Ethiopia, Somalia and Sudan) compared with Australian-born women. DESIGN A population-based observational study was conducted using the Victorian Perinatal Data Collection. Pearson's chi-square test and logistic regression analysis were performed to generate adjusted odds ratios for attempted and successful VBAC. SETTING Victoria, Australia. PARTICIPANTS 554 Eastern African immigrants and 24,587 Australian-born eligible women with previous CS having singleton births in public care. FINDINGS 41.5% of Eastern African immigrant women and 26.1% Australian-born women attempted a VBAC with 50.9% of Eastern African immigrants and 60.5% of Australian-born women being successful. After adjusting for maternal demographic characteristics and available clinical confounding factors, Eastern African immigrants were more likely to attempt (ORadj 1.94, 95% CI 1.57-2.47) but less likely to succeed (ORadj 0.54 95% CI 0.41-0.71) in having a VBAC. CONCLUSION/IMPLICATIONS FOR PRACTICE There are disparities in attempted and successful VBAC between Eastern African origin and Australian-born women. Unsuccessful VBAC attempt is more common among Eastern African immigrants, suggesting the need for improved strategies to select and support potential candidates for vaginal birth among these immigrants to enhance success and reduce potential complications associated with failed VBAC attempt.
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Affiliation(s)
- Fetene B Belihu
- Judith Lumley Centre, La Trobe University, 215 Franklin Street, Melbourne, VIC 3000, Australia.
| | - Rhonda Small
- Judith Lumley Centre, La Trobe University, 215 Franklin Street, Melbourne, VIC 3000, Australia.
| | - Mary-Ann Davey
- Judith Lumley Centre, La Trobe University, 215 Franklin Street, Melbourne, VIC 3000, Australia; Department of Obstetrics and Gynaecology, Monash University, 246 Clayton Road, Clayton, VIC 3168, Australia.
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Reif P, Brezinka C, Fischer T, Husslein P, Lang U, Ramoni A, Zeisler H, Klaritsch P. Labour and Childbirth After Previous Caesarean Section: Recommendations of the Austrian Society of Obstetrics and Gynaecology (OEGGG). Geburtshilfe Frauenheilkd 2016; 76:1279-1286. [PMID: 28017971 DOI: 10.1055/s-0042-118335] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The new expert recommendation from the Austrian Society of Obstetrics and Gynaecology (OEGGG) comprises an interpretation and summary of guidelines from the leading specialist organisations worldwide (RCOG, ACOG, SOGC, CNGOF, WHO, NIH, NICE, UpToDate). In essence it outlines alternatives to the direct pathway to elective repeat caesarean section (ERCS). In so doing it aligns with international trends, according to which a differentiated, individualised clinical approach is recommended that considers benefits and risks to both mother and child, provides detailed counselling and takes the patient's wishes into account. In view of good success rates (60-85 %) for vaginal birth after caesarean section (VBAC) the consideration of predictive factors during antenatal birth planning has become increasingly important. This publication provides a compact management recommendation for the majority of standard clinical situations. However it cannot and does not claim to cover all possible scenarios. The consideration of all relevant factors in each individual case, and thus the ultimate decision on mode of delivery, remains the discretion and responsibility of the treating obstetrician.
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Affiliation(s)
- P Reif
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz, Graz, Austria
| | - C Brezinka
- Universitätsklinik für Gynäkologische Endokrinologie und Reproduktionsmedizin, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - T Fischer
- Universitätsklinik für Frauenheilkunde und Geburtshilfe der Paracelsus Universität Salzburg, Salzburg, Austria
| | - P Husslein
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Wien, Vienna, Austria
| | - U Lang
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz, Graz, Austria
| | - A Ramoni
- Universitätsklinik für Gynäkologie und Geburtshilfe, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - H Zeisler
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Wien, Vienna, Austria
| | - P Klaritsch
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz, Graz, Austria
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