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Benzouina S, Boubkraoui MEM, Mrabet M, Chahid N, Kharbach A, El-Hassani A, Barkat A. Fetal outcome in emergency versus elective cesarean sections at Souissi Maternity Hospital, Rabat, Morocco. Pan Afr Med J 2016; 23:197. [PMID: 27347286 PMCID: PMC4907743 DOI: 10.11604/pamj.2016.23.197.7401] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 04/10/2016] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Perinatal mortality rates have come down in cesarean sections, but fetal morbidity is still high in comparison to vaginal delivery and the complications are more commonly seen in emergency than in elective cesarean sections. The objective of the study was to compare the fetal outcome and the indications in elective versus emergency cesarean section performed in a tertiary maternity hospital. METHODS This comparative cross-sectional prospective study of all the cases undergoing elective and emergency cesarean section for any indication at Souissi maternity hospital of Rabat, Morocco, was carried from January 1, to February 28, 2014. Data were analyzed with emphasis on fetal outcome and cesarean sections indications. Mothers who had definite antenatal complications that would adversely affect fetal outcome were excluded from the study. RESULTS There was 588 (17.83%) cesarean sections among 3297 births of which emergency cesarean section accounted for 446 (75.85%) and elective cesarean section for 142 cases (24.15%). Of the various factors analyzed in relation to the two types of cesarean sections, statistically significant associations were found between emergency cesarean section and younger mothers (P < 0.001), maternal illiteracy (P = 0.049), primiparity (P = 0.005), insufficient prenatal care (P < 0.001), referral from other institution for pregnancy complications or delivery (P < 0.001), cesarean section performed under general anesthesia (P < 0.001), lower birth weight (P < 0.016), neonatal morbidity and early mortality (P < 0.001), and admission in neonatal intensive care unit (P = 0.024). The commonest indication of emergency cesarean section was fetal distress (30.49%), while the most frequent indication in elective cesarean section was previous cesarean delivery (47.18%). CONCLUSION The overall fetal complications rate was higher in emergency cesarean section than in elective cesarean section. Early recognition and referral of mothers who are likely to undergo cesarean section may reduce the incidence of emergency cesarean sections and thus decrease fetal complications.
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Affiliation(s)
- Soukayna Benzouina
- National Reference Center in Neonatology and Nutrition, Children's Hospital, University Hospital, Rabat, Morocco; Research Team on Health and Nutrition of Mother and Child, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Morocco
| | - Mohamed El-Mahdi Boubkraoui
- National Reference Center in Neonatology and Nutrition, Children's Hospital, University Hospital, Rabat, Morocco; Research Team on Health and Nutrition of Mother and Child, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Morocco
| | - Mustapha Mrabet
- Research Team on Health and Nutrition of Mother and Child, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Morocco; Departement of Public Health, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Morocco
| | - Naima Chahid
- Research Team on Health and Nutrition of Mother and Child, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Morocco; Souissi Maternity Hospital, Rabat, University Hospital, Morocco
| | - Aicha Kharbach
- Research Team on Health and Nutrition of Mother and Child, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Morocco; Souissi Maternity Hospital, Rabat, University Hospital, Morocco
| | - Amine El-Hassani
- Cheikh Zaid Hospital, Abulcasis International University of Health Sciences, Rabat, Morocco
| | - Amina Barkat
- National Reference Center in Neonatology and Nutrition, Children's Hospital, University Hospital, Rabat, Morocco; Research Team on Health and Nutrition of Mother and Child, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Morocco
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Abstract
BACKGROUND Prior to 1996, most women who had undergone two previous cesarean deliveries were offered only cesarean delivery at Al-Hasa Health Centre. A policy of trial of labor was instituted in 1996. We compared the outcome of trial of labor versus cesarean delivery in women with a history of two previous cesarean deliveries who delivered between 1997 and 2002. PATIENTS AND METHODS All patients with a history of two previous lower segment cesarean deliveries were included in the study. Those considered suitable were permitted a trial of labor that was neither induced nor augmented at any stage. RESULTS Of the 205 patients in the study, 66 delivered vaginally (32.2%), 68 had an emergency cesarean delivery (33.2%), and 71 an elective cesarean delivery (34.6%). No scar dehiscence was observed, nor was hysterectomy performed in either group. The rate of complications was lower in the vaginal delivery group (4.5%) than in the cesarean delivery group (19.4%). CONCLUSION Trial of labor in women with a history of two cesarean deliveries is a reasonable consideration, and when carried out without the use of oxytocics or prostaglandins, is associated with reduced maternal morbidity with no difference in perinatal morbidity.
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Affiliation(s)
- Vibha Kailash Garg
- Department of Obstetrics & Gynecology, Al Hasa Health Center (Saudi Aramco Medical Services Organization), Saudi Aramco, Al Hasa, Saudi Arabia.
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Kraemer DF, Berlin M, Guise JM. The relationship of health care delivery system characteristics and legal factors to mode of delivery in women with prior cesarean section: a systematic review. Womens Health Issues 2004; 14:94-103. [PMID: 15193637 DOI: 10.1016/j.whi.2004.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2003] [Revised: 02/20/2004] [Accepted: 04/08/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate the relationship of health care delivery system characteristics and legal factors to mode of delivery in women with prior cesarean section. METHODS We identified relevant studies by searching MEDLINE and HealthSTAR (1980 to May 2002), reference lists of pertinent articles, and recommendations of local and national experts. We also searched the online Cochrane systematic reviews and controlled trials registries, Database of Abstracts and Reviews on Effectiveness, and EMBASE databases. RESULTS Studies of guidelines suggested that opinion leaders influence provider behavior regarding repeat cesarean delivery versus trial of labor decisions. Studies of hospital and insurance characteristics provided inconsistent results. There was insufficient evidence to evaluate the relationship between provider characteristics and delivery outcomes. Legislation and liability-related factors effected limited change. CONCLUSION Studies of health care system characteristics and other factors focused primarily on rates of delivery modes (vaginal birth after cesarean or repeat cesarean delivery) rather than patient safety or health outcomes. Future studies must account for case mix, time trends, and other potential confounders, especially concerning associations of provider characteristics.
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Affiliation(s)
- Dale F Kraemer
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon 97239, USA.
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Affiliation(s)
- E J Quilligan
- Department of Obstetrics and Gynecology, University of California, Irvine, USA
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Bais JM, van der Borden DM, Pel M, Bonsel GJ, Eskes M, van der Slikke HJ, Bleker OP. Vaginal birth after caesarean section in a population with a low overall caesarean section rate. Eur J Obstet Gynecol Reprod Biol 2001; 96:158-62. [PMID: 11384799 DOI: 10.1016/s0301-2115(00)00416-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the clinical outcome of vaginal birth after caesarean section (VBAC) in a Dutch population with a low overall caesarean section (CS) rate of 6.5%. STUDY DESIGN Prospective population based cohort study of 252 patients with a previous caesarean section (CS). Outcome parameters were trial of labour (TOL), success rate and VBAC rate. RESULTS The TOL rate in the study cohort was 73%, success rate 77%, VBAC rate 56%. The reason for the previous CS influenced success rate. Complications, morbidity and mortality were not different between elective, emergency CS and TOL group, except for a higher incidence of haemorrhage more than 500 ml in the elective CS compared to the TOL group (29% versus 17%, relative risk (RR) 1.74 (1.15--2.34)). CONCLUSIONS In this Dutch study the success rate is comparable to rate in US study reports. Increase of the VBAC rate can mainly be achieved by increasing the number of women attempting TOL.
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Affiliation(s)
- J M Bais
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
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6
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Mozurkewich EL, Hutton EK. Elective repeat cesarean delivery versus trial of labor: a meta-analysis of the literature from 1989 to 1999. Am J Obstet Gynecol 2000; 183:1187-97. [PMID: 11084565 DOI: 10.1067/mob.2000.108890] [Citation(s) in RCA: 256] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to compare a trial of labor with elective repeat cesarean delivery among women with previous cesarean delivery. STUDY DESIGN We searched MEDLINE and EMBASE databases from 1989 through 1999 with the following terms: vaginal birth after cesarean delivery, trial of labor, trial of scar, and uterine rupture. We included all controlled trials from developed countries in which the control group had been eligible for a trial of labor. Outcomes of interest were uterine rupture, hysterectomy, maternal febrile morbidity, maternal mortality, 5-minute Apgar score <7, and fetal or neonatal mortality. We computed pooled odds ratios for each outcome. RESULTS The search strategy identified 52 controlled studies, 37 of which were excluded because many of the control subjects were not eligible for a trial of labor. Fifteen studies with a total of 47,682 women were included. Uterine rupture occurred more frequently among women undergoing a trial of labor than among those undergoing elective repeat cesarean delivery (odds ratio, 2.10; 95% confidence interval, 1.45-3.05). There was no difference in maternal mortality risk between the 2 groups (odds ratio, 1.52; 95% confidence interval, 0.36-6.38). Fetal or neonatal death (odds ratio, 1.71; 95% confidence interval, 1.28-2.28) and 5-minute Apgar scores <7 (odds ratio, 2.24; 95% confidence interval, 1.29-3.88) were more frequent in the trial of labor group than in the control group. Mothers undergoing a trial of labor were less likely to have febrile morbidity (odds ratio, 0.70; 95% confidence interval, 0.64-0.77) or to require transfusion (odds ratio, 0.57; 95% confidence interval, 0.42-0.76) or hysterectomy (odds ratio, 0.39; 95% confidence interval, 0.27-0.57). CONCLUSION A trial of labor may result in small increases in the uterine rupture rate and in fetal and neonatal mortality rates with respect to elective repeat cesarean delivery. Maternal morbidity, including febrile morbidity, and the need for transfusion or hysterectomy may be reduced with a trial of labor.
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Affiliation(s)
- E L Mozurkewich
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Abstract
This paper describes delivery outcomes for women from Victoria, Australia, who gave birth in 1995 and whose immediately previous (penultimate) delivery, within a 5-year search period, was a Caesarean section. Because of the large numbers of records involved, dedicated computer software for record linkage was used to identify the previous delivery and link it with the woman's current birth in 1995. Overall, 79% of the records from multiparous women were linked successfully. Approximately 15% were not linked because the previous birth was before the search period or was an abortion that would not have been reported to the Perinatal Data Collection Unit. Reasons for not being able to link the last 6% of the records include the previous pregnancy being overseas or interstate. Women who had a vaginal birth as the penultimate birth or a multiple birth at either event were excluded, resulting in a study population of 4663 linked records. More women (68%) had a repeat Caesarean than went into labour and, of the remaining women who laboured, 56% delivered vaginally. Overall, 18% of the women delivered vaginally. For the women who went into labour, the reported number experiencing a uterine rupture was two per 1000 births. Uterine rupture was not reported in the two-thirds who did not labour but had a repeat Caesarean. A review of the perinatal deaths identified only two deaths, one baby being born by elective Caesarean and one by a vaginal birth after a previous Caesarean (VBAC) where the choice of delivery methods may have contributed to the death. This large study is one of the few in the literature to provide population-based information on vaginal births after a previous Caesarean and related outcomes.
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Affiliation(s)
- C Stone
- Perinatal Data Collection Unit, Public Health and Development Division, Department of Human Services, Victoria, Australia.
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Appleton B, Targett C, Rasmussen M, Readman E, Sale F, Permezel M. Vaginal birth after Caesarean section: an Australian multicentre study. VBAC Study Group. Aust N Z J Obstet Gynaecol 2000; 40:87-91. [PMID: 10870788 DOI: 10.1111/j.1479-828x.2000.tb03175.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Retrospective analysis of medical records and individual case review was undertaken at 11 major obstetric hospitals for a 5 year period from July 1992 to June 1997 to investigate rates of vaginal birth after Caesarean section (VBAC), the occurrences of uterine rupture, and the outcomes for mother and infant following rupture. Total deliveries were 234,015, of which 21,452 or 9.2% were associated with one or more previous Caesarean sections. Within this scar group, 5419 patients or 25.3% were delivered vaginally. There were 62 cases of significant uterine rupture with no maternal deaths. Perinatal mortality with rupture was 25% and serious maternal complications (usually hysterectomy) occurred in 25% of those with uterine rupture. In women attempting vaginal delivery after a previous lower segment Caesarean section, the uterine rupture rate was estimated at 0.3%, with 0.05% experiencing a perinatal death and 0.05% requiring a hysterectomy. Although VBAC rates in Australia remain lower than many overseas reported series, rates are increasing. While rupture continues to be associated with serious adverse outcomes, the incidence of rupture during trial of labour is low and appears to be associated with a better outcome than rupture of an unscarred uterus.
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Affiliation(s)
- B Appleton
- Mercy Hospital for Women, Melbourne, Australia
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Pires HM, Cecatti JG, Faúndes A. [Factors associated to the trial of labor in primipara women with one previous cesarean section]. Rev Saude Publica 1999; 33:342-8. [PMID: 10542467 DOI: 10.1590/s0034-89101999000400004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The purpose of this study was to identify medical and non-medical factors associated to the performance of a trial of labor during the second delivery of women with one previous cesarean section. METHODS This was a nested case control study, with a secondary data analysis from a retrospective population based cohort study. It was primarily performed on a population of women who had had their first children in Campinas, SP, Brazil, during 1985. The study population was constituted of the 1,352 women of the cohort study who had had their first deliveries by cesarean section and also had their second deliveries no matter when. The group of cases (333 women, almost 25%) was constituted of those women who had a trial of labor during their second deliveries and the control group (1,019 women) of those who had not had it. For each possible associated factor evaluated, the Odds Ratio and its respective 95% Confidence Interval were calculated. For the ordered categorical variables, the chi2 for trend was also calculated. Finally, a non conditional multivariate regression analysis was performed, identifying the significant factors and then estimating their adjusted Odds Ratio. RESULTS The main factors associated with the trial of labor in this situation were a low monthly family income, having public medical insurance by the national health system, a low maternal age, the occurrence of rupture of membranes during the second delivery, and having been in childbirth during the first delivery. CONCLUSION It is concluded that the main determinants for a trial of labor among primipara women with one previous cesarean section were basically social and economic factors, rather than medical ones.
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Affiliation(s)
- H M Pires
- Departamento de Tocoginecologia da Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
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Affiliation(s)
- T G Stovall
- Department of Obstetrics and Gynecology, University of Tennessee Memphis, 38163, USA
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11
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Jongen VH, Halfwerk MG, Brouwer WK. Vaginal delivery after previous caesarean section for failure of second stage of labour. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1998; 105:1079-81. [PMID: 9800930 DOI: 10.1111/j.1471-0528.1998.tb09939.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the outcome of subsequent labour in primiparous women after a caesarean section for delay in descent in the second stage of labour in cephalic presentations with or without trial of instrumental vaginal delivery. DESIGN Retrospective follow up study. SETTING Medical Centre Leeuwarden, The Netherlands. PARTICIPANTS All primiparous parturients who delivered after prior caesarean section during the second stage of labour in the period 19861998. METHODS Data concerning the outcome of the first subsequent delivery were gathered from delivery notes and patients charts. The group of women was subdivided into those with or without trial of instrumental vaginal delivery during the previous labour. RESULTS Of 132 women, 29 (22%) underwent a planned repeat caesarean section. Of the 103 women who were allowed a trial of labour, 82 (80%) were successful in having a vaginal delivery, and 21 (20%) had a second caesarean section. Of the 74 women with a failed trial of instrumental delivery during the previous labour, 19 had a planned repeat caesarean section and 41 of the remaining 55 (75%) had a successful trial of labour. CONCLUSIONS In women with a cephalic presentation who had an arrest of descent in the second stage of labour during their first delivery, the chances of vaginal delivery in their next pregnancy are high, even after a failed instrumented vaginal delivery, and a trial of labour can usually be pursued.
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Affiliation(s)
- V H Jongen
- Department of Obstetrics and Gynaecology, Medical Centre Leeuwarden, The Netherlands
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12
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Abstract
BACKGROUND Although cesarean section is known to be associated with higher hospital charges than vaginal delivery, cost comparisons require further investigation. This study compared maternal hospital charges of women with one previous cesarean section undergoing a trial of labor with the charges of women who underwent an elective repeat cesarean section. Hospital charges for the trial of labor group were also compared with charges of women with a previous vaginal delivery but no previous cesarean section. METHODS A retrospective analysis of three primiparous privately insured patient groups who gave birth from July 1992 to October 1993 was conducted. Hospital charges for 50 primiparas with previous cesarean births who underwent a trial of labor were compared with those of 50 contemporaneous primiparas who underwent elective repeat cesarean section, and with those of 50 primiparas without a past history of cesarean birth. RESULTS Trial of labor was associated with a mean maternal hospital charge of $5820 +/- $1609 compared with $6785 +/- $771 for elective repeat cesarean section (p < 0.001). Trial of labor was also associated with a decreased length of stay when compared with elective cesarean section (2.48 +/- 0.88 days vs 3.62 +/- 0.57 days, p < 0.001). The difference in charges between these two groups was primarily due to charges associated with length of stay and the operating room, but was partly offset by charges associated with labor. The group of women without a past history of cesarean birth had a mean maternal hospital charge of $4685 +/- $966 and a mean length of stay of 1.96 +/- 0.63 days. CONCLUSIONS Trial of labor is associated with an overall 14 percent reduction in maternal hospital charges and a 31 percent reduction in length of stay compared with elective repeat cesarean section.
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Affiliation(s)
- J D Traynor
- Department of Obstetrics and Gynecology at Northwestern University Medical School, Northwestern Memorial Hospital, Chicago, Illinois 60611, USA
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Affiliation(s)
- S Chua
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
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Al Nuaim L, Soltan MH, Khashoggi T, Addar M, Chowdhury N, Adelusi B. Outcome in elective and emergency cesarean sections: A comparative study. Ann Saudi Med 1996; 16:645-9. [PMID: 17429248 DOI: 10.5144/0256-4947.1996.645] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
To study the obstetrics outcome of cesarean sections (CS) in relation to the elective or emergency nature of this procedure, a comparative study was conducted on 1426 females whose deliveries were by CS in King Khalid University Hospital (KKUH). Of the various factors analyzed in relation to the two types of CS, statistically significant associations were found between emergency CS and younger patients, low parity, irregular attendance at antenatal clinics, complications in labor, postoperative morbidity and low Apgar score(>6). It was concluded that every effort should be directed to effect-planned CS, as determined during the antenatal period, if possible, so as to reduce the various problems associated with emergency CS. The chances are that this approach is unlikely to influence the overall CS rate in either way.
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Affiliation(s)
- L Al Nuaim
- Department of Obstetrics and Gynecology, King Khalid University Hospital, Riyadh, Saudi Arabia
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Hanley ML, Smulian JC, Lake MF, McLean DA, Vintzileos AM. Analysis of repeat cesarean delivery indications: implications of heterogeneity. Am J Obstet Gynecol 1996; 175:883-8. [PMID: 8885741 DOI: 10.1016/s0002-9378(96)80018-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Our purpose was to describe the relative contributions and characteristics of various subgroups of patients to the overall repeat cesarean delivery rate and to determine modifiable practice patterns that might lead to fewer repeat cesarean deliveries. STUDY DESIGN Hospital records of all women with a previous cesarean section who were delivered between Jan. 1 and June 30, 1994, at St. Peter's Medical Center in New Brunswick, New Jersey, were reviewed. Four groups were identified: (1) elective repeat cesarean, (2) "indicated" repeat cesarean, (3) failed vaginal birth after cesarean, and (4) successful vaginal birth after cesarean. Descriptive and outcome data were collected. RESULTS There were 406 patients, 376 of whom had complete records available for review. Of these, 235 had a repeat cesarean delivery because of the following reasons: elective (107, 45%), "indicated" (56, 24%), and failed vaginal birth after cesarean (72, 31%). The remaining 141 patients had a vaginal birth after cesarean. Patients with private or health maintenance organization insurance were nearly seven times more likely to have a repeat cesarean delivery as an elective procedure as compared with Medicaid or self-pay patients (odds ratio 6.88, 95% confidence interval 2.33 to 20.38). The failed vaginal birth after cesarean group was characterized by more frequent inductions of labor, less use of amniotomy, and very early epidural placement. CONCLUSIONS Examination of patient characteristics is required to identify population-specific strategies to reduce repeat cesarean delivery rates. Modifiable practice patterns exist that may lead to interventions to reduce repeat cesarean delivery rates.
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Affiliation(s)
- M L Hanley
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, USA
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16
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Abstract
In a retrospective review of 333 pregnancies in women who had 1 previous Caesarean section, 244 (73.3%) underwent a trial of scar, and 89 (26.7%) had an elective Caesarean section. In the trial of scar group 197 (80.7%) had a vaginal delivery and 47 (19.3%) required an emergency Caesarean section. The success of the trial was favourably influenced by a nonrecurring indication for the original Caesarean section, a previous vaginal delivery, and a smaller baby. Maternal morbidity was greater in the groups requiring a Caesarean section, whether elective or emergency. Those patients delivered vaginally spent significantly less time in hospital. In 2 of the 244 patients (0.8%) who underwent a trial of scar the previous lower segment scar was found at Caesarean section to have dehisced or ruptured.
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Affiliation(s)
- R Lovell
- Liverpool Hospital, New South Wales
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Abstract
A small Canberra survey provided the opportunity to investigate the observation that tertiary education is associated with lower hysterectomy rates. Despite the sample's being small and unrepresentative of either the Australian or even the Canberra population, it was possible to replicate a simple version of a national model of hysterectomy. Tertiary education remained strongly predictive of a low rate of hysterectomy. Additionally, the study showed, first, the tertiary-educated women were less likely than others to be told that they needed a hysterectomy in the first place. Secondly, they were less likely to accept such advice: hysterectomy was undergone by only 1 of 5 of the better educated women to whom it had been suggested, but by 4 of 5 of the less educated.
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Affiliation(s)
- G Santow
- Health Transition Centre, Australian National University, Canberra
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