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Sánchez-Romero J, Gallego-Pozuelo RM, Dahmouni-Dahmouni H, Blanco-Carnero JE, Araico-Rodríguez F, Herrera-Giménez J, Guijarro-Campillo AR, Nieto-Díaz A, de Paco K. External cephalic version following prior cesarean delivery: A comparative cohort analysis. Int J Gynaecol Obstet 2024. [PMID: 38881234 DOI: 10.1002/ijgo.15738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/30/2024] [Accepted: 06/03/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE To analyze the success rate of external cephalic version (ECV) in pregnant women with a history of previous cesarean section, as well as to describe the rate of complications associated with the procedure. METHODS A retrospective cohort study of women who were offered an ECV at "Virgen de la Arrixaca" Clinic University Hospital (Murcia, Spain) between January 2014 and December 2023. We collected data for previous cesarean delivery, obstetric history, fetal presentation, amniotic fluid volume, ECV success rate, complications related to ECV, mode of delivery, and neonatal outcomes. The study confidently performed ECV under sedation with propofol and tocolysis with ritodrine. Univariate and multivariate analyses were conducted to compare the success rate of ECV, ECV complications, and mode of delivery between women with and without previous cesarean sections. RESULTS Of 1116 pregnant women who were offered ECV, 911 were included in the study, with 42 having a previous cesarean section. The success rate of ECV in pregnant women with a previous cesarean section was 78.6% (adjusted odds ratio 1.18; 95% confidence interval 0.49-2.86; P = 0.708), with a low complication rate of 9.5%, such as non-reassuring fetal heart rate (7.1%) or major vaginal bleeding (2.4%). Of the women who attempted a vaginal delivery after ECV, 80.8% were successful. CONCLUSIONS These findings support that ECV is a safe and effective option for women with a previous cesarean section, with success rates comparable to those in women without a previous cesarean section.
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Affiliation(s)
- Javier Sánchez-Romero
- Department of Obstetrics and Gynecology, Clinic University Hospital "Virgen de la Arrixaca", Murcia, Spain
- Department of Obstetrics, Gynecology, Surgery and Pediatrics, University of Murcia, Murcia, Spain
| | - Rosa María Gallego-Pozuelo
- Department of Obstetrics and Gynecology, Clinic University Hospital "Virgen de la Arrixaca", Murcia, Spain
- Department of Obstetrics, Gynecology, Surgery and Pediatrics, University of Murcia, Murcia, Spain
| | - Hajar Dahmouni-Dahmouni
- Department of Obstetrics, Gynecology, Surgery and Pediatrics, University of Murcia, Murcia, Spain
| | - José Eliseo Blanco-Carnero
- Department of Obstetrics and Gynecology, Clinic University Hospital "Virgen de la Arrixaca", Murcia, Spain
- Department of Obstetrics, Gynecology, Surgery and Pediatrics, University of Murcia, Murcia, Spain
| | - Fernando Araico-Rodríguez
- Department of Obstetrics and Gynecology, Clinic University Hospital "Virgen de la Arrixaca", Murcia, Spain
| | - Javier Herrera-Giménez
- Department of Obstetrics and Gynecology, Clinic University Hospital "Virgen de la Arrixaca", Murcia, Spain
| | | | - Aníbal Nieto-Díaz
- Department of Obstetrics and Gynecology, Clinic University Hospital "Virgen de la Arrixaca", Murcia, Spain
- Department of Obstetrics, Gynecology, Surgery and Pediatrics, University of Murcia, Murcia, Spain
| | - Katy de Paco
- Department of Obstetrics and Gynecology, Clinic University Hospital "Virgen de la Arrixaca", Murcia, Spain
- Department of Obstetrics, Gynecology, Surgery and Pediatrics, University of Murcia, Murcia, Spain
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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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