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Karampas G, Witkowski M, Metallinou D, Steinwall M, Matsas A, Panoskaltsis T, Christopoulos P. Delivery Progress, Labor Interventions and Perinatal Outcome in Spontaneous Vaginal Delivery of Singleton Pregnancies between Nulliparous and Primiparous Women with One Previous Elective Cesarean Section: A Retrospective Comparative Study. Life (Basel) 2023; 13:2016. [PMID: 37895398 PMCID: PMC10608638 DOI: 10.3390/life13102016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
Trial of labor after cesarean (TOLAC) is an alternative to repeated cesarean for women with singleton pregnancy and one previous transverse lower segment cesarean section (LSCS), resulting in most cases being a successful vaginal birth after cesarean section (VBAC). The primary objective of this study was to examine if the progress and the duration of the active first stage and the second stage of labor in nulliparous women with singleton pregnancy, spontaneous start of labor and vaginal birth differ from primiparous women succeeding VBAC after one previous elective LSCS in a country with a low cesarean section and high VBAC rate. Secondary objectives were to compare labor interventions and maternal-neonatal outcomes between the two groups. METHODS This is a retrospective comparative study. Data were collected in a four-year period at the departments of Obstetrics and Gynecology at Kristianstad and Ystad hospitals in Sweden. Out of 14,925 deliveries, 106 primipara women with one previous elective LSCS and a spontaneous labor onset in the subsequent singleton pregnancy were identified. Of these women, 94 (88.7%) delivered vaginally and were included in the study (VBAC group). The comparison group included 212 randomly selected nulliparous women that had a normal singleton pregnancy, spontaneous labor onset and delivered vaginally. RESULTS The rate of cervical dilation during the active first stage of labor as well as the duration of the second stage did not differ between the two groups. When adjusting for cervical dilation at admission, there was no significant difference between the two groups regarding the duration of the active phase of the first stage of labor. No significant differences were found in maternal-neonatal outcomes between the two groups except for higher birth weight in the VBAC group. The use of epidural analgesia was associated with slower dilation rhythm over the duration of the active phase and second stage of labor, need for labor augmentation, postpartum bleeding and need for transfusion at higher rates, irrespective of parity when epidural was used. CONCLUSIONS Our study provides evidence that in women with one previous elective LSCS undergoing TOLAC in the subsequent pregnancy resulting in vaginal birth, the progress and duration of labor are not different from those in nulliparous women when labor is spontaneous and the it is a singleton pregnancy. The use of epidural was associated with prolonged labor, need for labor augmentation and higher postpartum bleeding, irrespective of parity. This information may be useful in patient counseling and labor management in TOLAC.
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Affiliation(s)
- Grigorios Karampas
- Department of Obstetrics and Gynecology, Skånes University Hospital, 21428 Malmö-Lund, Sweden
- Second Department of Obstetrics & Gynecology, Medical School, University of Athens “Aretaieion” Hospital, 11528 Athens, Greece
| | - Martin Witkowski
- Department of Obstetrics and Gynecology, Kristianstad/Ystad Community Hospitals, 27133 Ystad, Sweden
| | - Dimitra Metallinou
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
| | - Margareta Steinwall
- Department of Obstetrics and Gynecology, Kristianstad/Ystad Community Hospitals, 27133 Ystad, Sweden
| | - Alkis Matsas
- Second Department of Obstetrics & Gynecology, Medical School, University of Athens “Aretaieion” Hospital, 11528 Athens, Greece
| | - Theodoros Panoskaltsis
- Second Department of Obstetrics & Gynecology, Medical School, University of Athens “Aretaieion” Hospital, 11528 Athens, Greece
| | - Panagiotis Christopoulos
- Second Department of Obstetrics & Gynecology, Medical School, University of Athens “Aretaieion” Hospital, 11528 Athens, Greece
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Rao J, Fan D, Li P, Li Y, Hu P, Wu Z, He J, Liu X, Peng B, Guo X, Liu Z. Prediction of vaginal birth after cesarean in China. Int J Gynaecol Obstet 2023; 163:202-210. [PMID: 37096667 DOI: 10.1002/ijgo.14801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVE This study aimed to develop and validate a prediction model of vaginal birth after cesarean delivery (VBAC) in China. METHODS A nomogram for effective prediction of VBAC of singleton, cephalic and one previous low-transverse cesarean section deliveries was created by comparing the combinations of ultrasonographic and non-ultrasonographic factors from five hospitals between 2018 and 2019. RESULTS A total of 1066 women were included. Of the women who underwent trial of labor after cesarean (TOLAC), 854 (80.1%) had a VBAC. Ultrasound factors included reached a higher area under the curve (AUC) combined with non-ultrasonographic factors. Of the three ultrasonographic factors analyzed, the best predictive factor for successful TOLAC was fetal abdominal circumference. A nomogram was generated with eight validated factors, including maternal age, gestational week, height, previous vaginal delivery, Bishop score, dilatation of the cervix at the time of admission, body mass index at delivery, and fetal abdominal circumference by ultrasound. The trained and validated AUC were 0.719 (95% confident interval 0.674-0.764) and 0.774 (95% confident interval 0.712-0.837), respectively. CONCLUSION Our VBAC nomogram based on obstetric factors and fetal abdominal circumference obtained by ultrasound could be used to counsel women who are considering TOLAC.
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Affiliation(s)
- Jiaming Rao
- Foshan Fetal Medicine Institute, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University (Foshan Maternity & Child Healthcare Hospital), Foshan, Guangdong, China
| | - Dazhi Fan
- Foshan Fetal Medicine Institute, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University (Foshan Maternity & Child Healthcare Hospital), Foshan, Guangdong, China
| | - Pengsheng Li
- Foshan Fetal Medicine Institute, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University (Foshan Maternity & Child Healthcare Hospital), Foshan, Guangdong, China
| | - Yiying Li
- Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University (Foshan Maternity & Child Healthcare Hospital), Foshan, Guangdong, China
| | - Pengzhen Hu
- Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University (Foshan Maternity & Child Healthcare Hospital), Foshan, Guangdong, China
| | - Zhaoxia Wu
- Department of Obstetrics, Nanhai Maternity & Child Healthcare Hospital, Foshan, Guangdong, China
| | - Jieyun He
- Department of Obstetrics, Shunde Maternity & Child Healthcare Hospital, Foshan, Guangdong, China
| | - Xinjuan Liu
- Department of Obstetrics, The People's Hospital of Gaoming, Foshan, Guangdong, China
| | - BingJie Peng
- Department of Obstetrics, Sanshui Maternity & Child Healthcare Hospital, Foshan, Guangdong, China
| | - Xiaoling Guo
- Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University (Foshan Maternity & Child Healthcare Hospital), Foshan, Guangdong, China
| | - Zhengping Liu
- Foshan Fetal Medicine Institute, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University (Foshan Maternity & Child Healthcare Hospital), Foshan, Guangdong, China
- Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University (Foshan Maternity & Child Healthcare Hospital), Foshan, Guangdong, China
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Li H, Sheng W, Cai M, Chen Q, Lin B, Zhang W, Li W. A predictive nomogram for a failed trial of labor after cesarean: A retrospective cohort study. J Obstet Gynaecol Res 2022; 48:2798-2806. [PMID: 36055678 PMCID: PMC9825937 DOI: 10.1111/jog.15398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 01/11/2023]
Abstract
AIM To validate risk factors and a nomogram prediction model for the failure of a trial of labor after cesarean section (TOLAC) in a Chinese population. METHODS We included women who tried TOLAC between January 2017 and May 2019, grouped according to the success/failure of TOLAC. The patients were randomized 3:1 into the development and validation sets. Multivariable logistic regression analyses were used to develop a nomogram prediction model for TOLAC failure. RESULTS In total, 535 (86.3%) of the women (n = 620) aged 29-34 years had a successful vaginal birth after cesarean (VBAC). All women had a fully healed previous uterine incision. The univariable analyses showed that the cephalopelvic score (p < 0.001), BMI (p = 0.001), full engagement into the pelvis (p < 0.001), Bishop cervical maturity score (p < 0.001), and estimated fetal weight at admission (p < 0.001) could enter the multivariable model. Furthermore, the multivariable analysis showed that the cephalopelvic score (OR = 0.42, 95%CI: 0.23-0.77, p = 0.005), full engagement in the pelvis (OR = 0.16, 95%CI: 0.08-0.33, p < 0.001), and Bishop cervical maturity score (OR = 0.46, 95%CI: 0.35-0.59, p < 0.001) were independent predictors of the failure of TOLAC. CONCLUSION This study proposes a nomogram that can assess the risk of failure of TOLAC in Chinese pregnant women. The statistical model could help clinicians know the likelihood of successful TOLAC in the clinical setting.
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Affiliation(s)
- Hua Li
- Department of ObstetricsChangsha Hospital for Maternal & Child Health CareChangshaHunan ProvinceChina
| | - Wen Sheng
- Department of ObstetricsChangsha Hospital for Maternal & Child Health CareChangshaHunan ProvinceChina
| | - Min Cai
- Department of ObstetricsChangsha Hospital for Maternal & Child Health CareChangshaHunan ProvinceChina
| | - Qiuling Chen
- Department of ObstetricsChangsha Hospital for Maternal & Child Health CareChangshaHunan ProvinceChina
| | - Beibei Lin
- Department of ObstetricsChangsha Hospital for Maternal & Child Health CareChangshaHunan ProvinceChina
| | - Weishe Zhang
- Department of ObstetricsXiangya Hospital Central South UniversityHunanChina
| | - Wenxia Li
- Department of ObstetricsChangsha Hospital for Maternal & Child Health CareChangshaHunan ProvinceChina
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Deng B, Li Y, Chen JY, Guo J, Tan J, Yang Y, Liu N. Prediction models of vaginal birth after cesarean delivery: A systematic review. Int J Nurs Stud 2022; 135:104359. [PMID: 36152466 DOI: 10.1016/j.ijnurstu.2022.104359] [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: 03/23/2022] [Revised: 08/26/2022] [Accepted: 08/27/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Cesarean section rates are rising in the world. Women with a history of cesarean section will select a cesarean section at the next pregnancy. An objective and accurate prediction about the success rate of vaginal delivery after cesarean section can help women to reduce the complications caused by cesarean section, shorten the time spent in the hospital, and effectively plan medical resources. OBJECTIVE To systematically review and critically assess the existing prediction models of vaginal delivery after cesarean section. METHODS Some databases (PubMed, Web of Science, EMBASE, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature) were searched from 2000 to 2021 for studies regarding the prediction model of vaginal birth after cesarean delivery. The researchers successively conducted independent literature screening, data extraction and quality evaluation of the included literature, and then utilized the Prediction model Risk of Bias Assessment Tool to assess the methodological quality of the models in the included studies. RESULTS A total of 33 studies were included, in which 20 prediction models were identified. Sixteen studies involved external validation of existing models (Grobman's models). In the 20 prediction models, 12 were internally validated, only three had external validation, and seven models were not explicitly reported, with the area under the curve ranging from 0.660 to 0.953; The most common predictors included in the model were body mass index and previous vaginal delivery, followed by maternal age, previous cesarean delivery indication, history of vaginal birth after cesarean, fetal weight, and Bishop's score, gestational age, history of vaginal birth after cesarean, maternal race; The prediction effect of Grobman's model was validated in multiple external populations; The majority of the studies(n = 27) had high risk of bias in the of the Prediction model Risk of Bias Assessment Tool. CONCLUSIONS This review provides obstetricians and midwives with important information about the prediction models of vaginal birth after cesarean section, which has been reported optimistic predictive performance and acceptable predictive power. However, the majority of the development studies have methodological limitations, which may hinder the widely application of these models by obstetricians. Further studies are supposed to develop predictive models with low risk of bias, and conduct internal and external validation, providing pragmatic and practical predictions to obstetricians. PROSPERO REGISTRATION NUMBER CRD42022299048.
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Affiliation(s)
- Bo Deng
- Department of Nursing, Zhuhai Campus of Zunyi Medical University, Guangdong, China
| | - Yan Li
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Jia-Yin Chen
- Department of Nursing, Zhuhai Campus of Zunyi Medical University, Guangdong, China
| | - Jun Guo
- Department of Nursing, Zhuhai Campus of Zunyi Medical University, Guangdong, China
| | - Jing Tan
- Department of Nursing, Zhuhai Campus of Zunyi Medical University, Guangdong, China
| | - Yang Yang
- Department of Nursing, Zhuhai Campus of Zunyi Medical University, Guangdong, China
| | - Ning Liu
- Department of Nursing, Zhuhai Campus of Zunyi Medical University, Guangdong, China.
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Alalaf SK, Mansour TMM, Sileem SA, Shabila NP. Intrapartum ultrasound measurement of the lower uterine segment thickness in parturients with previous scar in labor: a cross-sectional study. BMC Pregnancy Childbirth 2022; 22:409. [PMID: 35568830 PMCID: PMC9107280 DOI: 10.1186/s12884-022-04747-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 05/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background There is a lack of reliable methods to estimate the risk of uterine rupture or dehiscence during a trial of labor in women with previous cesarean sections. This study aimed to assess the lower uterine segment and myometrial thickness by ultrasonography in women with previous cesarean sections during labor and assess their association with the uterine defect. Methods A cross-sectional study was conducted on 161 women in the active phase of labor having one previous cesarean section. The study was conducted et al.-Azhar University Hospital, Assiut City, Egypt, from March 2018 to March 2019. Ultrasound measurements of lower uterine segment thickness and myometrial thickness were conducted by vaginal and abdominal ultrasound by two observers. The correlation of both thicknesses with the uterine defect was analyzed. Results Uterine defects were reported in 42 women (25.9%), uterine rupture in four women (2.5%), and dehiscence in 38 women (23.5%). The uterine defects were not associated with maternal factors (maternal age, gestational age at labor, body mass index, birth weight, interpregnancy, and inter-delivery interval). Receiver operating curve analysis demonstrated that lower uterine segment thickness was linked with uterine defect, with an area under the curve of 60% (95% CI, 51–70%, P = 0.044). Myometrial thickness was also linked to the uterine defect, with an area under the curve of 61% (95% CI, 52–71%, P = 0.025). Full lower uterine segment thickness of 2.3 mm and myometrial thickness of 1.9 mm were the cutoff value with the best combination of sensitivity and specificity for the uterine defect. Lower uterine segment thickness (OR = 0.49, 95%CI 0.24–0.96) and myometrial thickness (OR = 0.44, 95%CI 0.20–0.94) were significantly associated with the uterine defect. Lower uterine segment thickness (OR = 0.41, 95%CI 0.22–0.76) and myometrial thickness (OR = 0.33, 95%CI 0.16–0.66) were also significantly associated with cesarean section delivery. Conclusion A lower uterine segment thickness of 2.3 mm and myometrial thickness of 1.9 mm during the first stage of labor are associated with a high risk of uterine defects during a labor trial. These measurements during labor can have a practical application in deciding the mode of delivery in women with previous cesarean sections and might reduce uterine rupture.
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Affiliation(s)
- Shahla K Alalaf
- Department of Obstetrics and Gynecology, College of Medicine, Hawler Medical University, Kurdistan Region, Erbil city, Iraq
| | | | - Sileem Ahmad Sileem
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Assuit, Egypt
| | - Nazar P Shabila
- Department of Community Medicine, College of Medicine, Hawler Medical University, Kurdistan Region, Erbil City, Iraq.
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Mi Y, Qu P, Guo N, Bai R, Gao J, Ma Z, He Y, Wang C, Luo X. Evaluation of factors that predict the success rate of trial of labor after the cesarean section. BMC Pregnancy Childbirth 2021; 21:527. [PMID: 34303355 PMCID: PMC8305496 DOI: 10.1186/s12884-021-04004-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 07/09/2021] [Indexed: 11/20/2022] Open
Abstract
Background For most women who have had a previous cesarean section, vaginal birth after cesarean section (VBAC) is a reasonable and safe choice, but which will increase the risk of adverse outcomes such as uterine rupture. In order to reduce the risk, we evaluated the factors that may affect VBAC and and established a model for predicting the success rate of trial of the labor after cesarean section (TOLAC). Methods All patients who gave birth at Northwest Women’s and Children’s Hospital from January 2016 to December 2018, had a history of cesarean section and voluntarily chose the TOLAC were recruited. Among them, 80% of the population was randomly assigned to the training set, while the remaining 20% were assigned to the external validation set. In the training set, univariate and multivariate logistic regression models were used to identify indicators related to successful TOLAC. A nomogram was constructed based on the results of multiple logistic regression analysis, and the selected variables included in the nomogram were used to predict the probability of successfully obtaining TOLAC. The area under the receiver operating characteristic curve was used to judge the predictive ability of the model. Results A total of 778 pregnant women were included in this study. Among them, 595 (76.48%) successfully underwent TOLAC, whereas 183 (23.52%) failed and switched to cesarean section. In multi-factor logistic regression, parity = 1, pre-pregnancy BMI < 24 kg/m2, cervical score ≥ 5, a history of previous vaginal delivery and neonatal birthweight < 3300 g were associated with the success of TOLAC. The area under the receiver operating characteristic curve in the prediction and validation models was 0.815 (95% CI: 0.762–0.854) and 0.730 (95% CI: 0.652–0.808), respectively, indicating that the nomogram prediction model had medium discriminative power. Conclusion The TOLAC was useful to reducing the cesarean section rate. Being primiparous, not overweight or obese, having a cervical score ≥ 5, a history of previous vaginal delivery or neonatal birthweight < 3300 g were protective indicators. In this study, the validated model had an approving predictive ability. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04004-z.
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Affiliation(s)
- Yang Mi
- Department of Obstetrics and Gynecology, Northwest Women's and Children's Hospital, Xi'an, 710061, China
| | - Pengfei Qu
- Translational Medicine Center, Northwest Women's and Children's Hospital, Xi'an , 710061, China
| | - Na Guo
- Department of Obstetrics and Gynecology, Northwest Women's and Children's Hospital, Xi'an, 710061, China
| | - Ruimiao Bai
- Department of Obstetrics and Gynecology, Northwest Women's and Children's Hospital, Xi'an, 710061, China
| | - Jiayi Gao
- Department of Nutrition and Food Safety, School of Public Health, Xi'an Jiaotong University, Xi'an , 710061, China
| | - Zhengfeei Ma
- Department of Health and Environmental Sciences, Xi'an Jiaotong-Liverpool University, Suzhou, 215123, China
| | - Yiping He
- Department of Obstetrics and Gynecology, Northwest Women's and Children's Hospital, Xi'an, 710061, China
| | - Caili Wang
- Department of Obstetrics and Gynecology, Northwest Women's and Children's Hospital, Xi'an, 710061, China
| | - Xiaoqin Luo
- Department of Nutrition and Food Safety, School of Public Health, Xi'an Jiaotong University, Xi'an , 710061, China.
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