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Deshmukh U, Denoble AE, Son M. Trial of labor after cesarean, vaginal birth after cesarean, and the risk of uterine rupture: an expert review. Am J Obstet Gynecol 2024; 230:S783-S803. [PMID: 38462257 DOI: 10.1016/j.ajog.2022.10.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/21/2022] [Accepted: 10/21/2022] [Indexed: 03/12/2024]
Abstract
The decision to pursue a trial of labor after cesarean delivery is complex and depends on patient preference, the likelihood of successful vaginal birth after cesarean delivery, assessment of the risks vs benefits of trial of labor after cesarean delivery, and available resources to support safe trial of labor after cesarean delivery at the planned birthing center. The most feared complication of trial of labor after cesarean delivery is uterine rupture, which can have catastrophic consequences, including substantial maternal and perinatal morbidity and mortality. Although the absolute risk of uterine rupture is low, several clinical, historical, obstetrical, and intrapartum factors have been associated with increased risk. It is therefore critical for clinicians managing patients during trial of labor after cesarean delivery to be aware of these risk factors to appropriately select candidates for trial of labor after cesarean delivery and maximize the safety and benefits while minimizing the risks. Caution is advised when considering labor augmentation and induction in patients with a previous cesarean delivery. With established hospital safety protocols that dictate close maternal and fetal monitoring, avoidance of prostaglandins, and careful titration of oxytocin infusion when induction agents are needed, spontaneous and induced trial of labor after cesarean delivery are safe and should be offered to most patients with 1 previous low transverse, low vertical, or unknown uterine incision after appropriate evaluation, counseling, planning, and shared decision-making. Future research should focus on clarifying true risk factors and identifying the optimal approach to intrapartum and induction management, tools for antenatal prediction, and strategies for prevention of uterine rupture during trial of labor after cesarean delivery. A better understanding will facilitate patient counseling, support efforts to improve trial of labor after cesarean delivery and vaginal birth after cesarean delivery rates, and reduce the morbidity and mortality associated with uterine rupture during trial of labor after cesarean delivery.
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Affiliation(s)
- Uma Deshmukh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA
| | - Annalies E Denoble
- Section of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University, New Haven, CT
| | - Moeun Son
- Section of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University, New Haven, CT.
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2
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Ma K, Yang M, Feng X, Liu L, Li L, Li Y. Predictors of vaginal delivery following balloon catheter for labor induction in women with one previous cesarean. BMC Pregnancy Childbirth 2023; 23:417. [PMID: 37277699 DOI: 10.1186/s12884-023-05734-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/24/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND The aim of this study was to estimate predictors for vaginal birth following balloon catheter induction of labor (IOL) in women with one previous cesarean section (CS) and an unfavorable cervix. METHODS This 4-year retrospective cohort study was conducted in Longhua District Central Hospital in Shenzhen China, between January 2015 and December 2018. Patients with one previous CS and a current singleton-term pregnancy who underwent balloon catheter cervical ripening and IOL were enrolled. Univariate analysis was used to identify predictive factors associated with vaginal birth after cesarean section (VBAC). Binary logistic regression was further used to identify which factors were independently associated with the outcome measure. The primary outcome was VBAC, which was a successful trial of labor after cesarean delivery (TOLAC) following IOL. RESULTS A total of 69.57% (208/299) of the women who planned for IOL had VBAC. In the final binary logistic regression equation, lower fetal weight (< 4000 g) (odds ratio [OR]5.26; 95% confidence interval [CI] 2.09,13.27), lower body mass index (BMI,<30 kg/m2) (OR 2.27; CI 1.21, 4.26), Bishop score after cervical ripening > 6 (OR 1.94; CI 1.37, 2.76) remained independently associated with an increased chance of VBAC. CONCLUSIONS The influencing factors of VBAC following IOL were fetal weight, BMI, and Bishop score after cervical ripening. Adequate individualized management and assessment of the IOL may help improve the VBAC rate.
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Affiliation(s)
- Kaidong Ma
- Obstetrics department, Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Ming Yang
- Obstetrics department, The First Dongguan Affiliated Hospital of Guangdong Medical University, Dongguan, China
| | - Xiaoling Feng
- Obstetrics department, Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Liyuan Liu
- Obstetrics department, Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Liangliang Li
- Obstetrics department, Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Yunxiu Li
- Obstetrics department, Shenzhen Longhua District Central Hospital, Shenzhen, China.
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3
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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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Levin G, Tsur A, Tenenbaum L, Mor N, Zamir M, Meyer R. Predictors of successful vaginal birth after cesarean without an epidural among women with no prior vaginal delivery. Birth 2022; 49:159-165. [PMID: 34490653 DOI: 10.1111/birt.12589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 07/31/2021] [Accepted: 08/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Data are scarce on predictors for success of labor after cesarean (LAC) among women delivering without epidural anesthesia (EA). We aimed to study the predictors for success of LAC among women with no prior vaginal delivery that did not use EA. METHODS A retrospective study including all women undergoing LAC between 3/2011 and 1/2021 with no prior vaginal delivery that did not use EA. Factors associated with successful vaginal birth after cesarean were examined using multivariable analysis. RESULTS Of the 466 no EA LAC, 339 (72.7%) delivered vaginally. Women in the successful LAC group had lower pregestational and predelivery BMI as compared to those who had a repeat cesarean [odds ratio (OR) 95% confidence interval (CI) 0.90 (0.85-0.94), P < 0.001, and 0.89 (0.85-0.93), P < 0.001, respectively]. The rate of labor dystocia in previous cesarean was lower in the LAC success group [92 (27.1%) vs 50 (39.4%), OR 95% CI 0.57 (0.37-0.88)]. Mean gestational age at LAC was lower in the LAC success group (385/7 ± 25/7 vs 395/7 ± 15/7 , P = 0.014). In a multivariable logistic regression analysis, the following factors were negatively and independently associated with LAC success: higher predelivery BMI [adjusted odds ratio (aOR) 95% CI 0.90 (0.86-0.95)], higher gestational age at previous cesarean and at LAC [aOR 95% CI 0.81 (0.70-0.93) and 0.97 (0.94-0.98), respectively], induction of labor [aOR 95% CI 0.08 (0.03-0.25)], and duration of ruptured membranes [aOR 95% CI 0.97 (0.96-0.99)]. CONCLUSIONS We have identified that lower BMI, lower gestational age, shorter ruptured membranes duration, and spontaneous labor are associated with successful LAC among nonusers of EA with no prior vaginal delivery at one tertiary care facility in Israel.
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Affiliation(s)
- Gabriel Levin
- Department of Gynecologic Oncology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, 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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Carauleanu A, Tanasa IA, Nemescu D, Socolov D. Professional ethics, VBAC and COVID-19 pandemic: A challenge to be resolved (Review). Exp Ther Med 2021; 22:956. [PMID: 34335898 PMCID: PMC8290459 DOI: 10.3892/etm.2021.10388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/11/2021] [Indexed: 11/07/2022] Open
Abstract
Since the declaration of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic by the World Health Organization (WHO) on March 11, 2020, the entire healthcare system is trying to adapt its capabilities to a challenge that induces a deep and continuous metamorphosis of people, strategies and policies. The right to proper health care is universal, and the patient's autonomy must be respected even in ambiguous times. In the context of increased Cesarean section (CS) rates, the women's desire to achieve vaginal birth after Cesarean section (VBAC) is becoming more articulate, and healthcare professionals need to adapt their approaches regarding the mode of delivery. But how to balance this aspect with respect to the paucity of resources during the pandemic, without infringing the fundamental rights and ethical principles is a demanding question. This article describes a clinical ethical decision-making framework for recommending trial of labor after Cesarean section (TOLAC), and individualized management of VBAC cases tailored upon the new circumstances dictated by the SARS-CoV-2 pandemic.
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Affiliation(s)
- Alexandru Carauleanu
- Department of Obstetrics and Gynecology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ingrid Andrada Tanasa
- Department of Obstetrics and Gynecology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Dragos Nemescu
- Department of Obstetrics and Gynecology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Demetra Socolov
- Department of Obstetrics and Gynecology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
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Bart Y, Mohr-Sasson A, Mazaki-Tovi S, Kalter A, Shapira M, Sivan E, Hendler I. The effect of polyhydramnios on the success of trial of labor after cesarean delivery (TOLAC): A retrospective cohort. Eur J Obstet Gynecol Reprod Biol 2020; 253:187-190. [PMID: 32890818 DOI: 10.1016/j.ejogrb.2020.08.017] [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: 05/02/2020] [Revised: 07/29/2020] [Accepted: 08/21/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Prediction of success of trial of labor after cesarean delivery (TOLAC) is of major importance. We investigated the impact of polyhydramnios on the success rate of TOLAC. STUDY DESIGN A retrospective cohort study of all women with singleton pregnancies ≥ 34th weeks of gestation who underwent TOLAC after one previous cesarean delivery, between 2011 and 2016 in a single tertiary care center. Polyhydramnios was defined as amniotic fluid index ≥ 240 mm. Primary outcome was defined as the rate of successful TOLAC. RESULTS 31,245 women gave birth during the study period, of them 1637 (5.3 %) women underwent TOLAC and met inclusion criteria. 39 (2.4 %) women with polyhydramnios were compared to a control group of 1598 (97.6 %) women with amniotic fluid index < 240 mm. Polyhydramnios significantly reduced the rate of successful TOLAC: 69.2 % (27/39) in the study group compared to 85.8 % (1371/1598) in the control group (P = 0.009). In a subgroup analysis based on amniotic fluid index, women with AFI > 270 mm had substantially lower TOLAC success rate [9/19 (47.4 %) vs 18/20 (90 %); P = 0.006]. There was no difference in the rate of uterine rupture between the groups (0/39 (o%) vs 9/1598 (0.56 %); P = 0.64). Logistic regression analysis revealed that polyhydramnios remained significantly associated with higher rates of cesarean delivery [OR 3.09 (95 % CI, 1.37-6.98)] after adjustment for confounding factors. CONCLUSION Polyhydramnios was associated with significantly reduced TOLAC success rate with no statistical difference in the rate of uterine rupture. This information should be considered in physician counseling.
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Affiliation(s)
- Yossi Bart
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Aya Mohr-Sasson
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shali Mazaki-Tovi
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Kalter
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moran Shapira
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Sivan
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Israel Hendler
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Abstract
Trial of labor after cesarean delivery (TOLAC) refers to a planned attempt to deliver vaginally by a woman who has had a previous cesarean delivery, regardless of the outcome. This method provides women who desire a vaginal delivery the possibility of achieving that goal-a vaginal birth after cesarean delivery (VBAC). In addition to fulfilling a patient's preference for vaginal delivery, at an individual level, VBAC is associated with decreased maternal morbidity and a decreased risk of complications in future pregnancies as well as a decrease in the overall cesarean delivery rate at the population level (). However, although TOLAC is appropriate for many women, several factors increase the likelihood of a failed trial of labor, which in turn is associated with increased maternal and perinatal morbidity when compared with a successful trial of labor (ie, VBAC) and elective repeat cesarean delivery (). Therefore, assessing the likelihood of VBAC as well as the individual risks is important when determining who is an appropriate candidate for TOLAC. Thus, the purpose of this document is to review the risks and benefits of TOLAC in various clinical situations and to provide practical guidelines for counseling and management of patients who will attempt to give birth vaginally after a previous cesarean delivery.
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8
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Boujenah J, Fleury C, Tigaizin A, Benbara A, Mounsambote L, Murtada R, Fermaut M, Carbillon L. [Induction of labor in women with previous caesarean delivery with balloon catheter: Is it worth it?]. ACTA ACUST UNITED AC 2019; 47:273-280. [PMID: 30745158 DOI: 10.1016/j.gofs.2019.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIF Balloon catheters for labor induction at term after previous cesarean section is an alternative option to iterative cesarean section. The aim of this study was to analyze the maternal and neonatal outcomes of the trial of labor after cesarean (TOLAC) in women with unfavorable cervix and balloon catheter induction, 2 years after introduction of this process. METHODS Unicentric observational study of women with term cephalic singleton, unfavorable cervix (simplified Bishop score<5) after TOLAC using double-balloon catheter. Were analyzed the mode of delivery and severe maternal (uterine rupture, post-partum hemorrhage, severe perineal tears) and neonatal (neonatal unit admission, APGAR<7 at 5minutes, pH<7.1) outcomes. Predictive factors for failed TOLAC were analyzed by using multivariate logistic regression. RESULTS Between 2016-2017, 455 (75.4%) women had TOLAC, whose 59 (13%) women with balloon catheter. The overall vaginal delivery (VD) was 73.9%. After Balloon catheter, the VD rate was 50.8%, versus 79.1% after spontaneous labor, and 68.2% after alone oxytocin/artificial membrane rupture induction (P<0.05). Previous VD (aOR 0.176 CI-95% [0.048-0.651]) and prior sweeping membrane (aOR 0.161 CI-95% [0.034-0.761]) was protective for cesarean section after TOLAC. Severe maternal and neonatal morbidities were observed in 10 (17%) and 8 (13.6%) cases, respectively. CONCLUSION Double-Balloon catheter is an option for unfavorable cervix and term induction after previous cesarean section. However, the TOLAC in women whose unfavorable cervix is not without maternal and neonatal risk, especially due to its failure.
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Affiliation(s)
- J Boujenah
- Pôle femme et enfant, groupe hospitalier universitaire Paris Seine Saint-Denis, site Jean-Verdier, avenue du 14 Juillet, 93140 Bondy, France; UFR SMBH, université Paris 13, Sorbonne Paris cité, 93000 Bobigny, France.
| | - C Fleury
- Pôle femme et enfant, groupe hospitalier universitaire Paris Seine Saint-Denis, site Jean-Verdier, avenue du 14 Juillet, 93140 Bondy, France
| | - A Tigaizin
- Pôle femme et enfant, groupe hospitalier universitaire Paris Seine Saint-Denis, site Jean-Verdier, avenue du 14 Juillet, 93140 Bondy, France
| | - A Benbara
- Pôle femme et enfant, groupe hospitalier universitaire Paris Seine Saint-Denis, site Jean-Verdier, avenue du 14 Juillet, 93140 Bondy, France
| | - L Mounsambote
- Pôle femme et enfant, groupe hospitalier universitaire Paris Seine Saint-Denis, site Jean-Verdier, avenue du 14 Juillet, 93140 Bondy, France
| | - R Murtada
- Pôle femme et enfant, groupe hospitalier universitaire Paris Seine Saint-Denis, site Jean-Verdier, avenue du 14 Juillet, 93140 Bondy, France
| | - M Fermaut
- Pôle femme et enfant, groupe hospitalier universitaire Paris Seine Saint-Denis, site Jean-Verdier, avenue du 14 Juillet, 93140 Bondy, France
| | - L Carbillon
- Pôle femme et enfant, groupe hospitalier universitaire Paris Seine Saint-Denis, site Jean-Verdier, avenue du 14 Juillet, 93140 Bondy, France; UFR SMBH, université Paris 13, Sorbonne Paris cité, 93000 Bobigny, France
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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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Ram M, Hiersch L, Ashwal E, Nassie D, Lavie A, Yogev Y, Aviram A. Trial of labor following one previous cesarean delivery: the effect of gestational age. Arch Gynecol Obstet 2018; 297:907-913. [DOI: 10.1007/s00404-018-4677-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 01/15/2018] [Indexed: 11/30/2022]
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Sakiyeva KZ, Abdelazim IA, Farghali M, Zhumagulova SS, Dossimbetova MB, Sarsenbaev MS, Zhurabekova G, Shikanova S. Outcome of the vaginal birth after cesarean section during the second birth order in West Kazakhstan. J Family Med Prim Care 2018; 7:1542-1547. [PMID: 30613556 PMCID: PMC6293889 DOI: 10.4103/jfmpc.jfmpc_293_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Vaginal birth after cesarean section (VBAC) increases the chance of subsequent vaginal deliveries and reduces the repeat cesarean section (CS) rate with subsequent postoperative morbidity. Objectives To detect the outcome of VBAC during the second birth order in Aktobe region of West Kazakhstan. Patients and Methods A total of 832 women eligible for trial of VBAC were included in this study. Women who signed the consent of VBAC were evaluated thoroughly and data such as maternal age, body mass index, height, gestational age at admission, indication of the previous CS, estimated fetal weight, engagement of the fetal head, condition of the membranes, and cervical dilatation were collected. Data collected after delivery include duration from active phase of labor, mode of delivery, fetal, and neonatal outcomes. The collected data analyzed to detect the outcome of trial of VBAC during the second birth order in Aktobe region of West Kazakhstan. Results Logistic analysis and odds ratio (OR) showed that body mass index (BMI) ≤25 kg/m2 (OR 1.7; P = 0.0004), height ≥150 cm (OR 1.7; P = 0.002), gestational age ≤40 weeks (OR 2.3; P = 0.0001), and inter-delivery interval ≥2 years (OR 1.6; P = 0.008) were significantly associated with successful VBAC. In addition, <2/5 of the fetal head palpable abdominally, station <-2 (OR 1.7; P = 0.0009), cervical dilatation ≥4 cm (OR 1.7; P = 0.003), and duration of active phase of labor ≤7 h (OR 1.6; P = 0.01) were significantly associated with successful VBAC. Conclusion VBAC is safe in properly selected cases. BMI ≤25 kg/m2, gestational age ≤40 weeks, inter-delivery interval ≥2 years, and fetal head <-2 station increase the success of VBAC. Prolonged active phase of labor >7 h and the need for labor augmentation decrease the chance of VBAC success.
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Affiliation(s)
- K Zh Sakiyeva
- Department of Obstetrics and Gynecology, Marat Ospanov, West Kazakhstan State Medical University (WKSMU), Aktobe, Kazakhstan
| | - Ibrahim A Abdelazim
- Department of Obstetrics Gynecology, Ain Shams University, Cairo, Egypt.,Department of Obstetrics Gynecology, Ahmadi Hospital, Kuwait Oil Company, Kuwait
| | - M Farghali
- Department of Obstetrics Gynecology, Ain Shams University, Cairo, Egypt
| | - S S Zhumagulova
- Department of Obstetrics and Gynecology, Marat Ospanov, West Kazakhstan State Medical University (WKSMU), Aktobe, Kazakhstan
| | - M B Dossimbetova
- Department of Obstetrics and Gynecology, Marat Ospanov, West Kazakhstan State Medical University (WKSMU), Aktobe, Kazakhstan
| | - M S Sarsenbaev
- Department of Obstetrics and Gynecology, Marat Ospanov, West Kazakhstan State Medical University (WKSMU), Aktobe, Kazakhstan
| | - G Zhurabekova
- Department of Normal and Topographical Anatomy, Marat Ospanov, West Kazakhstan State Medical University (WKSMU), Aktobe, Kazakhstan
| | - S Shikanova
- Department of Obstetrics and Gynecology, Marat Ospanov, West Kazakhstan State Medical University (WKSMU), Aktobe, Kazakhstan
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Labor trials in 300 patients with a previous cesarean section. MEDICINA UNIVERSITARIA 2017. [DOI: 10.1016/j.rmu.2017.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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13
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Abstract
Trial of labor after cesarean delivery (TOLAC) refers to a planned attempt to deliver vaginally by a woman who has had a previous cesarean delivery, regardless of the outcome. This method provides women who desire a vaginal delivery the possibility of achieving that goal-a vaginal birth after cesarean delivery (VBAC). In addition to fulfilling a patient's preference for vaginal delivery, at an individual level, VBAC is associated with decreased maternal morbidity and a decreased risk of complications in future pregnancies as well as a decrease in the overall cesarean delivery rate at the population level (1-3). However, although TOLAC is appropriate for many women, several factors increase the likelihood of a failed trial of labor, which in turn is associated with increased maternal and perinatal morbidity when compared with a successful trial of labor (ie, VBAC) and elective repeat cesarean delivery (4-6). Therefore, assessing the likelihood of VBAC as well as the individual risks is important when determining who is an appropriate candidate for TOLAC. Thus, the purpose of this document is to review the risks and benefits of TOLAC in various clinical situations and to provide practical guidelines for counseling and management of patients who will attempt to give birth vaginally after a previous cesarean delivery.
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A prospective observational study of trial of labor after cesarean in rural India. Int J Gynaecol Obstet 2015; 129:156-60. [PMID: 25801195 DOI: 10.1016/j.ijgo.2014.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 10/28/2014] [Accepted: 12/22/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the success rate of trial of labor after cesarean (TOLAC) in rural India. METHODS The present prospective observational study enrolled pregnant women attending Dr Rajendra Prasad Government Medical College, Kangra, India, in 2013. Eligible women had a previous low-segment cesarean delivery and had a singleton pregnancy with cephalic presentation. Women in labor were managed as per the institutional protocol. RESULTS In total, 482 women were included. TOLAC led to a vaginal delivery in 383 (79.6%) women. Overall, 2 (0.4%) women had scar rupture, and 4 (0.8%) had scar dehiscence. Fetal death was recorded in one woman with scar rupture, for whom peripartum hysterectomy was necessary. Blood loss was significantly lower among the 316 women with normal vaginal delivery than among the 99 who underwent cesarean (P<0.001). Blood transfusion was required in 2 (0.6%) women with normal vaginal delivery and 2 (2.0%) with cesarean delivery (P=0.05). The proportion of neonates who had to be admitted to intensive care did not differ significantly by mode of delivery (P=0.06). CONCLUSION Under strict supervision, TOLAC is a reasonable option even in rural India.
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Abdelazim IA, Elbiaa AAM, Al-Kadi M, Yehia AH, Sami Nusair BM, Faza MA. Maternal and obstetrical factors associated with a successful trial of vaginal birth after cesarean section. J Turk Ger Gynecol Assoc 2014; 15:245-9. [PMID: 25584035 DOI: 10.5152/jtgga.2014.14104] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 11/04/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To detect the maternal and obstetrical factors associated with successful trial of vaginal birth among women with a previous cesarean delivery. MATERIAL AND METHODS A total of 122 women who were eligible for a trial of labor after cesarean section (TOLAC) according to departmental protocol were included in this comparative prospective study. After informed consent, the women included in this study were subjected to a thorough history to detect maternal and obstetric characteristics and a standard examination to estimate fetal weight, engagement of the fetal head, intra-partum features of fetal membranes, and cervical dilatation. After delivery, data on duration of labor, labor augmentation, mode of delivery, birth outcome, and neonatal intensive care (NICU) admission were recorded and analyzed. RESULTS Trial of labor after cesarean section was successful in 72.13% and was unsuccessful in 27.87%. Body mass index (BMI) was significantly lower in the successful TOLAC group compared to the unsuccessful group (23.8±0.03 versus 26.2±0.02 kg/m(2)), and the number of women with BMI >25 kg/m(2) was significantly high in the unsuccessful group; also, mean gestational age was significantly lower in the successful TOLAC group compared to the unsuccessful group (37.5±0.04 versus 38.5±0.03 weeks), and the number of women admitted in labor with gestation ≥40 weeks was significantly high in the unsuccessful group. The number of women admitted with >2/5 of fetal head palpable abdominally and fetal head station ≥-2 was significantly high in the unsuccessful TOLAC group. CONCLUSION In carefully selected cases, TOLAC is safe and often successful. Presence of BMI >25 kg/m(2), gestation ≥40 weeks, and vertex station ≥-2 were risk factors for unsuccessful TOLAC.
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Affiliation(s)
- Ibrahim A Abdelazim
- Department of Obstetrics and Gynecology, Ain Shams University Faculty of Medicine, Cairo, Egypt ; Department of Obstetrics and Gynecology, Ahmadi Hospital, Kuwait Oil Company (KOC), Ahmadi, Kuwait
| | - Assem A M Elbiaa
- Department of Obstetrics and Gynecology, Ain Shams University Faculty of Medicine, Cairo, Egypt ; Department of Obstetrics and Gynecology, Sabah Maternity Hospital, Kuwait
| | - Mohamed Al-Kadi
- Department of Obstetrics and Gynecology, Ain Shams University Faculty of Medicine, Cairo, Egypt
| | - Amr H Yehia
- Department of Obstetrics and Gynecology, Ain Shams University Faculty of Medicine, Cairo, Egypt
| | - Bassam M Sami Nusair
- Department of Obstetrics and Gynecology and Reproductive Endocrinology, King Hussein Medical Center, Amman, Jordan
| | - Mohannad Abu Faza
- Department of Obstetrics and Gynecology, Ahmadi Hospital, Kuwait Oil Company (KOC), Ahmadi, Kuwait
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Siddiqui SA. Obstetric factors for unsuccessful trial of labor in second-order birth following previous cesarean. Ann Saudi Med 2013; 33:356-62. [PMID: 24060714 PMCID: PMC6078504 DOI: 10.5144/0256-4947.2013.356] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The trial of labor after previous cesarean (TOLAC) is an important strategy to limit repeat cesarean sections and their complications. An unsuccessful TOLAC leads to maternal and neonatal morbidities. The success or failure of TOLAC after the first cesarean is determinant for the subsequent vaginal birth. Limited studies are available from low-income countries, exclusively conducted in women in their sec.ond-order birth following the first cesarean section. This study aims at determining the frequency of unsuccessful attempts at vaginal delivery in the second-order term (37-41+6/7 weeks) birth among women with previous cesarean sections and to describe maternal and obstetric factors for unsuccessful laborTOLACs in the same group. DESIGN AND SETTINGS A cross-sectional study conducted from April to December 2010 at Obstetrics & Gynaecology Unit II, Civil Hospital Karachi. PATIENTS AND METHODS All eligible patients at term pregnancy in their second-order birth were included. The frequency of unsuccessful attempts at vaginal birth was determined, followed by secondary analysis by calculating odds ratio for maternal and obstetric factors, that is, body mass index (BMI), hight, gestation ≥40 weeks, interdelivery interval, engagement of head in 5th, estimated fetal weight, ruptured membranes, duration of labor ≥7 hours, augmentation of labor, cervical dilatation < 4 cm, and vertex station -2 or higher on admission. RESULTS Out of 122 study subjects, the proportion of unsuccessful vaginal birth after cesarean (VBAC) was 27.9% (n=34). Among maternal and obstetric factors, BMI > 25 (AOR, 5.00), gestation ≥40 weeks (AOR, 5.45), cervical dilatation < 4 cm (AOR, 5.90), and station of vertex -2 or higher (AOR, 3.83) had highly significant adjusted odds for failed TOLAC. CONCLUSION With a well-defined protocol, the rates of unsuccessful attempts at VBAC are not high for the second-order birth. The risk of failure can be anticipated by factors such as BMI > 25, pregnancy duration ≥40 weeks, cervical dilatation < 4 cm, and vertex station -2 or higher on admission.
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Affiliation(s)
- Saima Aziz Siddiqui
- Dr. Saima Aziz Siddiqui, Obstetrics and Gynaecology,, Dow University of Health Sciences,, baba-e-urdu Road, Karachi 74200, Pakistan, T: +92-21-99215740,
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Abstract
Uterine rupture during attempted vaginal birth after cesarean is a rare, but serious complication and can result in death or long-term disability. Several factors can increase the risk of uterine rupture during vaginal birth after cesarean and adequate counseling is necessary. Current literature suggests that timely diagnosis and delivery of the fetus is necessary for optimal outcome.
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Affiliation(s)
- Calla M Holmgren
- Department of Maternal-Fetal Medicine, Intermountain Medical Center and Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, USA.
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Wise MR, Anderson NH, Sadler L. Ethnic disparities in repeat caesarean rates at Auckland Hospital. Aust N Z J Obstet Gynaecol 2013; 53:443-50. [PMID: 23582022 DOI: 10.1111/ajo.12078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 02/12/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND New Zealand guidelines recommend that information regarding childbirth choices be given to women with previous caesarean, so they can make informed decisions about their care. We hypothesised that rates of trial of labour (TOL) and vaginal birth after caesarean (VBAC) would vary by women's ethnicity. AIM To estimate the association of ethnicity with TOL and VBAC rates. MATERIALS AND METHODS Clinical data were used to identify women who gave birth at Auckland Hospital in 2006-2009 with history of previous caesarean eligible for TOL. Multivariable models were used to estimate the association of women's characteristics (ethnicity, age, socio-economic status (SES), height, body mass index, lead maternity carer, diabetes, hypertension, haemorrhage, labour induction, gestational age) with rates of TOL and VBAC. RESULTS In the study cohort of 2400 women, the TOL rate was 39.5%; the VBAC rate was 57.4%. Pacific women were twice as likely to have TOL, while Asian and non-New Zealand European women were half as likely to have VBAC, compared with New Zealand European women. Women in more deprived areas were more likely to have TOL, but SES was not associated with VBAC rates. Women under the care of private obstetricians were least likely to have TOL or VBAC. CONCLUSIONS There are ethnic disparities in TOL and VBAC rates at our hospital. Strategies need to be developed to ensure that women of all ethnicities have access to both options for mode of delivery.
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Affiliation(s)
- Michelle R Wise
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Barger MK, Dunn JT, Bearman S, DeLain M, Gates E. A survey of access to trial of labor in California hospitals in 2012. BMC Pregnancy Childbirth 2013; 13:83. [PMID: 23551909 PMCID: PMC3636061 DOI: 10.1186/1471-2393-13-83] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 03/13/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In 2010, the NIH and ACOG recommended increasing women's access to trial of labor after cesarean (TOLAC). This study explored access to TOLAC in California, change in access since 2007 and 2010, and characteristics of TOLAC and non-TOLAC hospitals. METHODS Between November 2011 and June 2012, charge nurses at all civilian California birth hospitals were surveyed about hospitals' TOLAC availability and requirements for providers. VBAC rates were obtained from the California Office of Statewide Health Planning and Development (OSHPD). Distance between hospitals was calculated using OSHPD geocoding. RESULTS All 243 birth hospitals that were contacted participated. In 2010, among the 56% TOLAC hospitals, the median VBAC rate among TOLAC hospitals was 10.8% (range 0-37.3%). The most cited reason for low VBAC rates was physician unwillingness to perform them, especially due to the requirement to be continually present during labor. TOLAC hospitals were more likely to be larger hospitals in urban communities with obstetrical residency training. However, there were six (11.3%) residency programs in non-TOLAC hospitals and 5 (13.5%) rural hospitals offering TOLAC. The majority of TOLAC hospitals had 24/7 anesthesia coverage and required the obstetrician to be continually present if a TOLAC patient was admitted; 17 (12.2%) allowed personnel to be 15-30 minutes away. TOLAC eligibility criteria included one prior cesarean (32.4%), spontaneous labor (52.5%), continuous fetal monitoring and intravenous access (99.3%), and epidural analgesia (19.4%). The mean distance from a non-TOLAC to a TOLAC hospital was 37 mi. with 25% of non-TOLAC hospitals more than 51 mi. from the closest TOLAC hospital. In 2012, 139 hospitals (57.2%) offered TOLAC, 16.6% fewer than in 2007. Since 2010, five hospitals started and four stopped offering TOLAC, a net gain of one hospital offering TOLAC with three more considering it. Only two hospitals cited change in ACOG guidelines as a reason for the change. CONCLUSIONS Despite the 2010 NIH and ACOG recommendations encouraging greater access to TOLAC, 44% of California hospitals do not allow TOLAC. Of the 56% allowing TOLAC, 10.8% report fewer than 3% VBAC births. Thus, national recommendations encouraging greater access to TOLAC had a minor effect in California.
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Affiliation(s)
- Mary K Barger
- Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, CA, USA.
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Schmitz T. Situations cliniques particulières, maternelles ou fœtales, influençant le choix du mode d’accouchement en cas d’antécédent de césarienne. ACTA ACUST UNITED AC 2012; 41:772-81. [DOI: 10.1016/j.jgyn.2012.09.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Clark SM, Carver AR, Hankins GDV. Vaginal birth after cesarean and trial of labor after cesarean: what should we be recommending relative to maternal risk:benefit? ACTA ACUST UNITED AC 2012; 8:371-83. [PMID: 22757729 DOI: 10.2217/whe.12.28] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Trial of labor after cesarean (TOLAC) delivery is currently a hot obstetrical topic owing to the acute rise in the rate of cesarean deliveries, both primary and repeat. When the physician and patient are considering TOLAC, several factors should be considered: risk of uterine rupture, contraindications, minimizing risk and morbidity, choosing the appropriate candidate and whether or not to induce. Each patient has her own set of individual risk factors that may decrease her chance of successful vaginal birth after cesarean delivery or increase her risks with TOLAC. Once all things are considered, the risk:benefit of TOLAC should be weighed up before a decision is reached. Each of these factors is discussed in respect to maternal risk:benefit, with the focus on evidence presented in the current literature.
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Affiliation(s)
- Shannon M Clark
- University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA.
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Hamai Y, Imanishi Y. Efforts to promote vaginal delivery after a previous cesarean section. J Obstet Gynaecol Res 2011; 38:113-7. [PMID: 21917066 DOI: 10.1111/j.1447-0756.2011.01630.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to examine the results of vaginal delivery in patients with a past history of cesarean section. METHODS The type of delivery, interventions during delivery, and the prognoses of the mothers and babies were examined in 145 women with a history of cesarean section over the 10-year period from January 2000 to December 2009. RESULTS A scheduled cesarean section was performed in 27 cases. Vaginal delivery was recommended in 118 cases and the success rate was 94.9% (112/118). Uterine rupture was observed in one patient who experienced a natural rupture at home and whose previous cesarean section was an inverse T incision. No cases required a blood transfusion or hysterectomy. CONCLUSIONS The prognoses of both mothers and babies were good and the vaginal delivery success rate was 94.9%. Uterine rupture was observed in one case. Vaginal delivery with previous cesarean section should be considered in cases with expectation and informed consent.
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Affiliation(s)
- Yoko Hamai
- Department of Obstetrics and Gynecology, Tokyo Metropolitan Police Hospital, Tokyo, Japan.
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Abstract
Uterine rupture, which involves complete separation of the uterine wall, occurs in about 1% of those attempting vaginal birth after cesarean. Because uterine rupture is one of the most significant complications of a trial of labor (TOL) after previous cesarean, identifying those at increased risk of uterine rupture is paramount to the safety of a TOL after previous cesarean birth. It seems that both antepartum demographic characteristics and intrapartum factors modify the risk of uterine rupture. The ability to reliably predict an individual's a priori risk for intrapartum uterine rupture remains a major area of investigation.
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Affiliation(s)
- Carolyn M Zelop
- Beth Israel Deaconess Medical Center, Division of Maternal Fetal Medicine, Harvard University School of Medicine, Boston, MA 02215, USA.
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Ball E, Hinshaw K. The current management of vaginal birth after previous caesarean delivery. ACTA ACUST UNITED AC 2011. [DOI: 10.1576/toag.9.2.077.27307] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Informed Consent for a Vaginal Birth After Previous Cesarean Delivery. J Midwifery Womens Health 2010; 54:249-53. [DOI: 10.1016/j.jmwh.2009.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Revised: 02/09/2009] [Accepted: 02/09/2009] [Indexed: 10/20/2022]
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Affiliation(s)
- Liz Baxter
- Corbar Birth Centre, Buxton, Stockport NHS Foundation Trust,
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Lydon-Rochelle MT, Cahill AG, Spong CY. Birth after previous cesarean delivery: short-term maternal outcomes. Semin Perinatol 2010; 34:249-57. [PMID: 20654775 DOI: 10.1053/j.semperi.2010.03.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
An estimated 40% of the 1.3 million cesarean deliveries performed each year in the United States are repeat procedures. The appropriate clinical management approach for women with previous cesarean delivery remains challenging because options are limited. The risks and benefits of clinical management choices in the woman's health need to be quantified. Thus, we discuss the available published scientific data on (1) the short-term maternal outcomes of trial of labor after cesarean and elective repeat cesarean delivery, (2) the differences between outcomes for both, (3) the important factors that influence these outcomes, and (4) successful vs. unsuccessful vaginal birth after cesarean. For women with a previous cesarean delivery, a successful trial of labor offers several distinct, consistently reproducible advantages compared with elective repeat cesarean delivery, including fewer hysterectomies, fewer thromboembolic events, lower blood transfusion rates, and shorter hospital stay. However, when trial of labor after cesarean fails, emergency cesarean is associated with increased uterine rupture, hysterectomy, operative injury, blood transfusion, endometritis, and longer hospital stay. Care of women with a history of previous cesarean delivery involves a confluence of interactions between medical and nonmedical factors; however, the most important determinants of the short-term outcomes among these women are likely individualized counseling, accurate clinical diagnoses, and careful management during a trial of labor. We recommend a randomized controlled trial among women undergoing a TOLAC and a longitudinal cohort study among women with previous cesarean to evaluate adverse outcomes, with focused attention on both mother and the infant.
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Affiliation(s)
- Mona T Lydon-Rochelle
- National Perinatal Epidemiology Centre, Department of Obstetrics and Gynecology, University of College, Cork, Cork, Ireland.
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Al-Zirqi I, Stray-Pedersen B, Forsén L, Vangen S. Uterine rupture after previous caesarean section. BJOG 2010; 117:809-20. [DOI: 10.1111/j.1471-0528.2010.02533.x] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ogbonmwan SEO, Miller V, Ogbonmwan DE, Akinsola AA. Review of vaginal birth after primary caesarean section without prostaglandin induction and or syntocinon augmentation in labour. J Matern Fetal Neonatal Med 2009; 23:281-5. [DOI: 10.3109/14767050903067394] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Oxytocin is the most common pharmacologic agent used for the induction and augmentation of labor. Oxytocin protocols can be divided into high-dose and low-dose protocols depending on the initial dose and the amount and rate of sequential increase in dose. Despite the frequency with which oxytocin in used in clinical practice, there is little consensus regarding which protocol is most appropriate. The purpose of this chapter is to review the most current data concerning recommendations for the use of oxytocin in the induction of labor, including cases of intrauterine fetal demise and vaginal birth after cesarean.
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Affiliation(s)
- Jennifer G Smith
- Department of Obstetrics and Gynecology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA
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Macones GA, Cahill AG, Stamilio DM, Odibo A, Peipert J, Stevens EJ. Can uterine rupture in patients attempting vaginal birth after cesarean delivery be predicted? Am J Obstet Gynecol 2006; 195:1148-52. [PMID: 17000247 DOI: 10.1016/j.ajog.2006.06.042] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2006] [Revised: 05/15/2006] [Accepted: 06/10/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This study was undertaken to use multivariable methods to develop clinical predictive models for the occurrence of uterine rupture by using both antepartum and early intrapartum factors. STUDY DESIGN This was a planned secondary analysis from a multicenter case-control study of uterine rupture among women attempting vaginal birth after cesarean (VBAC) delivery. Multivariable methods were used to develop 2 separate clinical predictive indices--one that used only prelabor factors and the other that used both prelabor and early labor factors. These indices were also assessed with the use of Receiver operating characteristic curves. RESULTS We identified 134 cases of uterine rupture and 665 noncases. No single individual factor is sufficiently sensitive or specific for clinical prediction of uterine rupture. Likewise, the 2 clinical predictive indices were neither sufficiently sensitive nor specific for clinical use (receiver operating characteristic curve [area under the curve] 0.67 and 0.70, respectively). CONCLUSION Uterine rupture cannot be predicted with either individual or combinations of clinical factors. This has important clinical and medical-legal implications.
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Affiliation(s)
- George A Macones
- Department of Obstetrics and Gynecology, Washington University, St. Louis, MO, USA
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Bujold E, Hammoud A, Hendler I. Safety and efficacy of vaginal birth after cesarean delivery attempts at or beyond 40 weeks of gestation. Obstet Gynecol 2006; 107:205; author reply 205. [PMID: 16394062 DOI: 10.1097/01.aog.0000195334.60976.ce] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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