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Rubashkin N. Epistemic Silences and Experiential Knowledge in Decisions After a First Cesarean: The case of a vaginal birth after cesarean calculator. Med Anthropol Q 2023; 37:341-353. [PMID: 37459454 PMCID: PMC10993819 DOI: 10.1111/maq.12784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 05/01/2023] [Indexed: 12/02/2023]
Abstract
Evidence-based obstetrics can employ statistical models to justify greater use of cesareans, sometimes excluding experiential elements from informed decision making. Over the past decade, prenatal providers adopted a vaginal birth after cesarean (VBAC) calculator designed to support patients in making informed decisions about their births by estimating their probability for a VBAC. Among other factors, the calculator used race and ethnicity to make its estimate, assigning lower probabilities for a successful VBAC to Black and Hispanic patients. I analyze how a diverse group of women and their providers engaged with the VBAC calculator. Some providers used low calculator scores to remove a shared decision-making model by prescriptively counseling Black and Hispanic women who desired a VBAC into undergoing repeat cesareans. Consequently, women racialized by the calculator as Black or Hispanic used experiential knowledge to challenge the calculator's assessment of their supposed lesser ability to give birth vaginally.
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Affiliation(s)
- Nicholas Rubashkin
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California at San Francisco, San Francisco, United States
- Institute for Global Health Sciences, University of California at San Francisco, San Francisco, United States
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2
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Elammary MN, Zohiry M, Sayed A, Atef F, Ali N, Hussein I, Mahran MA, Said AE, Elassall GM, Radwan AA, Shazly SA. Middle eastern college of obstetricians and gynecologists (MCOG) practice guidelines: Role of prediction models in management of trial of labor after cesarean section. Practice guideline no. 05-O-22 ✰,✰✰,★,★★. J Gynecol Obstet Hum Reprod 2023; 52:102598. [PMID: 37087045 DOI: 10.1016/j.jogoh.2023.102598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/11/2023] [Accepted: 04/19/2023] [Indexed: 04/24/2023]
Abstract
Cesarean delivery rates have been steadily rising since the beginning of the 21st century. The growing incidence is even more prominent in developing countries owing to lack of evidence-based guidance and audit, and the expansion of private practice. The uprise in Cesarean delivery rate has been associated with considerable financial burden and has increased the risk otherwise uncommon serious complications such as placenta accreta disorders and uterine rupture. In addition to primary prevention of Cesarean delivery, trial of labor after cesarean section is one of the most successful strategies to reduce Cesarean deliveries and minimize risks associated with higher order Cesarean deliveries. This guideline appraises patient selection strategies and use of prediction model to promote counseling and enhance safety in women considering vaginal birth after Cesarean.
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Affiliation(s)
| | - Mariam Zohiry
- Middle Eastern College of Obstetricians and Gynecologists (MCOG) Practice Office. Leeds, United Kingdom
| | - Asmaa Sayed
- Middle Eastern College of Obstetricians and Gynecologists (MCOG) Practice Office. Leeds, United Kingdom
| | - Fatma Atef
- Middle Eastern College of Obstetricians and Gynecologists (MCOG) Practice Office. Leeds, United Kingdom
| | - Nada Ali
- Middle Eastern College of Obstetricians and Gynecologists (MCOG) Practice Office. Leeds, United Kingdom
| | - Islam Hussein
- Middle Eastern College of Obstetricians and Gynecologists (MCOG) Practice Office. Leeds, United Kingdom
| | - Manar A Mahran
- Middle Eastern College of Obstetricians and Gynecologists (MCOG) Practice Office. Leeds, United Kingdom
| | - Aliaa E Said
- Middle Eastern College of Obstetricians and Gynecologists (MCOG) Practice Office. Leeds, United Kingdom
| | - Gena M Elassall
- Middle Eastern College of Obstetricians and Gynecologists (MCOG) Practice Office. Leeds, United Kingdom
| | - Ahmad A Radwan
- Middle Eastern College of Obstetricians and Gynecologists (MCOG) Practice Office. Leeds, United Kingdom
| | - Sherif A Shazly
- Middle Eastern College of Obstetricians and Gynecologists (MCOG) Practice Office. Leeds, United Kingdom; Department of Obstetrics and Gynecology, Leeds Teaching Hospitals, Leeds, United Kingdom.
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3
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Awawdeh S, Rawashdeh H, Aljalodi H, Shamleh RA, Alshorman S. Vaginal birth after cesarean section prediction model for Jordanian population. Comput Biol Chem 2023; 104:107877. [PMID: 37182360 DOI: 10.1016/j.compbiolchem.2023.107877] [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: 10/02/2022] [Revised: 04/08/2023] [Accepted: 04/29/2023] [Indexed: 05/16/2023]
Abstract
The rate of cesarean section has increased significantly worldwide, creating a group of women with one lower segment cesarean section concerned about the mode of delivery in their future pregnancies. This group of mothers will face a complex discussion because the likelihood for a successful vaginal birth after cesarean section provided to them is a general one. The probability of having a successful vaginal birth is the cornerstone factor of the mothers' decision. Therefore, providing a case-specific likelihood that respects the characteristics of each pregnancy will refine counseling, lower the decision conflict, and improve the success rate of vaginal birth trials eventually improving maternal and fetal outcomes. This paper aims to develop a clinical decision support system to evaluate the individualized likelihood mode of delivery for pregnant women with a previous lower segment cesarean section based on their unique characteristics. The study included six hundred fifty-nine pregnant women, where three hundred twenty-seven records had missing values. Various pre-processing steps, including missing data imputation and feature selection, were applied to the original dataset before model development to improve the data quality. Missing values were handled first, then a feature selection process using a genetic algorithm was applied to select the relevant features and to exclude features that may have been affected negatively by missing data imputation. After that, four machine learning classifiers, namely Decision Tree, Random Forest, K-Nearest Neighbors (KNN), and Logistic Regression, were used to build the prediction model. The results showed that imputing missing values followed by feature selection was more efficient than deleting them since the Area Under the Curve (AUC) has increased from 0.655 to 0.812 using the KNN classifier.
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Affiliation(s)
- Shatha Awawdeh
- King Abdullah II School for Information Technology, The University of Jordan, Amman, Jordan; School of Information Technology, Applied Science Private University, Amman, Jordan.
| | - Hasan Rawashdeh
- Department of Obstetrics and Gynaecology, Jordan University of Science and Technology, Jordan
| | - Haneen Aljalodi
- Department of Obstetrics and Gynaecology, Jordan University of Science and Technology, Jordan
| | - Rafeef Abu Shamleh
- Department of Obstetrics and Gynaecology, Jordan University of Science and Technology, Jordan
| | - Sumyah Alshorman
- Obstetrics and Gynecology Department, King Abdullah University Hospital, Al-Ramtha, Jordan
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4
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Trial of labor after cesarean in women with hypertensive disorders and no prior vaginal delivery. Arch Gynecol Obstet 2023; 307:771-777. [PMID: 35578135 DOI: 10.1007/s00404-022-06601-5] [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: 01/05/2022] [Accepted: 04/27/2022] [Indexed: 11/02/2022]
Abstract
KEY MESSAGE Trial of labor among women who never delivered vaginally with hypertensive disorder is associated with nearly half the success rate of the general population. PURPOSE To study the trial of labor after cesarean (TOLAC) among women with hypertensive disorders and no prior vaginal delivery. METHODS A retrospective cohort study was conducted including women with no prior vaginal delivery undergoing TOLAC during 2010-2020. Women with hypertensive disorder were compared to those without. RESULTS A total of 54/2,144 (2.5%) TOLACs had a hypertensive disorder: 32 (59%) had gestational hypertension, 16 (30%) had chronic hypertension and 6 (11%) had preeclampsia. Women with hypertensive disorders had higher BMI and higher proportion of diabetic disorders. TOLAC success rate was lower among hypertensive mothers: 32 (59%) vs. 1,605 (76.8%), p=0.003 odds ratio (OR), 95% confidence interval (CI) 0.44 (0.25-0.76). The rate of uterine rupture was 23/2,144 (1.1%). In a multivariable logistic regression analysis, hypertensive disorder was independently negatively associated with TOLAC success, adjusted OR (95% CI) 0.47 (0.26-0.85). Other factors negatively independently associated with TOLAC failure were maternal age, predelivery body mass index, dystocia at primary CD, gestational age at TOLAC, induction of labor and birth weight. Epidural was independently positively associated with TOLAC success, adjusted OR (95% CI) 1.54 (1.18-1.99). CONCLUSION TOLAC in hypertensive women with no prior vaginal delivery is safe. Success rate is impaired in comparison to non-hypertensive women.
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Fruscalzo A, Rossetti E, Londero AP. Trial of Labor after Three or More Previous Cesarean Sections:
Systematic Review and Meta-Analysis of Observational Studies. Z Geburtshilfe Neonatol 2022; 227:96-105. [PMID: 36455615 DOI: 10.1055/a-1965-4125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Abstract
Aims To assess the success rate and prevalence of maternal or neonatal
complications in women undergoing a trial of labor after three or more
(≥3) previous cesarean sections (CSs).
Methods A systematic literature review and meta-analysis was conducted
from inception to May 2022 in Medline, Scopus, ENBASE, ClinicalTrials.gov, and
the Cochrane Central Register of Controlled Trials and Reviews. Items detailing
success rate and complications in women with a history of≥3 previous CSs
were considered. Selected articles were evaluated for quality, heterogeneity,
and publication bias. A pooled prevalence or odds ratio was calculated.
Findings Twelve articles were included for a total of 540 women with a
history of≥3 CSs, accounting for the 2% (CI 95%
1–4%) of the whole cohort of trial of labor. Our findings show a
0.67 (CI 95% 0.53–0.78) rate of successful vaginal delivery. A
higher success rate was observed in women having a history of a prior vaginal
delivery (0.90, CI 95% 0.77–0.96) and when prostaglandins,
peridural anesthesia or oxytocin were allowed (respectively 0.73, CI 95%
0.62–0.83, 0,73, CI 95% 0.57–0.85 and 0.73, CI
95% 0.64–0.81). Uterine rupture rate was 0.01 (CI 95%
0.00–0.01). No cases of fetal asphyxia or maternal or neonatal death
were registered.
Conclusions The success rate and low frequency of severe complications
observed seem to support a trial of labor in selected patients desiring a
natural birth. However, a potential underestimation of serious maternal and
neonatal complications should be considered in the decision-making process.
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Affiliation(s)
- Arrigo Fruscalzo
- Department of Obstetrics and Gynecology, HFR Fribourg,
Switzerland
- Faculty of Medicine, University of Münster,
Germany
| | - Emma Rossetti
- Department of Obstetrics and Gynecology, Brixen General Hospital,
Brixen, Italy
| | - Ambrogio P. Londero
- Academic Unit of Obstetrics and Gynaecology; Department of
Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant
Health, University of Genova, Italy
- Ennergi Research (non-profit organization), 33050 Lestizza, UD, Italy
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Downs S, Mokhtari N, Gold S, Ghofranian A, Kawakita T. Maternal and neonatal outcomes of trial of labor compared with elective cesarean delivery according to predicted likelihood of vaginal delivery. J Matern Fetal Neonatal Med 2022; 35:10487-10493. [PMID: 36216354 DOI: 10.1080/14767058.2022.2130239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The vaginal birth after cesarean (VBAC) calculator developed by the Maternal-Fetal Medicine Units Network (MFMU) helps to identify the likelihood of VBAC. We sought to compare adverse maternal and neonatal outcomes of trial of labor after cesarean (TOLAC) to those of elective cesarean delivery after stratifying by VBAC likelihood. STUDY DESIGN This was a retrospective cohort study of all women whose primary low transverse segment cesarean delivery and subsequent singleton term delivery with vertex presentation occurred at an academic center from January 2009 to June 2018. Only data from the second pregnancy were analyzed. The final analysis included 835 women. The MFMU VBAC calculator was used to assess the likelihood of VBAC. The two primary outcomes were composite adverse maternal (death or severe maternal complications) and neonatal outcomes (perinatal death or severe neonatal complications). The analyses were stratified based on the VBAC likelihood (less than 60% and 60-100%). Multivariable logistic regression was used to calculate adjusted odds ratio (OR) and 95% confidence interval (CI), controlling for predefined covariates. RESULTS Among women with VBAC likelihood less than 60%, TOLAC compared with elective cesarean was associated with increased odds of the primary adverse maternal outcome (16.4% vs. 4.2%; adjusted OR 4.60 [95%CI 1.48-14.35]) and the primary adverse neonatal outcome (17.8% vs. 6.3%; adjusted OR 3.93 [95%CI 1.31-11.75]). Among women with VBAC likelihood of 60-100%, TOLAC compared with elective cesarean was associated with decreased odds of the primary adverse maternal outcome (6.4% vs. 11%; adjusted OR 0.47 [95%CI 0.25-0.89]) and similar odds of the primary adverse neonatal outcome (6.7% vs. 8.3%; adjusted OR 0.98 [95%CI 0.52-1.84]). CONCLUSIONS Among women with a history of a primary low transverse cesarean delivery, those who underwent TOLAC compared to those who had elective cesarean had increased odds of adverse maternal and neonatal outcomes when VBAC likelihood was less than 60%.
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Affiliation(s)
- Sarah Downs
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Neggin Mokhtari
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Stacey Gold
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Atoosa Ghofranian
- Department of Obstetrics and Gynecology, Northwell Health, New York, NY, USA
| | - Tetsuya Kawakita
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
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Fitzpatrick KE, Quigley MA, Kurinczuk JJ. Planned mode of birth after previous cesarean section: A structured review of the evidence on the associated outcomes for women and their children in high-income setting. Front Med (Lausanne) 2022; 9:920647. [PMID: 36148449 PMCID: PMC9486480 DOI: 10.3389/fmed.2022.920647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/08/2022] [Indexed: 12/05/2022] Open
Abstract
In many high-income settings policy consensus supports giving pregnant women who have had a previous cesarean section a choice between planning an elective repeat cesarean section (ERCS) or planning a vaginal birth after previous cesarean (VBAC), provided they have no contraindications to VBAC. To help women make an informed decision regarding this choice, clinical guidelines advise women should be counseled on the associated risks and benefits. The most recent and comprehensive review of the associated risks and benefits of planned VBAC compared to ERCS in high-income settings was published in 2010 by the US Agency for Healthcare Research and Quality (AHRQ). This paper describes a structured review of the evidence in high-income settings that has been published since the AHRQ review and the literature in high-income settings that has been published since 1980 on outcomes not included in the AHRQ review. Three databases (MEDLINE, EMBASE, and PsycINFO) were searched for relevant studies meeting pre-specified eligible criteria, supplemented by searching of reference lists. Forty-seven studies were identified as meeting the eligibility criteria and included in the structured review. The review suggests that while planned VBAC compared to ERCS is associated with an increased risk of various serious birth-related complications for both the mother and her baby, the absolute risk of these complications is small for either birth approach. The review also found some evidence that planned VBAC compared to ERCS is associated with benefits such as a shorter length of hospital stay and a higher likelihood of breastfeeding. The limited evidence available also suggests that planned mode of birth after previous cesarean section is not associated with the child’s subsequent risk of experiencing adverse neurodevelopmental or health problems in childhood. This information can be used to manage and counsel women with previous cesarean section about their subsequent birth choices. Collectively, the evidence supports existing consensus that there are risks and benefits associated with both planned VBAC and ERCS, and therefore women without contraindications to VBAC should be given an informed choice about planned mode of birth after previous cesarean section. However, further studies into the longer-term effects of planned mode of birth after previous cesarean section are needed along with more research to address the other key limitations and gaps that have been highlighted with the existing evidence.
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8
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Levin G, Rosenbloom JI, Yagel S, Bart Y, Meyer R. Prediction of successful preterm vaginal birth after cesarean among women who never delivered vaginally. Arch Gynecol Obstet 2022; 305:1143-1149. [PMID: 34491416 DOI: 10.1007/s00404-021-06222-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 08/31/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE We aimed to determine the factors associated with a successful trial of labor after cesarean (TOLAC) in the setting of preterm delivery of women with no prior vaginal delivery. METHODS A retrospective cohort study conducted at two tertiary medical centers during 2010-2020, including all TOLACs with a single cesarean delivery and no prior vaginal delivery, delivering a singleton preterm newborn. Factors associated with successful vaginal delivery were examined by multivariable analysis. RESULTS Of the 232 women with TOLAC who constituted the study cohort, 178 (76.7%) successfully delivered vaginally. Previous cesarean delivery characteristics did not differ between study groups. Maternal characteristics did not differ between TOLAC success and failure groups. The median gestational age at delivery was 35 3/7 weeks (IQR 34 0/7-36 0/7). The rate of epidural analgesia administration was higher in the TOLAC success group (54.5% vs. 35%, p = 0.013). Preterm premature rupture of membranes (PPROM) rate was lower in the TOLAC success group (53.9% vs. 83%, p < 0.001). The rate of induction of labor did not differ between TOLAC success and TOLAC failure groups. There were no cases of uterine rupture. In a multivariable logistic regression analysis, PPROM was the only independent factor associated with TOLAC success [adjusted OR (95% CI) 0.29 (0.10-0.83), p = 0.030]. CONCLUSION TOLAC in preterm deliveries among women with no prior vaginal delivery is safe, has a high success rate and PPROM is the only negatively associated predictor.
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Affiliation(s)
- Gabriel Levin
- Faculty of Medicine, Department of Gynecologic Oncology, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Joshua I Rosenbloom
- Faculty of Medicine, Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Simcha Yagel
- Faculty of Medicine, Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yossi Bart
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv-Hebrew University, Tel-Aviv, Israel
| | - Raanan Meyer
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv-Hebrew University, Tel-Aviv, Israel
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Meyer R, Tsur A, Tenenbaum L, Mor N, Zamir M, Levin G. Sonographic fetal head circumference is associated with trial of labor after cesarean section success. Arch Gynecol Obstet 2022; 306:1913-1921. [PMID: 35235023 DOI: 10.1007/s00404-022-06472-w] [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: 12/22/2021] [Accepted: 02/16/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE The purpose is to study the association of the fetal sonographic head circumference (SHC) with trial of labor after cesarean (TOLAC) success rate, among women with no prior vaginal deliveries. METHODS A retrospective case-control study including all women with no prior vaginal delivery undergoing TOLAC during 3/2011-6/2020 with a sonographic estimated fetal weight within one week from delivery. TOLAC success and failure groups were compared. RESULTS Of 1232 included women, 948 (76.9%) delivered vaginally. The mean fetal SHC was smaller in the TOLAC success group (330 ± 10 vs. 333 ± 11 mm, p < 0.001). In a multivariate regression analysis, predelivery BMI, hypertensive disorders, gestational age at prior CD, SHC and epidural analgesia administration were independently associated with TOLAC success. A ROC analysis of the multivariable model composed of the factors found independently associated with TOLAC success, excluding SHC, yielded an area under curve of 0.659 (95% CI 0.622-0.697) compared with 0.668 (95% CI 0.630-0.705) with SHC included. CONCLUSION Smaller SHC is independently associated with TOLAC success among women that did not deliver vaginally before, and has additive clinical value for the prediction of TOLAC success when combined with non-sonographic factors.
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Affiliation(s)
- Raanan Meyer
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, 5266202, Ramat-Gan, Israel. .,Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. .,The Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel.
| | - Abraham Tsur
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, 5266202, Ramat-Gan, Israel.,Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Lee Tenenbaum
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nizan Mor
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Gabriel Levin
- Department of Gynecologic Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Higher risk of hemorrhage and maternal morbidity in vaginal birth after second stage of labor C-section. Arch Gynecol Obstet 2021; 305:1431-1438. [DOI: 10.1007/s00404-021-06254-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
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11
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Chiossi G, D’Amico R, Tramontano AL, Sampogna V, Laghi V, Facchinetti F. Prevalence of uterine rupture among women with one prior low transverse cesarean and women with unscarred uterus undergoing labor induction with PGE2: A systematic review and meta-analysis. PLoS One 2021; 16:e0253957. [PMID: 34228760 PMCID: PMC8259955 DOI: 10.1371/journal.pone.0253957] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/16/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND As uterine rupture may affect as many as 11/1000 women with 1 prior cesarean birth and 5/10.000 women with unscarred uterus undergoing labor induction, we intended to estimate the prevalence of such rare outcome when PGE2 is used for cervical ripening and labor induction. METHODS We searched MEDLINE, ClinicalTrials.gov and the Cochrane library up to September 1st 2020. Retrospective and prospective cohort studies, as well as randomized controlled trials (RCTs) on singleton viable pregnancies receiving PGE2 for cervical ripening and labor induction were reviewed. Prevalence of uterine rupture was meta-analyzed with Freeman-Tukey double arcsine transformation among women with 1 prior low transverse cesarean section and women with unscarred uterus. RESULTS We reviewed 956 full text articles to include 69 studies. The pooled prevalence rate of uterine rupture is estimated to range between 2 and 9 out of 1000 women with 1 prior low transverse cesarean (5/1000; 95%CI 2-9/1000, 122/9000). The prevalence of uterine rupture among women with unscarred uterus is extremely low, reaching at most 0.7/100.000 (<1/100.000.000; 95%CI <1/100.000.000-0.7/100.000, 8/17.684). CONCLUSIONS Uterine rupture is a rare event during cervical ripening and labor induction with PGE2.
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Affiliation(s)
- Giuseppe Chiossi
- Division of Obstetrics, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto D’Amico
- Statistics Unit, Department of Diagnostic and Clinical Medicine and Public Health, University of Modena and Reggio Emilia, Modena, Italy
| | - Anna L. Tramontano
- Division of Obstetrics, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Veronica Sampogna
- Division of Obstetrics, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Viola Laghi
- Division of Obstetrics, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Facchinetti
- Division of Obstetrics, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
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12
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Levin G, Tsur A, Tenenbaum L, Mor N, Zamir M, Meyer R. Prediction of successful vaginal birth after cesarean in women with diabetic disorders and no prior vaginal delivery. Int J Gynaecol Obstet 2021; 157:165-172. [PMID: 33969481 DOI: 10.1002/ijgo.13736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/14/2021] [Accepted: 05/07/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To study the factors associated with successful trial of labor after cesarean (TOLAC) among women with diabetes and no prior vaginal delivery and compare with TOLAC in nondiabetic women. METHODS A retrospective study including all women undergoing TOLAC who had no prior vaginal delivery between March 2011 and June 2020 at Sheba Medical Center. Women with diabetic disorders were compared with those without. Multivariate regression analysis was performed to identify factors independently associated with TOLAC success. RESULTS Of 2144 deliveries with TOLAC, 163 (7.6%) were to women with a diabetic disorder. TOLAC success rate was comparable between diabetic and nondiabetic women (124 [76.1%] vs 1513 [76.4%], respectively; P = 0.931). Uterine rupture rate was 1.1% (23 out of 2144). Among women with diabetes the uterine rupture rate was 0.6% (1 out of 163) and did not differ between the success or fail TOLAC groups. Multivariate logistic regression showed that epidural anesthesia and cervical effacement were the only independent factors associated with TOLAC success in women with diabetes (adjusted OR 3.32; 95% CI, 1.31-8.69, P = 0.011 and aOR 1.04; 95% CI, 1.01-1.07, P = 0.007, respectively). CONCLUSION TOLAC in women with diabetes with no prior vaginal delivery has a high success rate. Epidural analgesia is the only modifiable independent predictor of TOLAC success.
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Affiliation(s)
- Gabriel Levin
- Department of Gynecologic Oncology, Hadassah-Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Faculty of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Abraham Tsur
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel.,Faculty of Medicine, Tel-Aviv-Hebrew University, Tel-Aviv, Israel
| | - Lee Tenenbaum
- Faculty of Medicine, Tel-Aviv-Hebrew University, Tel-Aviv, Israel
| | - Nizan Mor
- Faculty of Medicine, Tel-Aviv-Hebrew University, Tel-Aviv, Israel
| | - Michal Zamir
- Faculty of Medicine, Tel-Aviv-Hebrew University, Tel-Aviv, Israel
| | - Raanan Meyer
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel.,Faculty of Medicine, Tel-Aviv-Hebrew University, Tel-Aviv, Israel
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Mayne L, Liu C, Tanaka K, Amoako A. Caesarean section rates: applying the modified ten-group Robson classification in an Australian tertiary hospital. J OBSTET GYNAECOL 2021; 42:61-66. [PMID: 33938362 DOI: 10.1080/01443615.2021.1873923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of this study was to determine the main contributors to caesarean section (CS) rates at an Australian tertiary hospital. We conducted a retrospective review of women who delivered in an Australian tertiary hospital between 2014 and 2017. Women were allocated according to a modified Robson Ten-Group Classification System and CS indications were collected in nulliparous women and women with previous CS. The largest contributor to the 35.7% overall CS rate was women with a term cephalic infant and a previous CS (31.5% relative CS rate) and the most common indication was repeat CS. The group CS rate in nulliparous women with a cephalic term infant was higher when labour was induced compared to occurring spontaneously (36.6% and 18.1% respectively). The primary CS indication for these women was labour dystocia and maternal request was the most common CS indication for nulliparous women with a pre-labour CS.IMPACT STATEMENTWhat is already known on this subject? Significantly increasing caesarean section (CS) rates continue to prompt concern due to the associated neonatal and maternal risks. The World Health Organisation have endorsed the Robson Ten-Group Classification System to identify and analyse CS rate contributors.What do the results of this study add? We have used the modified Robson Ten-Group Classification System to identify that women with cephalic term infants who are nulliparous or who have had a previous CS are the largest contributors to overall CS rates. CS rates were higher in these nulliparous women if labour was induced compared to occurring spontaneously and the primary CS indication was labour dystocia. In nulliparous women with a CS prior to labour the most common CS indication was maternal request. Majority of women with a previous CS elected for a repeat CS.What are the implications of these findings for clinical practice? Future efforts should focus on minimising repeat CS in multiparous women and primary CS in nulliparous women. This may be achieved by redefining the definition of labour dystocia, exploring maternal request CS reasoning and critically evaluating induction timing and indication. Appropriately promoting a trial of labour in women with a previous CS in suitable candidates may reduce repeat CS incidence.
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Affiliation(s)
- Leah Mayne
- Department of Obstetrics and Gynaecology, The Royal Brisbane and Women's Hospital, Brisbane, Australia.,Faculty of Medicine, Griffith University, Gold Coast, Australia
| | - Cathy Liu
- Department of Obstetrics and Gynaecology, The Royal Brisbane and Women's Hospital, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Keisuke Tanaka
- Department of Obstetrics and Gynaecology, The Royal Brisbane and Women's Hospital, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Akwasi Amoako
- Department of Obstetrics and Gynaecology, The Royal Brisbane and Women's Hospital, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
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14
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Cañadas JV, González MT, Limón NP, Alguacil MS, Prieto MGL, Riaza RC, Montero-Macías R. Intracervical double-balloon catheter versus dinoprostone for cervical ripening in labor induction in pregnancies with a high risk of uterine hyperstimulation. Arch Gynecol Obstet 2021; 304:1475-1484. [PMID: 33904957 DOI: 10.1007/s00404-021-06071-1] [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: 11/12/2020] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE There are numerous methods for cervical ripening although not all of them are indicated in women presenting a higher risk of uterine hyperstimulation. To compare the efficacy and security of the two methods for cervical ripening in the induction of labor in these pregnancies. METHODS Retrospective analysis of two cohorts consisting of pregnant women who gave birth from 2016 to 2019 (112 inductions with dinoprostone and 112 with intracervical double- balloon). RESULTS There are statistically significant differences in favor of dinoprostone in deliveries that occurred before 12 h since the start of the induction (28.6% vs 13.4%, p = 0.005) and a higher rate of cervical ripening (55.4% vs 33.9%; p = 0.001). There were no statistically significant differences in induction time, the percentage of women delivering within 24 h or beyond, nor in the type of delivery. Additionally, a decreased need of oxytocin (60.7% vs 42.9%; p = 0.001) and a lower dose when used has been observed in the dinoprostone group. However, Dinoprostone also has a higher rate of minor maternal complications as uterine hyperstimulation (18.8% vs 3.6%; p = 0.001) and altered cardiotocography (26.8% vs 4.5%; p = 0.001). No significant difference has been found between the two groups regarding severe complications. CONCLUSIONS Dinoprostone presents a greater efficacy for cervical ripening and delivery in ≤ 12 h, with less need of oxytocin perfusion than inductions using an intracervical double-balloon. There is no significant difference in severe maternal complications between the two groups. In conclusion, Dinoprostone could be an effective and safe option for patients at risk of uterine hyperstimulation.
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Affiliation(s)
- Javier Vega Cañadas
- Obstetrics and Gynecology Department, Fuenlabrada University Hospital, Rey Juan Carlos University, Madrid, Spain.
| | - María Teulón González
- Obstetrics and Gynecology Department, Fuenlabrada University Hospital, Rey Juan Carlos University, Madrid, Spain
| | - Natalia Pagola Limón
- Obstetrics and Gynecology Department, Fuenlabrada University Hospital, Rey Juan Carlos University, Madrid, Spain
| | - María Sanz Alguacil
- Obstetrics and Gynecology Department, Fuenlabrada University Hospital, Rey Juan Carlos University, Madrid, Spain
| | - María García-Luján Prieto
- Obstetrics and Gynecology Department, Fuenlabrada University Hospital, Rey Juan Carlos University, Madrid, Spain
| | - Rocío Canete Riaza
- Obstetrics and Gynecology Department, Fuenlabrada University Hospital, Rey Juan Carlos University, Madrid, Spain
| | - Rosa Montero-Macías
- Obstetrics and Gynecology Department, Centre Hospitalier Simone-Veil, Eaubonne, France
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15
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De Leo R, La Gamba DA, Manzoni P, De Lorenzi R, Torresan S, Franchi M, Uccella S. Vaginal Birth after Two Previous Cesarean Sections versus Elective Repeated Cesarean: A Retrospective Study. Am J Perinatol 2020; 37:S84-S88. [PMID: 32898889 DOI: 10.1055/s-0040-1714344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Trial of labor after cesarean delivery (TOLAC) is a common practice worldwide but the evidence is still scant regarding this practice in women who underwent 2 previous cesareans. The purpose of this study is to retrospectively review our experience with vaginal birth after two previous cesarean sections (VBA2C), with specific attention to the indications for previous cesarean and to the women's motivation for attempting trial of labor. STUDY DESIGN This was a retrospective cohort study conducted in a primary care hospital between January 2011 and December 2019. Inclusion criteria were: singleton pregnancies, absence of morphological abnormalities at ultrasonographic screening of the second trimester (or at any other stage of pregnancy), and two previous cesarean sections. RESULTS The final analysis included 114 cases for maternal and neonatal outcomes. In total, 40.4% of women chose trial of labor after two cesarean delivery (TOLA2C group). TOLA2C was associated with a success rate of 76.1%, a higher gestational age at birth, and a shorter hospital stay, compared with elective repeated cesarean delivery group. There were no significant differences in the rate of Apgar scores at 5 minutes <7 between both groups. The percentage of successful TOLA2C in women with prior vaginal delivery was 92.8%. Factors related to failed TOLA2C included failure to progress (3/11, 27.3%), nonreassuring fetal heart rate (3/11, 27.3%), and no onset of spontaneous labor after premature rupture of membranes (5/11, 45.4%). In the group of TOLA2C, more than 70% accepted to travel more than 45 minutes to reach our hospital, with the aim to attempt VBA2C. CONCLUSION TOLA2C is a possible option for both mothers and neonates in selected cases. Adequate counseling about pros and cons of TOLA2C is mandatory. The woman's motivation represents a key element to determine the success of VBA2C. KEY POINTS · Selection of candidates and motivation of the patients represent key elements for successful TOLA2C.. · A careful record of obstetrical history and previous deliveries can provide clinicians useful information.. · Mode of delivery in women with two previous cesareans is strongly associated with doctor's counseling..
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Affiliation(s)
- Rossella De Leo
- Obstetrics and Gynecology Department, San Giacomo Apostolo Hospital-ULSS 2, Castelfranco Veneto, Italy
| | - Domenico Antonio La Gamba
- Obstetrics and Gynecology Department, San Giacomo Apostolo Hospital-ULSS 2, Castelfranco Veneto, Italy
| | - Paolo Manzoni
- Division of Pediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Health, Ospedale degli Infermi, ASL Biella, Ponderano, Biella, Italy
| | - Raffaella De Lorenzi
- Obstetrics and Gynecology Department, San Giacomo Apostolo Hospital-ULSS 2, Castelfranco Veneto, Italy
| | - Sonia Torresan
- Obstetrics and Gynecology Department, San Giacomo Apostolo Hospital-ULSS 2, Castelfranco Veneto, Italy
| | - Massimo Franchi
- Department of Obstetrics and Gynecology, AOUI, University of Verona, Verona, Italy
| | - Stefano Uccella
- Department of Obstetrics and Gynecology, AOUI, University of Verona, Verona, Italy.,Division of Obstetrics and Gynecology, Department of Maternal, Neonatal, and Infant Health, Ospedale degli Infermi, ASL Biella, Ponderano, Biella, Italy
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16
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Dissanayake MV, Bovbjerg ML, Tilden EL, Snowden JM. The Association between Hospital Frequency of Labor after Cesarean and Outcomes in California. Womens Health Issues 2020; 30:453-461. [PMID: 32859469 DOI: 10.1016/j.whi.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 07/09/2020] [Accepted: 07/24/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Labor after cesarean (LAC) is an alternative to planned repeat cesarean delivery. The effect of hospital-level factors on LAC frequency and vaginal birth after cesarean (VBAC) has been relatively understudied. It was our goal to determine if hospital frequency of LAC (number of women undergoing LAC/number of women with previous uterine scars) is associated with increased VBAC and associated outcomes among women undergoing LAC. METHODS We analyzed 43,331 term, singleton births to women who experienced LAC in California from 2007 to 2010. We conducted multivariable logistic regressions of infant and maternal outcomes for women at hospitals with high LAC frequency (≥median) compared with low LAC frequency (<median), adjusting for maternal and hospital characteristics. We stratified analyses by overall hospital birth volume (categories 1, low; 2, medium; 3, high). RESULTS We did not observe an association between high LAC frequency and VBAC in any category of hospital birth volume in regression models. We found that women in hospitals with high LAC frequency had higher odds of infection in category 1 (low) and 2 (medium) hospitals (category 1 hospitals adjusted odds ratio [aOR], 1.61; 95% confidence interval [CI], 1.04-2.48; category 2 hospitals, aOR, 2.12; 95% CI, 1.34-3.35) and postpartum hemorrhage in category 2 and 3 hospitals (category 2 hospitals: aOR, 2.49; 95% CI, 1.57-3.94; category 3 hospitals: aOR, 1.83; 95% CI, 1.24-2.70). We observed that high LAC frequency was associated with more adverse outcomes (e.g., infection, severe perineal lacerations, decreased Apgar scores) in category 2 than in category 1 and 3 hospitals. CONCLUSIONS We did not find that high LAC frequency was associated with more VBAC, nor with many perinatal complications in category 1 and 3 hospitals. The associations between high LAC frequency and both infection and postpartum hemorrhage are concerning and require further investigation. There may be a sensitive balance between increasing LAC access and determining appropriate LAC candidate selection.
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Affiliation(s)
- Mekhala V Dissanayake
- Department of Obstetrics & Gynecology, Oregon Health and Science University, Portland, Oregon.
| | - Marit L Bovbjerg
- College of Public Health & Human Sciences, Oregon State University, Corvallis, Oregon
| | - Ellen L Tilden
- Department of Obstetrics & Gynecology, Oregon Health and Science University, Portland, Oregon; Department of Nurse-Midwifery, Oregon Health & Science University School of Nursing, Portland, Oregon
| | - Jonathan M Snowden
- Department of Obstetrics & Gynecology, Oregon Health and Science University, Portland, Oregon; School of Public Health, Oregon Health and Science University/Portland State University, Portland, Oregon
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17
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Old and novel insights into emergency peripartum hysterectomy: a time-trend analysis. Arch Gynecol Obstet 2020; 301:1159-1165. [PMID: 32221710 DOI: 10.1007/s00404-020-05504-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 03/12/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To assess changing trends, role of the triad patient-pregnancy-health professionals and health care cost in emergency peripartum hysterectomy (EPH). METHODS Demographics, indications, perinatal outcomes, perioperative complications in EPH cases performed in a 10-year period were extracted from the local birth registry. Experience of health professionals in the management of the post-partum haemorrhage was valued. Two subgroups (Period I, 2009-2013 vs. Period II, 2014-2018) were recognized. Overall and detailed EPH ratios/1000 deliveries were calculated. Cost analysis was achieved in agreement with the diagnosis-related group (DGR) system. RESULTS A total of 39 EPH were performed among 36,053 deliveries. EPH incidence increased from 0.8 to 1.32‰ across study periods (p < 0.001). The mean maternal age (36.9 ± 4.7 vs. 38.9 ± 5.9 years, p = 0.035) and the high socio-economic status (0 vs. 19.2%, p = 0.027) were statistically different. Multiparity (84.6 vs. 96.2%, p = 0.005), previous caesarean section (CS) (0.9 ± 0.9 vs. 1.2 ± 1.6, p = 0.049), and emergent CS (7.7 vs. 19.2%, p = 0.048) were found statistically different. In Period II, increased attempts in conservative approaches (7.7 vs. 36.8%, p = 0.007), reduction in blood loss (3184 ± 1753 vs. 2511 ± 1252 mL, p = 0.045), advanced age of gynecologists performing EPH (54.5 ± 9.2 vs. 60.3 ± 6.4 years, p = 0.024), and augmented health care costs (mean DRG of € 2.782 vs. 3.371,95, p < 0.001) were observed. CONCLUSIONS As a "near-miss" event, advances on identification of EPH factors are mandatory. Time-trend analyses might add information and address novel strategies.
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18
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Obstetric outcome of induction of labor using prostaglandin gel in patients with previous one cesarean section. Obstet Gynecol Sci 2019; 62:397-403. [PMID: 31777735 PMCID: PMC6856483 DOI: 10.5468/ogs.2019.62.6.397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/18/2019] [Accepted: 05/08/2019] [Indexed: 12/02/2022] Open
Abstract
Objective After globally acceptance of planned vaginal birth after cesarean section (VBAC), the mode of induction is still a matter of debate and requires further discussion. We aimed to study obstetric outcomes in post-cesarean patients undergoing induction of labor with prostaglandin gel compared with patients who developed spontaneous labor pains. Methods All patients at 34 weeks or more of gestation with previous one cesarean section eligible for trial of labor after cesarean section admitted in a labor room within one year were divided in 2 groups. Group one consisted of patients who experienced the spontaneous onset of labor pains and group 2 consisted of patients who underwent induction of labor with prostaglandin gel. They were analyzed for maternofetal outcomes. Descriptive statistics, independent sample t-test, and chi-square test were applied using SPSS 20 software for statistical analysis. Results Both groups were comparable in maternal age, parity, and fetal weight, but different in bishop score, mode of delivery, and neonatal outcome. Admisson bishop score was 6.61±2.51 in group 1 and 3.15±1.27 in group 2 (P<0.005). In the patients who experienced spontaneous labor, 86.82% had successful VBAC. In the patients with induced labor, 64.34% had successful VBAC with an average dose of gel of 1.65±0.75. Both groups had one case each of uterine rupture. The neonatal intensive care unit admission rate was 4.1% in group one and 10.4% in group 2. Conclusion This study reflects that supervised labor induction with prostaglandin gel in previous one cesarean section patients is a safe and effective option.
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19
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Wilson E, Sivanesan K, Veerasingham M. Rates of vaginal birth after caesarean section: What chance do obese women have? Aust N Z J Obstet Gynaecol 2019; 60:88-92. [PMID: 31211408 DOI: 10.1111/ajo.13003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 04/19/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND For women considering vaginal birth after caesarean section (VBAC), obesity has been associated with a lower rate of vaginal birth and a higher rate of uterine rupture. To enhance antenatal counselling, this study aimed to evaluate the success rates of morbidly obese women undergoing a trial of labour (TOL). METHOD A retrospective analysis was performed of women who birthed at our hospital who had previously had one caesarean section. Routinely collected data were reviewed for mode of birth for women who underwent a TOL. A number of maternal and neonatal outcomes were also gathered. The data were analysed according to those women with a body mass index (BMI) equal to or above 40, compared to those women with a BMI below 40. RESULTS From 2011 to 2018, 2097 women gave birth at our hospital and had a caesarean section for a prior pregnancy. Of these women, 1234 (58.9%) had an elective caesarean section and 863 (41.1%) underwent a TOL. Of the women undertaking a TOL, 73.1% gave birth vaginally. Women with a BMI equal to or greater than 40 were less likely to have a successful VBAC compared to women with a BMI less than 40 (58.9% vs 74.1%, P = 0.013). Only 50% of women with a BMI equal to or greater than 40 had a successful VBAC if they had not previously had a vaginal birth. CONCLUSION Women with a BMI over 40 had lower rates of successful VBAC. Rates were even lower for those who had not had a prior vaginal birth.
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Affiliation(s)
- Erin Wilson
- Ipswich Hospital, Ipswich, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Kanapathippillai Sivanesan
- Ipswich Hospital, Ipswich, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Mayooran Veerasingham
- Ipswich Hospital, Ipswich, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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20
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Jardine JE, Knight HE, Carroll FE, Gurol-Urganci I. Risk of obstetric anal sphincter injury in women having a vaginal birth after a previous caesarean section: A population-based cohort study. Eur J Obstet Gynecol Reprod Biol 2019; 236:7-13. [DOI: 10.1016/j.ejogrb.2019.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/04/2019] [Accepted: 02/05/2019] [Indexed: 01/21/2023]
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21
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Vaginal Birth After Previous Cesarean Birth: A Comparison of 3 National Guidelines. Obstet Gynecol Surv 2018; 73:537-543. [PMID: 30265740 DOI: 10.1097/ogx.0000000000000596] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Importance Vaginal birth after previous cesarean birth (VBAC) is a reasonable option for many women with previous cesarean delivery. Objective The aim of this study was to summarize evidence and compare recommendations from national guidelines regarding VBAC. Evidence Acquisition A descriptive review of 3 national guidelines on VBAC was conducted: Royal College of Obstetricians and Gynaecologists on "Birth After Previous Caesarean Birth," American College of Obstetricians and Gynecologists on "Vaginal Birth After Cesarean Delivery," and Society of Obstetricians and Gynaecologists of Canada on "Guidelines for Vaginal Birth After Previous Caesarean Birth." These guidelines were summarized and compared in terms of the recommended antenatal and intrapartum care of women. Recommendations and strength of evidence were also reviewed based on method of reporting. Results The variations mentioned on the different guidelines reflect the heterogeneity of the published data on the management of VBAC during the antenatal and intrapartum care. Conclusions Evidence-based medicine could support the conception of international recommendations for VBAC, which may improve both safety and efficacy of this procedure.
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22
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Mu Y, Li X, Zhu J, Liu Z, Li M, Deng K, Deng C, Li Q, Kang L, Wang Y, Liang J. Prior caesarean section and likelihood of vaginal birth, 2012-2016, China. Bull World Health Organ 2018; 96:548-557. [PMID: 30104795 PMCID: PMC6083396 DOI: 10.2471/blt.17.206433] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 05/14/2018] [Accepted: 06/08/2018] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To examine the trends and safety of vaginal birth after caesarean section around the period of the one-child policy relaxation in China. METHODS We used data from China's National Maternal Near Miss Surveillance System between 2012 and 2016. To examine trends in vaginal birth after caesarean section, we used Poisson regression with a robust variance estimator. We also assessed the association between vaginal birth after caesarean section and maternal and perinatal outcomes. FINDINGS We analysed 871 636 deliveries by women with a previous caesarean section. Both in 2012 and 2016, the rate of vaginal birth after caesarean section was 9.8%. After adjusting for institutional, sociodemographic and obstetric characteristics, the rate increased by 14% between 2012 and 2016 (adjusted relative risk, aRR: 1.14; 95% confidence interval, CI: 1.07-1.21). Compared to women with a repeat caesarean section, women with a vaginal birth after caesarean section experienced lower incidence of uterine rupture (aRR: 0.26, 95% CI: 0.16-0.42), blood transfusion (aRR: 0.68, 95% CI: 0.53-0.87) and admission to the intensive care unit (aRR: 0.36, 95% CI: 0.25-0.52), but higher incidence of intrapartum stillbirths, (aRR: 7.20, 95% CI: 6.09-8.51), newborns with a 5-minute Apgar score less than 7 (aRR: 1.75, 95% CI: 1.54-1.99) and neonatal death before discharge (aRR: 1.90, 95% CI: 1.61-2.24). CONCLUSION Promotion of vaginal birth after caesarean section could increase the rate even further in China. To ensure the safety of mothers and their newborns, national policies and guidelines on vaginal birth after caesarean section are needed.
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Affiliation(s)
- Yi Mu
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xiaohong Li
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Jun Zhu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Zheng Liu
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Mingrong Li
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Kui Deng
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Changfei Deng
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Qi Li
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Leni Kang
- National Office for Maternal and Child Health Surveillance of China, Department of Paediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yanping Wang
- National Office for Maternal and Child Health Surveillance of China, Department of Paediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Juan Liang
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
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23
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Chen SW, Hutchinson AM, Nagle C, Bucknall TK. Women's decision-making processes and the influences on their mode of birth following a previous caesarean section in Taiwan: a qualitative study. BMC Pregnancy Childbirth 2018; 18:31. [PMID: 29343215 PMCID: PMC5773050 DOI: 10.1186/s12884-018-1661-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 01/07/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Vaginal birth after caesarean (VBAC) is an alternative option for women who have had a previous caesarean section (CS); however, uptake is limited because of concern about the risks of uterine rupture. The aim of this study was to explore women's decision-making processes and the influences on their mode of birth following a previous CS. METHODS A qualitative approach was used. The research comprised three stages. Stage I consisted of naturalistic observation at 33-34 weeks' gestation. Stage II involved interviews with pregnant women at 35-37 weeks' gestation. Stage III consisted of interviews with the same women who were interviewed postnatally, 1 month after birth. The research was conducted in a private medical centre in northern Taiwan. Using a purposive sampling, 21 women and 9 obstetricians were recruited. Data collection involved in-depth interviews, observation and field notes. Constant comparative analysis was employed for data analysis. RESULTS Ensuring the safety of mother and baby was the focus of women's decisions. Women's decisions-making influences included previous birth experience, concern about the risks of vaginal birth, evaluation of mode of birth, current pregnancy situation, information resources and health insurance. In communicating with obstetricians, some women complied with obstetricians' recommendations for repeat caesarean section (RCS) without being informed of alternatives. Others used four step decision-making processes that included searching for information, listening to obstetricians' professional judgement, evaluating alternatives, and making a decision regarding mode of birth. After birth, women reflected on their decisions in three aspects: reflection on birth choices; reflection on factors influencing decisions; and reflection on outcomes of decisions. CONCLUSIONS The health and wellbeing of mother and baby were the major concerns for women. In response to the decision-making influences, women's interactions with obstetricians regarding birth choices varied from passive decision-making to shared decision-making. All women have the right to be informed of alternative birthing options. Routine provision of explanations by obstetricians regarding risks associated with alternative birth options, in addition to financial coverage for RCS from National Health Insurance, would assist women's decision-making. Establishment of a website to provide women with reliable information about birthing options may also assist women's decision-making.
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Affiliation(s)
- Shu-Wen Chen
- Deakin University, Faculty of Health, School of Nursing and Midwifery, Geelong, Australia.
- National Taipei University of Nursing and Health Science, School of Nursing, Taipei, Taiwan.
| | - Alison M Hutchinson
- Deakin University, Faculty of Health, School of Nursing and Midwifery, Geelong, Australia
- Centre for Quality and Patient Safety Research-Monash Health Partnership, Clayton, Australia
| | - Cate Nagle
- James Cook University & Townsville Hospital and Health Service, School of Nursing and Midwifery, Townsville, Australia
| | - Tracey K Bucknall
- Deakin University, Faculty of Health, School of Nursing and Midwifery, Geelong, Australia
- Centre for Quality and Patient Safety Research- Alfred Health Partnership, Melbourne, Australia
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24
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Chaillet N, Bujold E, Masse B, Grobman WA, Rozenberg P, Pasquier JC, Shorten A, Johri M, Beaudoin F, Abenhaim H, Demers S, Fraser W, Dugas M, Blouin S, Dubé E, Gauthier R. A cluster-randomized trial to reduce major perinatal morbidity among women with one prior cesarean delivery in Québec (PRISMA trial): study protocol for a randomized controlled trial. Trials 2017; 18:434. [PMID: 28931404 PMCID: PMC5608183 DOI: 10.1186/s13063-017-2150-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 08/15/2017] [Indexed: 11/10/2022] Open
Abstract
Background Rates of cesarean delivery are continuously increasing in industrialized countries, with repeated cesarean accounting for about a third of all cesareans. Women who have undergone a first cesarean are facing a difficult choice for their next pregnancy, i.e.: (1) to plan for a second cesarean delivery, associated with higher risk of maternal complications than vaginal delivery; or (b) to have a trial of labor (TOL) with the aim to achieve a vaginal birth after cesarean (VBAC) and to accept a significant, but rare, risk of uterine rupture and its related maternal and neonatal complications. The objective of this trial is to assess whether a multifaceted intervention would reduce the rate of major perinatal morbidity among women with one prior cesarean. Methods/design The study is a stratified, non-blinded, cluster-randomized, parallel-group trial of a multifaceted intervention. Hospitals in Quebec are the units of randomization and women are the units of analysis. As depicted in Figure 1, the study includes a 1-year pre-intervention period (baseline), a 5-month implementation period, and a 2-year intervention period. At the end of the baseline period, 20 hospitals will be allocated to the intervention group and 20 to the control group, using a randomization stratified by level of care. Medical records will be used to collect data before and during the intervention period. Primary outcome is the rate of a composite of major perinatal morbidities measured during the intervention period. Secondary outcomes include major and minor maternal morbidity; minor perinatal morbidity; and TOL and VBAC rate. The effect of the intervention will be assessed using the multivariable generalized-estimating-equations extension of logistic regression. The evaluation will include subgroup analyses for preterm and term birth, and a cost-effectiveness analysis. Discussion The intervention is designed to facilitate: (1) women’s decision-making process, using a decision analysis tool (DAT), (2) an estimate of uterine rupture risk during TOL using ultrasound evaluation of low-uterine segment thickness, (3) an estimate of chance of TOL success, using a validated prediction tool, and (4) the implementation of best practices for intrapartum management. Trial registration Current Controlled Trials, ID: ISRCTN15346559. Registered on 20 August 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2150-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- N Chaillet
- Department of Obstetrics and Gynaecology, Laval University, Quebec, QC, Canada. .,Faculté de Médecine, Département d'Obstétrique & Gynécologie, Université Laval, Centre de recherche du CHUQ, 2705, Boul. Laurier, local T-R-92, Quebec, QC, G1V 4G2, Canada.
| | - E Bujold
- Department of Obstetrics and Gynaecology, Laval University, Quebec, QC, Canada
| | - B Masse
- Department of Epidemiology and Biostatistics, University of Montréal, Montréal, QC, Canada
| | - W A Grobman
- Department of Obstetrics and Gynaecology, Northwestern University, Chicago, IL, USA
| | - P Rozenberg
- Service de gynécologie obstétrique et médecine de la reproduction, Centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye, 10, rue du Champ-Gaillard, 78303, Poissy, France
| | - J C Pasquier
- Department of Obstetrics and Gynecology, Sherbrooke University, Quebec, QC, Canada
| | - A Shorten
- UAB School of Nursing, University of Alabama, Birmingham, AL, USA
| | - M Johri
- University of Montreal, Hospital Research Center (CRCHUM), Montreal, QC, Canada
| | - F Beaudoin
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, QC, Canada
| | - H Abenhaim
- Department of Obstetrics and Gynecology, McGill University, Jewish Hospital, Montreal, QC, Canada
| | - S Demers
- Department of Obstetrics and Gynaecology, Laval University, Quebec, QC, Canada
| | - W Fraser
- Department of Obstetrics and Gynecology, Sherbrooke University, Quebec, QC, Canada
| | - M Dugas
- Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre, Quebec, QC, Canada
| | - S Blouin
- Department of Obstetrics and Gynaecology, Laval University, Quebec, QC, Canada
| | - E Dubé
- Department of Obstetrics and Gynaecology, Laval University, Quebec, QC, Canada
| | - R Gauthier
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, QC, Canada
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Uterine Rupture at 21 Weeks in Twin Pregnancy with TTTS and Previous C-Section. Case Rep Obstet Gynecol 2017; 2017:2690675. [PMID: 28840046 PMCID: PMC5559912 DOI: 10.1155/2017/2690675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 07/06/2017] [Indexed: 11/17/2022] Open
Abstract
Uterine rupture is a health problem in every country. The diagnosis is not always obvious and fetal and maternal morbidity and mortality can be high.
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Li WH, Yang MJ, Wang PH, Juang CM, Chang YW, Wang HI, Chen CY, Yen MS. Vaginal birth after cesarean section: 10 years of experience in a tertiary medical center in Taiwan. Taiwan J Obstet Gynecol 2017; 55:394-8. [PMID: 27343322 DOI: 10.1016/j.tjog.2016.04.016] [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] [Accepted: 02/12/2015] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Because of the increased risk of uterine rupture and other morbidities, instances of trial of labor after cesarean (TOLAC) have decreased in number each year. Nevertheless, under careful assessment and advanced medical care, TOLAC is still a safe option for delivery. The objective of this study is to find the factors that impact the success rate for TOLAC and to compare the results with Taiwan national registry data. MATERIALS AND METHODS A longitudinal cohort study that includes a total of 254 cases of women receiving TOLAC in a tertiary medical center over a period of 10 years. RESULTS A total of 254 participants who underwent TOLAC, which accounts for 1.67% of total labor instances (254/15,166), were enrolled for analysis. The success rate of TOLAC was found to be 80.70% (205/254), including 146 (57.5%) normal deliveries, 45 (17.7%) vacuum-assisted deliveries, and 14 (5.5%) forceps-assisted deliveries. The conversion rate to cesarean section was 19.3%. There were no uterine rupture cases in our study, and there were only two suspected cases, which turned out to have no actual rupture. When analyzing the factors affecting the results of TOLAC, we found that a successfully spontaneously delivered baby had a lower birth weight than the failed TOLAC cases that were converted to cesarean delivery (mean, 2989 g vs. 3379 g; p < 0.001). Among the patients who were converted to cesarean section, the most common reason was dysfunctional labor (79.6%), followed by fetal distress (14.3%). CONCLUSION Under intensive care and observation, TOLAC section may still be a feasible choice. Nevertheless, the body weight of the baby has been shown to be a factor that can influence the success rate.
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Affiliation(s)
- Wai-Hou Li
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Jie Yang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - Chi-Mou Juang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - Yi-Wen Chang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsing-I Wang
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Taipei Mackay Memorial Hospital, Taipei, Taiwan
| | - Chih-Yao Chen
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang-Ming University, School of Medicine, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Ming-Shyen Yen
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang-Ming University, School of Medicine, Taipei, Taiwan
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Rogers AJ, Rogers NG, Kilgore ML, Subramaniam A, Harper LM. Economic Evaluations Comparing a Trial of Labor with an Elective Repeat Cesarean Delivery: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:163-173. [PMID: 28212958 PMCID: PMC5319694 DOI: 10.1016/j.jval.2016.08.738] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 08/01/2016] [Accepted: 08/19/2016] [Indexed: 05/16/2023]
Abstract
BACKGROUND For women who have had a previous low transverse cesarean delivery, the decision to undergo a trial of labor after cesarean (TOLAC) or an elective repeat cesarean delivery (ERCD) has important clinical and economic ramifications. OBJECTIVES To evaluate the cost-effectiveness of the alternative choices of a TOLAC and an ERCD for women with low-risk, singleton gestation pregnancies. METHODS We searched EMBASE, MEDLINE, CINAHL, Cochrane Library, EconLit, and the Cost-Effectiveness Analysis Registry with no language, publication, or date restrictions up until October 2015. Studies were included if they were primary research, compared a TOLAC with an ERCD, and provided information on the relative cost of the alternatives. Abstracts and partial economic evaluations were excluded. RESULTS Of 310 studies initially reviewed, 7 studies were included in the systematic review. In the base-case analyses, 4 studies concluded that TOLAC was dominant over ERCD, 1 study found ERCD to be dominant, and 2 studies found that although TOLAC was more costly, it offered more benefits and was thus cost-effective from a population perspective when considering societal willingness to pay for better outcomes. In sensitivity analyses, cost-effectiveness was found to be dependent on a high likelihood of TOLAC success, low risk of uterine rupture, and low relative cost of TOLAC compared with ERCD. CONCLUSIONS For women who are likely to have a successful vaginal delivery, routine ERCD may result in excess morbidity and cost from a population perspective.
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Affiliation(s)
- Anna Joy Rogers
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Nathaniel G Rogers
- Departments of Medicine and Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Meredith L Kilgore
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Akila Subramaniam
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lorie M Harper
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Gonsalves H, Al-Riyami N, Al-Dughaishi T, Gowri V, Al-Azri M, Salahuddin A. Use of Intracervical Foley Catheter for Induction of Labour in Cases of Previous Caesarean Section: Experience of a single tertiary centre in Oman. Sultan Qaboos Univ Med J 2016; 16:e445-e450. [PMID: 28003890 DOI: 10.18295/squmj.2016.16.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 07/19/2016] [Accepted: 08/02/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate rates of success and perinatal complications of labour induction using an intracervical Foley catheter among women with a previous Caesarean delivery at a tertiary centre in Oman. METHODS This retrospective cohort study included 68 pregnant women with a history of a previous Caesarean section who were admitted for induction via Foley catheter between January 2011 and December 2013 to the Sultan Qaboos University Hospital, Muscat, Oman. Patient data were collected from electronic and delivery ward records. RESULTS Most women were 25-35 years old (76.5%) and 20 women had had one previous vaginal delivery (29.4%). The most common indication for induction of labour was intrauterine growth restriction with oligohydramnios (27.9%). Most women delivered after 40 gestational weeks (48.5%) and there were no neonatal admissions or complications. The majority experienced no complications during the induction period (85.3%), although a few had vaginal bleeding (5.9%), intrapartum fever (4.4%), rupture of the membranes (2.9%) and cord prolapse shortly after insertion of the Foley catheter (1.5%). However, no cases of uterine rupture or scar dehiscence were noted. Overall, the success rate of vaginal birth after a previous Caesarean delivery was 69.1%, with the remaining patients undergoing an emergency Caesarean section (30.9%). CONCLUSION The use of a Foley catheter in the induction of labour in women with a previous Caesarean delivery appears a safe option with a good success rate and few maternal and fetal complications.
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Affiliation(s)
- Hazel Gonsalves
- Department of Obstetrics & Gynaecology, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Nihal Al-Riyami
- Department of Obstetrics & Gynaecology, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Tamima Al-Dughaishi
- Department of Obstetrics & Gynaecology, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Vaidayanathan Gowri
- Department of Obstetrics & Gynaecology, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Mohammed Al-Azri
- Department of Family Medicine & Public Health, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Ayesha Salahuddin
- Department of Obstetrics & Gynaecology, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
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Modest Rise in Caesarean Section from 2000-2010: The Dutch Experience. PLoS One 2016; 11:e0155565. [PMID: 27192534 PMCID: PMC4871460 DOI: 10.1371/journal.pone.0155565] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 04/29/2016] [Indexed: 11/19/2022] Open
Abstract
Background The caesarean delivery (CD) rate has risen in most countries over the last decades, but it remains relatively low in the Netherlands. Our objective was to analyse the trends of CD rates in various subgroups of women between 2000 and 2010, and identify the practice pattern that is attributable to the relative stability of the Dutch CD rate. Methods A total of 1,935,959 women from the nationwide Perinatal Registry of the Netherlands were included. Women were categorized into ten groups based on the modified CD classification scheme. Trends of CD rates in each group were described. Results The overall CD rate increased slightly from 14.0% in 2000–2001 to 16.7% in 2010. Fetal, early and late neonatal mortality rates decreased by 40–50% from 0.53%, 0.21%, 0.04% in 2000–2001 to 0.29%, 0.12%, 0.02% in 2010, respectively. During this period, the prevalence of non-vertex presentation decreased from 6.7% to 5.3%, even though the CD rate in this group was high. The nulliparous women with spontaneous onset of labor at term and a singleton child in vertex presentation had a CD rate of 9.9%, and 64.7% of multiparous women with at least one previous uterine scar and a singleton child in vertex presentation had a trial of labor and the success rate of vaginal delivery was 45.9%. Conclusions The Dutch experience indicates that external cephalic version for breech presentation, keeping the CD rate low in nulliparous women and encouraging a trial of labor in multiparous women with a previous scar, could help to keep the overall CD rate steady.
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Jastrow N, Vikhareva O, Gauthier RJ, Irion O, Boulvain M, Bujold E. Can third-trimester assessment of uterine scar in women with prior Cesarean section predict uterine rupture? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:410-414. [PMID: 26483275 DOI: 10.1002/uog.15786] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 09/28/2015] [Accepted: 10/06/2015] [Indexed: 06/05/2023]
Affiliation(s)
- N Jastrow
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Hôpitaux Universitaires de Genève, Université de Genève, Genève, Switzerland
| | - O Vikhareva
- Department of Obstetrics and Gynaecology, Skane University Hospital Malmö, Lund University, Malmö, Sweden
| | - R J Gauthier
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Hôpital Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - O Irion
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Hôpitaux Universitaires de Genève, Université de Genève, Genève, Switzerland
| | - M Boulvain
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Hôpitaux Universitaires de Genève, Université de Genève, Genève, Switzerland
| | - E Bujold
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Centre de Recherche du Centre Hospitalier Universitaire de Québec, Université Laval, Québec, QC, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
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Sinclair JL, Brown HC. Active management of spontaneous labour versus routine care in women who have had one or more previous caesarean sections. Hippokratia 2015. [DOI: 10.1002/14651858.cd010046.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Joanna L Sinclair
- Tunbridge Wells Hospital; Department of Obstetrics and Gynaecology; Tonbridge Road Tunbridge Wells Kent UK TN2 4QJ
| | - Heather C Brown
- Royal Sussex County Hospital; Department of Obstetrics and Gynaecology; Eastern Road Brighton UK BN2 5BE
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Fagerberg MC, Maršál K, Källén K. Predicting the chance of vaginal delivery after one cesarean section: validation and elaboration of a published prediction model. Eur J Obstet Gynecol Reprod Biol 2015; 188:88-94. [DOI: 10.1016/j.ejogrb.2015.02.031] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Revised: 01/25/2015] [Accepted: 02/19/2015] [Indexed: 12/01/2022]
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Vaginal birth after cesarean success in high-risk women: a population-based study. J Perinatol 2015; 35:252-7. [PMID: 25341198 DOI: 10.1038/jp.2014.196] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 06/22/2014] [Accepted: 09/03/2014] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The study aim was to identify factors associated with vaginal birth after cesarean (VBAC) in high-risk women. STUDY DESIGN This is a population-based retrospective cohort study of all births in Ohio during 2006 and 2007. High-risk patients were defined as singleton gestations in women with one previous cesarean who had ⩾1 of the following risk factors: body mass index (BMI)⩾30, hypertension, or diabetes. Multivariate logistic regression was utilized to estimate the relative influence of each factor on successful VBAC. RESULT A total of 280 882 births were analyzed: of them, 79 084 (27.1%) were high-risk pregnancies and 8658 (10.9%) women had undergone one previous cesarean; 1433 (16.6%) underwent a trial of labor after cesarean (TOLAC). Of them, 974 (68.0%) had a successful VBAC, whereas 459 (32.0%) did not. Factors significantly associated with VBAC success were as follows: a prior vaginal delivery; pregnancy weight gain ⩽30 lbs; Caucasian race; and labor augmentation. CONCLUSION High-risk women with one prior cesarean are unlikely to undergo a TOLAC, but have a high rate of VBAC.
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Annessi E, Del Giovane C, Magnani L, Carossino E, Baldoni G, Battagliarin G, Accorsi P, Fabio F. A modified prediction model for VBAC, in a European population. J Matern Fetal Neonatal Med 2015; 29:435-9. [PMID: 25586316 DOI: 10.3109/14767058.2014.1002767] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The first aim of the study is to validate the Grobman's Nomogram on Italian population, and then to include other variables with the purpose to increase the accuracy of the Nomogram. METHODS This is a multicenter study in which eligible subjects were pregnant women reaching term having one prior cesarean section (CS) and then choosing for a trial of labor. Multivariate logistic regression model have been performed, and then the predicted percentages of vaginal delivery (VD) success were divided into 10 groups and compared with the observed ones. RESULTS Among 1161 women, 1100 were enrolled, of which 857 (77.9%) delivered vaginally. At the multivariate logistic regression, the variables predicting vaginal birth after cesarean (VBAC) in the validation were maternal age (p < 0.001), maternal body mass index (p = 0.007), having had a VD (p = 0.008) and recurring indication for CS (p < 0.001). By adding the two new variables in the proposed model, was reached the significance of "African ethnicity" (p = 0.037) and especially "years of education" (p = 0.032). CONCLUSIONS The Grobman's Nomogram seems to be applicable to Italian population too, even if with less accuracy than in the US population. The addition of the level of maternal education increases the accuracy of the model, underlining the importance of the social context in the choice of VBAC.
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Affiliation(s)
- Eleonora Annessi
- a Mother-Infant Department , University of Modena and Reggio Emilia , Modena , Italy
| | - Cinzia Del Giovane
- b Statistics Unit, Department of Clinical and Diagnostic Medicine and Public Health , University of Modena and Reggio Emilia , Modena , Italy
| | - Laura Magnani
- c Obstetrics and Gynaecological Ward, Community Hospital "Infermi" of Rimini , Rimini , Italy , and
| | - Emanuela Carossino
- d Obstetrics and Gynaecological Ward, Community Hospital "Ramazzini" of Carpi , Modena , Italy
| | - Giulia Baldoni
- a Mother-Infant Department , University of Modena and Reggio Emilia , Modena , Italy
| | - Giuseppe Battagliarin
- c Obstetrics and Gynaecological Ward, Community Hospital "Infermi" of Rimini , Rimini , Italy , and
| | - Paolo Accorsi
- d Obstetrics and Gynaecological Ward, Community Hospital "Ramazzini" of Carpi , Modena , Italy
| | - Facchinetti Fabio
- a Mother-Infant Department , University of Modena and Reggio Emilia , Modena , Italy
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Fagerberg MC, Maršál K, Ekström P, Källén K. Indications for first caesarean and delivery mode in subsequent trial of labour. Paediatr Perinat Epidemiol 2013; 27:72-80. [PMID: 23215714 DOI: 10.1111/ppe.12024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND A previous caesarean delivery is no longer an indication per se for a subsequent, planned caesarean. We performed this study to identify women suitable for trial of labour after caesarean (TOLAC), investigating the association between the indication for the first caesarean and the risk of unplanned caesarean in the second pregnancy. METHODS We identified women with their first two pregnancies registered in the Swedish Medical Birth Registry 1992-2007. The indications for caesarean in the first pregnancy were determined using a previously published hierarchical system. For each indication group, the rate of caesarean among women with a first caesarean (n = 59 643) and a TOLAC in the second pregnancy was compared with that of primiparae (parity 0) (n = 354 053). RESULTS The TOLAC rate was 69.5%. Among women with TOLAC, the uterine rupture rate was 1.1%. The success rate of TOLAC varied substantially based on the indication for the first caesarean (range 51-83%). Multiple births, breech presentation, and placenta praevia in the first pregnancy were associated with marginally increased odds of unplanned caesarean in the second pregnancy when compared with primiparae (adjusted OR 1.27 [95% CI 1.10, 1.48], 1.42 [1.34, 1.51], and 1.65 [1.17, 2.31]; OR, odds ratio; CI, confidence interval). The indications based on complications during labour/delivery, macrosomia, and maternal diabetes, were associated with substantially increased OR: 3.87 [3.70, 4.06], 4.15 [3.74, 4.61], and 4.62 [3.79, 5.63], respectively. CONCLUSIONS Considering the indications for caesarean in the first pregnancy before recommending a TOLAC or a planned caesarean in the second pregnancy may help to lower the rate of unplanned caesarean deliveries.
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Affiliation(s)
- Marie C Fagerberg
- Department of Obstetrics and Gynaecology, Ystad Hospital, Ystad, Sweden.
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Chu K, Cortier H, Maldonado F, Mashant T, Ford N, Trelles M. Cesarean section rates and indications in sub-Saharan Africa: a multi-country study from Medecins sans Frontieres. PLoS One 2012; 7:e44484. [PMID: 22962616 PMCID: PMC3433452 DOI: 10.1371/journal.pone.0044484] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 08/08/2012] [Indexed: 11/19/2022] Open
Abstract
Objectives The World Health Organization considers Cesarean section rates of 5–15% to be the optimal range for targeted provision of this life saving intervention. However, access to safe Cesarean section in resource-limited settings is much lower, estimated at 1–2% reported in sub-Saharan Africa. This study reports Cesarean sections rates and indications in Democratic Republic of Congo, Burundi, and Sierra Leone, and describe the main parameters associated with maternal and early neonatal mortality. Methods Women undergoing Cesarean section from August 1 2010 to January 31 2011 were included in this prospective study. Logistic regression was used to model determinants of maternal and early neonatal mortality. Results 1276 women underwent a Cesarean section, giving a frequency of 6.2% (range 4.1–16.8%). The most common indications were obstructed labor (399, 31%), poor presentation (233, 18%), previous Cesarean section (184, 14%), and fetal distress (128, 10%), uterine rupture (117, 9%) and antepartum hemorrhage (101, 8%). Parity >6 (adjusted odds ratio [aOR] = 8.6, P = 0.015), uterine rupture (aOR = 20.5; P = .010), antepartum hemorrhage (aOR = 13.1; P = .045), and pre-eclampsia/eclampsia (aOR = 42.9; P = .017) were associated with maternal death. Uterine rupture (aOR = 6.6, P<0.001), anterpartum hemorrhage (aOR = 3.6, P<0.001), and cord prolapse (aOR = 2.7, P = 0.017) were associated with early neonatal death. Conclusions This study demonstrates that target Cesarean section rates can be achieved in sub-Saharan Africa. Identifying the common indications for Cesarean section and associations with mortality can target improvements in antenatal services and emergency obstetric care.
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Affiliation(s)
- Kathryn Chu
- Médecins sans Frontières, Johannesburg, South Africa.
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Chen MM, Hancock H. Women's knowledge of options for birth after Caesarean Section. Women Birth 2012; 25:e19-26. [DOI: 10.1016/j.wombi.2011.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 07/22/2011] [Accepted: 08/04/2011] [Indexed: 10/17/2022]
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C Warren F, R Abrams K, Golder S, J Sutton A. Systematic review of methods used in meta-analyses where a primary outcome is an adverse or unintended event. BMC Med Res Methodol 2012; 12:64. [PMID: 22553987 PMCID: PMC3528446 DOI: 10.1186/1471-2288-12-64] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 04/16/2012] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Adverse consequences of medical interventions are a source of concern, but clinical trials may lack power to detect elevated rates of such events, while observational studies have inherent limitations. Meta-analysis allows the combination of individual studies, which can increase power and provide stronger evidence relating to adverse events. However, meta-analysis of adverse events has associated methodological challenges. The aim of this study was to systematically identify and review the methodology used in meta-analyses where a primary outcome is an adverse or unintended event, following a therapeutic intervention. METHODS Using a collection of reviews identified previously, 166 references including a meta-analysis were selected for review. At least one of the primary outcomes in each review was an adverse or unintended event. The nature of the intervention, source of funding, number of individual meta-analyses performed, number of primary studies included in the review, and use of meta-analytic methods were all recorded. Specific areas of interest relating to the methods used included the choice of outcome metric, methods of dealing with sparse events, heterogeneity, publication bias and use of individual patient data. RESULTS The 166 included reviews were published between 1994 and 2006. Interventions included drugs and surgery among other interventions. Many of the references being reviewed included multiple meta-analyses with 44.6% (74/166) including more than ten. Randomised trials only were included in 42.2% of meta-analyses (70/166), observational studies only in 33.7% (56/166) and a mix of observational studies and trials in 15.7% (26/166). Sparse data, in the form of zero events in one or both arms where the outcome was a count of events, was found in 64 reviews of two-arm studies, of which 41 (64.1%) had zero events in both arms. CONCLUSIONS Meta-analyses of adverse events data are common and useful in terms of increasing the power to detect an association with an intervention, especially when the events are infrequent. However, with regard to existing meta-analyses, a wide variety of different methods have been employed, often with no evident rationale for using a particular approach. More specifically, the approach to dealing with zero events varies, and guidelines on this issue would be desirable.
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Affiliation(s)
- Fiona C Warren
- Peninsula College of Medicine and Dentistry, St Luke’s Campus, University of Exeter, Exeter, EX1 2LU, UK
| | - Keith R Abrams
- Department of Health Sciences, Adrian Building, University of Leicester, University Road, Leicester, LE1 7RH, UK
| | - Su Golder
- Centre for Reviews and Dissemination (CRD), University of York, York, YO10 5DD, UK
| | - Alex J Sutton
- Department of Health Sciences, Adrian Building, University of Leicester, University Road, Leicester, LE1 7RH, UK
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Fruscalzo A, Salmeri MG, Cendron A, Londero AP, Zanni G. Introducing routine trial of labour after caesarean section in a second level hospital setting. J Matern Fetal Neonatal Med 2011; 25:1442-6. [DOI: 10.3109/14767058.2011.640367] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Al Sakka M, Daulah W, Al Maslamani K. Rupture of the Gravid Utensis. Qatar Med J 2011. [DOI: 10.5339/qmj.2011.2.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Records were reviewed of 81 cases of ruptured gravid uteri seen in the hospitals of Hamad Medical Corporation, Doha, in the 32 years 1977–2008, an overall incidence of 0.025%, although the incidence 1977–1997 was 0.01 % and that of 1998–2008 was 0.036%. Grand multiparity was a prominent cause (56.5%) in the first 21 years but less so in the later period 1998–2008 (10%) although involvement of a uterine scar from a previous caesarian section was noted more (84%) in the later period than in 1977– 1997 (43.5%). Other associated factors were the use of oxytocin or PGE2. Epidural anesthesia in the later period might have provoked abnormal fetal heart rates. The need for hysterectomy decreased from 65% to 10%. Perinatal mortality decreased slightly. Although we conclude that uterine rupture is rare (0.025%) it can be catastrophic for mother and newborn and might be prevented by multi-layer uterine hysterotomy closure, a longer interpregnancy interval following a caesarian section, and no or limited use of prostaglandins.
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Affiliation(s)
- M. Al Sakka
- *Obstetrics and Gynecology Department, Women's Hospital
| | - W. Daulah
- **Obstetrics and Gynecology Department, Al Khor Hospital, Hamad Medical Corporation, Doha, Qatar
| | - K.H. Al Maslamani
- **Obstetrics and Gynecology Department, Al Khor Hospital, Hamad Medical Corporation, Doha, Qatar
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Budin WC. Turning the tide for birth. J Perinat Educ 2011; 19:1-3. [PMID: 20498750 DOI: 10.1624/105812410x495479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In this column, the editor of The Journal of Perinatal Education discusses the escalating cesarean surgery rate and the need for evidence-based practice changes that support vaginal birth after cesarean. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote natural, safe, and healthy birth practices.
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Affiliation(s)
- Wendy C Budin
- WENDY C. BUDIN is the editor-in-chief of The Journal of Perinatal Education. She is also the director of nursing research at NYU Langone Medical Center and a clinical professor at New York University, College of Nursing. She is a fellow in the American College of Childbirth Educators and is currently chair of the Lamaze International Certification Council
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Latendresse G, Murphy PA, Fullerton JT. A Description of the Management and Outcomes of Vaginal Birth After Cesarean Birth in the Homebirth Setting. J Midwifery Womens Health 2010; 50:386-91. [PMID: 16154065 DOI: 10.1016/j.jmwh.2005.02.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Our objective was to describe the outcomes of intended home birth among 57 women with a previous cesarean birth. Data were drawn from a larger prospective study of intended homebirth in nurse-midwifery practice. Available data included demographics, perinatal risk information, and outcomes of prenatal, intrapartum, postpartum, and neonatal care. The hospital course was reviewed for those transferred to the hospital setting. Fifty-three of 57 women (93%) had a spontaneous vaginal birth, 1 had a vacuum-assisted birth, and 3 (5.3%) had a repeat cesarean birth. Thirty-one of 32 (97%) women who had a previous vaginal birth after cesarean birth (VBAC) had a successful VBAC; 22 of 25 (88%) women without a history of VBAC successfully delivered vaginally. Fifty (87.7%) of these women delivered in the home setting, whereas 7 (12.3%) delivered in the hospital setting. None of the women experienced uterine rupture or dehiscence. One infant was stillborn. This event was attributed to a postdates pregnancy with meconium. Certified nurse-midwives with homebirth practices must be knowledgeable about the risks for mother and baby, screen clientele appropriately, and be able to counsel patients with regard to potential adverse outcomes. Given what is presently known, VBAC is not recommended in the homebirth setting. It is imperative in the light of current evidence and practice climate to advocate for the availability of certified nurse-midwife services and woman-centered care in the hospital setting.
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Affiliation(s)
- Gwen Latendresse
- University of Utah College of Nursing, Salt Lake City, UT 84112-5880, USA
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Souza JP, Gülmezoglu A, Lumbiganon P, Laopaiboon M, Carroli G, Fawole B, Ruyan P. Caesarean section without medical indications is associated with an increased risk of adverse short-term maternal outcomes: the 2004-2008 WHO Global Survey on Maternal and Perinatal Health. BMC Med 2010; 8:71. [PMID: 21067593 PMCID: PMC2993644 DOI: 10.1186/1741-7015-8-71] [Citation(s) in RCA: 378] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Accepted: 11/10/2010] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND There is worldwide debate about the appropriateness of caesarean sections performed without medical indications. In this analysis, we aim to further investigate the relationship between caesarean section without medical indication and severe maternal outcomes. METHODS This is a multicountry, facility-based survey that used a stratified multistage cluster sampling design to obtain a sample of countries and health institutions worldwide. A total of 24 countries and 373 health facilities participated in this study. Data collection took place during 2004 and 2005 in Africa and the Americas and during 2007 and 2008 in Asia. All women giving birth at the facility during the study period were included and had their medical records reviewed before discharge from the hospital. Univariate and multilevel analysis were performed to study the association between each group's mode of delivery and the severe maternal and perinatal outcome. RESULTS A total of 286,565 deliveries were analysed. The overall caesarean section rate was 25.7% and a total of 1.0 percent of all deliveries were caesarean sections without medical indications, either due to maternal request or in the absence of other recorded indications. Compared to spontaneous vaginal delivery, all other modes of delivery presented an association with the increased risk of death, admission to ICU, blood transfusion and hysterectomy, including antepartum caesarean section without medical indications (Adjusted Odds Ratio (Adj OR), 5.93, 95% Confidence Interval (95% CI), 3.88 to 9.05) and intrapartum caesarean section without medical indications (Adj OR, 14.29, 95% CI, 10.91 to 18.72). In addition, this association is stronger in Africa, compared to Asia and Latin America. CONCLUSIONS Caesarean sections were associated with an intrinsic risk of increased severe maternal outcomes. We conclude that caesarean sections should be performed when a clear benefit is anticipated, a benefit that might compensate for the higher costs and additional risks associated with this operation.
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Affiliation(s)
- J P Souza
- UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland.
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Affiliation(s)
- Liz Baxter
- Corbar Birth Centre, Buxton, Stockport NHS Foundation Trust,
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Normalizing birth in England: a qualitative study. J Midwifery Womens Health 2010; 55:262-9. [PMID: 20434087 DOI: 10.1016/j.jmwh.2010.01.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 01/01/2010] [Accepted: 01/27/2010] [Indexed: 11/22/2022]
Abstract
INTRODUCTION This study examined factors that foster or hinder the support of normal birth in two English National Health Service Trusts identified for public recognition of their work to normalize birth. METHODS This interpretative qualitative study was guided by institutional ethnographic and narrative methods. Purposive sampling was conducted to achieve maximal variation across social, demographic, cultural and ethnic groups. In-depth interviews explored clinician's and women's views and experiences of normal birth. Ethnographic observations of practice, clinical and administrative meetings, educational sessions, and informal discussions were conducted over 6 months at one of the maternity settings. Antenatal and intrapartum clinical guidelines were reviewed and analyzed. RESULTS Three key strategies supported the normalization of birth: 1) an "ethos" of normality; 2) "working" the evidence; and 3) "trusting" women to make informed choices best for them. Inappropriate use of technology, disregarding risk status when assigning women to units, lack of physician preparation in normal birth, and poor staffing levels were cited as barriers. DISCUSSION These strategies should be carefully examined for translation to the United States and future research.
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Sharma PS, Eden KB, Guise JM, Jimison HB, Dolan JG. Subjective risk vs. objective risk can lead to different post-cesarean birth decisions based on multiattribute modeling. J Clin Epidemiol 2010; 64:67-78. [PMID: 20558035 DOI: 10.1016/j.jclinepi.2010.02.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Revised: 02/03/2010] [Accepted: 02/13/2010] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare birth recommendations for pregnant women with a prior cesarean produced from a decision model using absolute risks vs. one using subjective interpretation of the same risks: (1) a multiattribute decision model based on patient prioritization of risks (subjective risk) and (2) a hybrid model that used absolute risks (objective risk). STUDY DESIGN AND SETTING The subjective risk multiattribute model used the Analytic Hierarchy Process to elicit priorities for maternal risks, neonatal risks, and the delivery experience from 96 postnatal women with a prior cesarean. The hybrid model combined the priorities for delivery experience obtained in the first model with the unadjusted absolute risk values. RESULTS The multiattribute model generated more recommendations for repeat cesarean delivery than the hybrid model: 73% vs. 18%, (P-value <0.001). The multiattribute model favored repeat cesarean because women heavily prioritized avoiding any risk (even rare risk) to the infant. The hybrid model favored the trial of labor because of lower probabilities of risk to the mother and its high success rate of vaginal birth after cesarean. CONCLUSION This study highlights the importance of patients and clinicians discussing the patient's priorities regarding the risks and other nonclinical considerations that may be important to her in the birthing decision.
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Affiliation(s)
- Poonam S Sharma
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR 97239-3098, USA.
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Carlsson Wallin M, Ekström P, Maršál K, Källén K. Apgar score and perinatal death after one previous caesarean delivery. BJOG 2010; 117:1088-97. [DOI: 10.1111/j.1471-0528.2010.02614.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Howell S, Johnston T, Macleod SL. Trends and determinants of caesarean sections births in Queensland, 1997-2006. Aust N Z J Obstet Gynaecol 2010; 49:606-11. [PMID: 20070708 DOI: 10.1111/j.1479-828x.2009.01100.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The determinants of Queensland's rising caesarean section (CS) rate remain poorly understood because of the historical absence of standard classification methods. AIMS We applied the Robson Ten Group Classification System (RTGCS) to population-based data to identify the main contributors to Queensland's rising CS rate. METHOD The RTGCS was applied retrospectively to the Queensland Perinatal Data Collection. CS rates were described for all ten RTGCS groups using data from 2006. Trends were evaluated using data for the years 1997-2006. Public and private sector patients were evaluated separately. RESULTS In Queensland, in 2006, CS rates were 26.9 and 48.0% among public and private sector patients, respectively. Multiparous women with a previous caesarean birth (Group 5) made the greatest contribution to the CS rate in both sectors, followed by nulliparous women who had labour induced or were delivered by CS prior to the onset of labour (Group 2) and nulliparous women in spontaneous labour (Group 1). CS rates have risen in all RTGCS groups between 1997 and 2006. The trend was pronounced among multiparous women with a previous caesarean delivery (Group 5), among women with multiple pregnancies (Group 8) and among nulliparous women who had labour induced or were delivered by CS prior to the onset of labour (Group 2). CONCLUSIONS The CS rate in Queensland in 2006 was higher than in any other Australian state. The increase in Queensland's CS rates can be attributed to both the rising number of primary caesarean births and the rising number of repeat caesareans.
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Affiliation(s)
- Stuart Howell
- Health Statistics Centre, Queensland Health, Forestry House, Brisbane, Queensland, Australia.
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Rozen G, Ugoni AM, Sheehan PM. A new perspective on VBAC: a retrospective cohort study. Women Birth 2010; 24:3-9. [PMID: 20447886 DOI: 10.1016/j.wombi.2010.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Revised: 04/12/2010] [Accepted: 04/12/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Previous studies assessing the safety of vaginal birth after caesarean section (VBAC) have compared VBAC to elective repeat caesarean section (ERCS), despite the fact that the risks posed by each are considerably different. Explaining the complications of VBAC in a way that is meaningful to women can be challenging, and thus a comparison to a similar group of women who have also not undergone previous vaginal delivery may be a more relevant comparison. RESEARCH QUESTION When counselling women undergoing planned VBAC, should a comparison of outcomes be made to women undergoing ERCS, or is a comparison to other nulliparous women undergoing vaginal birth a more valid comparison in terms of risk outcomes? PARTICIPANTS AND METHODS A retrospective cohort study was undertaken comprising a consecutive cohort of 21,389 women who delivered, stratified by Robson's criteria into Robson groups 1-5. Those in Robson groups 6-10 were not included. Demographic data and maternal/neonatal outcomes were reviewed, with main outcome measures comprising uterine rupture, post-partum haemorrhage (PPH), 3rd/4th degree tears and neonatal morbidity. RESULTS There was no increase in PPH, vaginal tears or neonatal complications in the VBAC group when compared to Robson groups 1 and 2 (nulliparous women in spontaneous or induced labour, respectively). Uterine rupture rates were low in all groups, with no correlation identified. DISCUSSION The maternal and neonatal morbidity associated with VBAC is comparable to primiparous women undergoing a vaginal birth. CONCLUSION In demonstrating the low relative morbidity in this comparison, these outcomes may aid in counselling women faced with the choice of VBAC versus ERCS.
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Affiliation(s)
- Genia Rozen
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, Flemington Road, Parkville, Victoria 3050, Australia.
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