1
|
Facchetti G, Teo Z, Sharma M, Budden A. Continuity obstetric care demonstrates greater vaginal birth after caesarean success. Aust N Z J Obstet Gynaecol 2024; 64:264-268. [PMID: 38180231 DOI: 10.1111/ajo.13790] [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: 07/03/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Australia's caesarean rate is higher than Organisation for Economic Co-operation and Development (OECD) average, and is rising. Vaginal birth after caesarean (VBAC) is safe for selected women. Midwifery continuity of care (CoC) is associated with higher rates of vaginal birth compared to other models; however, impacts on VBAC attempts and success are unknown. AIMS The primary aim was to determine if there is a difference in achieving VBAC between CoC and non-CoC (NCoC) models. The secondary aim was to determine if there is a difference in the proportion of women attempting VBAC between these models. MATERIALS AND METHODS Retrospective review of antenatal records and birthing data of all women who birthed in 2021 with one or more previous caesareans. Women were included if they had two or fewer caesareans. Women were excluded if contraindications to VBAC existed. RESULTS There were 142/1109 (12.8%) women who had previous caesareans and were eligible to attempt VBAC. There were 47/109 (43.1%) women who attempted vaginal birth after one caesarean with 78.7% success. After one caesarean, women in CoC were more likely to achieve VBAC than NCoC (45.2% vs 26.1%; relative risk (RR) 1.76, 95% CI 1.04-3.00), although when stratified by private and midwifery CoC models, women in midwifery CoC models were more likely to be successful (private RR 0.69, 95% CI 0.23-2.07 vs midwifery RR 2.48, 95% CI 1.50-4.11). Women in CoC were more likely to attempt VBAC (54.7% vs 34.8%; RR 1.57, 95% CI 1.02-2.41), and receive counselling about VBAC (92.5% vs 62%; RR 1.48, 95% CI 1.41-3.11). CONCLUSION CoC improves the rate of attempted and successful VBAC through several factors, including increased counselling and greater provision of birth choices.
Collapse
Affiliation(s)
- Georgina Facchetti
- Department of Obstetrics and Gynaecology, Coffs Harbour Hospital, Mid North Coast Local Health District, Coffs Harbour, New South Wales, Australia
- Department of Obstetrics and Gynaecology, Nepean Hospital, Nepean Blue Mountains Local Health District, Penrith, New South Wales, Australia
| | - Zhen Teo
- Department of Obstetrics and Gynaecology, Nepean Hospital, Nepean Blue Mountains Local Health District, Penrith, New South Wales, Australia
| | - Meenu Sharma
- Department of Obstetrics and Gynaecology, Coffs Harbour Hospital, Mid North Coast Local Health District, Coffs Harbour, New South Wales, Australia
- School of Women's and Children's Health, University of New South Wales, Coffs Harbour, New South Wales, Australia
| | - Aaron Budden
- Department of Obstetrics and Gynaecology, Coffs Harbour Hospital, Mid North Coast Local Health District, Coffs Harbour, New South Wales, Australia
- Gynaecology Research and Clinical Excellence (GRACE), Royal Hospital for Women, Sydney, New South Wales, Australia
| |
Collapse
|
2
|
Ghesquière L, Bengler C, Drumez E, Subtil D, Houfflin-Debarge V, Insubri S, Garabedian C. Factors associated with successful balloon catheter labor induction in women with a previous caesarean section: A retrospective single-center evaluation. J Gynecol Obstet Hum Reprod 2024; 53:102743. [PMID: 38341084 DOI: 10.1016/j.jogoh.2024.102743] [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: 10/11/2023] [Revised: 02/08/2024] [Accepted: 02/08/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Labor induction of women with a history of uterine scarring is an increasingly frequent situation and one for which there are currently no clear professional recommendations favoring one method over another. The objectives of this study were to determine the success rate of balloon catheter induction in women with a history of caesarean section and to evaluate the main factors associated with vaginal delivery. MATERIALS AND METHODS This single-center retrospective study was conducted between January 1, 2014, and December 31, 2018, in Lille, France, and included all women with one previous caesarean section who were induced by first-line balloon catheter induction. Multivariate analysis was performed to identify the factors associated with the primary outcome (vaginal delivery). RESULTS Of the 310 women in the sample, 192 delivered vaginally (62 %). After adjustment, factors associated with successful induction (vaginal delivery) were the number of previous vaginal deliveries (odds ratio [OR] 1.37; 95 % confidence interval [CI] 1.04-1.81), evolution of the Bishop score after balloon removal (OR 1.24; 95 % CI 1.10-1.41), and the initial Bishop score (OR 1.17; 95 % CI 1.00-1.37). Uterine rupture was observed in three women (1 %). CONCLUSION The vaginal delivery rate after balloon catheter induction in women with a previous caesarean section was 62 %. Prognostic factors for vaginal delivery include previous vaginal delivery, the initial Bishop score, and evolution of the Bishop score after balloon catheter induction.
Collapse
Affiliation(s)
- Louise Ghesquière
- Department of Obstetrics, CHU Lille, Lille F-59000, France; ULR 2694 - METRICS - Health Technology and Medical Practice Assessment, Univ. Lille, CHU Lille, Lille F-59000, France.
| | - Cyril Bengler
- Department of Obstetrics, CHU Lille, Lille F-59000, France
| | - Elodie Drumez
- ULR 2694 - METRICS - Health Technology and Medical Practice Assessment, Univ. Lille, CHU Lille, Lille F-59000, France; Department of Biostatistics, CHRU Lille, France
| | - Damien Subtil
- Department of Obstetrics, CHU Lille, Lille F-59000, France; ULR 2694 - METRICS - Health Technology and Medical Practice Assessment, Univ. Lille, CHU Lille, Lille F-59000, France
| | - Véronique Houfflin-Debarge
- Department of Obstetrics, CHU Lille, Lille F-59000, France; ULR 2694 - METRICS - Health Technology and Medical Practice Assessment, Univ. Lille, CHU Lille, Lille F-59000, France
| | | | - Charles Garabedian
- Department of Obstetrics, CHU Lille, Lille F-59000, France; ULR 2694 - METRICS - Health Technology and Medical Practice Assessment, Univ. Lille, CHU Lille, Lille F-59000, France
| |
Collapse
|
3
|
Pegu B, Subburaj SP, Chaturvedula L, Sarkar S, Nair NS, Keepanasseril A. External validation of prediction models for vaginal delivery after the trial of labour among women with previous one caesarean section - A cohort study. Eur J Obstet Gynecol Reprod Biol 2023; 291:10-15. [PMID: 37801782 DOI: 10.1016/j.ejogrb.2023.09.029] [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: 07/25/2023] [Revised: 09/28/2023] [Accepted: 09/30/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVE To externally validate three predictive models (the Grobman model (2007), the Zhang model (2020), and the Grobman model (2021)) for identifying women with increased chances of a successful trial of labour after caesarean section (TOLAC). METHODS This retrospective observational cohort study was conducted in a tertiary teaching hospital from 2018 to 2021. Individual probabilities were calculated for women with previous one caesarean section who underwent TOLAC at term, using the predicted probabilities from the logistic regression models. The primary outcome of this study was vaginal delivery following attempted TOLAC. The predictive ability of the models was assessed using the area under the receiver operative characteristics curves (AUC) and a calibration graph. RESULTS Of 1515 eligible women who underwent TOLAC, we found an overall rate of successful TOLAC of 60.3 %. No significant difference was noticed in adverse scar outcome and neonatal morbidity while comparing successful and failed TOLAC. The discriminative ability of Grobman-2007 and Grobman-2021 and the Zhang model were fair to poor with the AUC of 0.54(95 % CI 0.51-0.57), 0.62(95 % CI 0.59-0.65) and 0.66(95 % CI 0.63-0.69) respectively. The agreement between the observed rates of TOLAC success and the predicted probabilities for all three models was poor. CONCLUSION The performance of all three models predicting success after TOLAC was poor in the study population. A population-specific model may be needed, with the addition of factors influencing the labour, such as the methods of induction, which may aid in predicting the outcome.
Collapse
Affiliation(s)
- Bhabani Pegu
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Medical Education & Research, Puducherry 605006, India
| | - Sathiya Priya Subburaj
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Medical Education & Research, Puducherry 605006, India
| | - Latha Chaturvedula
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Medical Education & Research, Puducherry 605006, India
| | - Sonali Sarkar
- Preventive and Social Medicine, Jawaharlal Institute of Medical Education & Research, Puducherry 605006, India
| | - N Sreekumaran Nair
- Biostatistics, Jawaharlal Institute of Medical Education & Research, Puducherry 605006, India
| | - Anish Keepanasseril
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Medical Education & Research, Puducherry 605006, India.
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
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.
Collapse
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.
| |
Collapse
|
6
|
Gillor M, Levy R, Barak O, Ben Arie A, Vaisbuch E. Can assessing the angle of progression before labor onset assist to predict vaginal birth after cesarean?: A prospective cohort observational study. J Matern Fetal Neonatal Med 2022; 35:2046-2053. [PMID: 32519917 DOI: 10.1080/14767058.2020.1777269] [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: 12/01/2019] [Accepted: 05/29/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess whether pre-labor measurement of the angle of progression (AOP) can assist in predicting a successful vaginal birth after cesarean in women without a previous vaginal birth. METHODS A prospective observational cohort study performed in a single tertiary center including women at term with a single previous cesarean delivery (CD), without prior vaginal births, who desire a trial of labor. Transperineal ultrasound was used to measure the AOP before the onset of labor. The managing staff in the delivery suite was blinded to the ultrasound measurements. Clinical data and delivery outcome were retrieved from medical records. The study was approved by the institutional ethics committee (KMC 0117-10). RESULTS Of the 111 women included in the study, 67 (60.4%) had a successful vaginal birth after CD. Women were sonographically assessed at a median of 3 days [interquartile range (IQR) 1-3 days] prior to delivery. The median AOP was significantly narrower in women who eventually underwent a CD than in those who delivered vaginally (88°, IQR 78-96° vs. 99°, IQR 89-107°, respectively; p < .001). An AOP >98° (derived from a receiver operating characteristic curve) was associated with a successful vaginal birth after CD in 87.5% of women. Multivariable regression analysis demonstrated that each additional 1° in the AOP increases the chance for a successful vaginal birth after CD by 6%. CONCLUSIONS Pre-labor AOP may be a useful sonographic tool for predicting vaginal birth after CD and can assist in consulting primiparous women with a prior CD opting for a trial of labor.
Collapse
Affiliation(s)
- Moshe Gillor
- Department of Obstetrics and Gynecology, Kaplan Medical Center, Hebrew University and Hadassah School of Medicine, Rehovot, Israel
| | - Roni Levy
- Department of Obstetrics and Gynecology, Kaplan Medical Center, Hebrew University and Hadassah School of Medicine, Rehovot, Israel
| | - Oren Barak
- Department of Obstetrics and Gynecology, Kaplan Medical Center, Hebrew University and Hadassah School of Medicine, Rehovot, Israel
| | - Alon Ben Arie
- Department of Obstetrics and Gynecology, Kaplan Medical Center, Hebrew University and Hadassah School of Medicine, Rehovot, Israel
| | - Edi Vaisbuch
- Department of Obstetrics and Gynecology, Kaplan Medical Center, Hebrew University and Hadassah School of Medicine, Rehovot, Israel
| |
Collapse
|
7
|
Elias S, Wolde Z, Tantu T, Gunta M, Zewudu D. Determinants of early neonatal outcomes after emergency cesarean delivery at Hawassa University comprehensive specialised hospital, Hawassa, Ethiopia. PLoS One 2022; 17:e0263837. [PMID: 35324921 PMCID: PMC8947390 DOI: 10.1371/journal.pone.0263837] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/27/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Neonatal mortality after cesarean delivery is three folds higher than mortality after vaginal births. Post cesarean early neonatal outcomes are associated with preoperative and intraoperative fetomaternal factors which are preventable in the majority of cases. OBJECTIVE To identify determinants of early neonatal outcomes after emergency cesarean delivery at Hawassa University Comprehensive Specialized Hospital, Hawassa, Southern Ethiopia. METHOD Institution based cross sectional study was conducted on 270 emergency cesarean deliveries. Data were collected by using a pretested questionnaire by trained data collectors. Descriptive analysis was used to see the nature of the characteristics of interests. Pearson chi-square-test was used to check presence of association between independent and outcome variables. Bivariate analysis was used to sort out variables at p values less than 0.05 for multivariate logistic regression. Significance level was obtained using odds ratio with 95% CI and p value < 0.05. RESULTS The prevalence of adverse early neonatal outcome after emergency cesarean delivery was 26.7%. Around 11% of newborns had low (<7) fifth minute Apgar score and more than one-third (34.8%) of them admitted to neonatal intensive care unit for more than 24 hours. Fifteen (5.6%) newborns died within their first seven days of life. Neonates with a preoperative meconium-stained amniotic fluid and low birth weight (< 2500 grams) had greater odds of having adverse early neonatal outcome with (AOR = 6.37; 95% CI: 2.64, 15.34) and (AOR = 14.00; 95% CI: 3.64, 53.84) respectively. CONCLUSION The prevalence of adverse early neonatal outcome is high in this study and meconium-stained amniotic fluid during labor as well as low birth weight were the leading predictors of adverse early neonatal outcome during emergency cesarean delivery.
Collapse
Affiliation(s)
- Solomon Elias
- Department of Gynecology and Obstetrics, Final Year Resident in Obstetrics and Gynecology in Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Zenebe Wolde
- Department of Obstetrics and Gynecology in Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Temesgen Tantu
- Department of Obstetrics and Gynecology in Wolkite University College of Medicine and Health Sciences, Wolkite, Ethiopia
| | - Muluken Gunta
- Wolaita Zone Health Department Officer, Wolaita Sodo, Southern Nations, Ethiopia
| | - Dereje Zewudu
- Department of Anesthesia in Wolkite University College of Medicine and Health Sciences, Wolkite, Ethiopia
| |
Collapse
|
8
|
Jamshed S, Chien SC, Tanweer A, Asdary RN, Hardhantyo M, Greenfield D, Chien CH, Weng SF, Jian WS, Iqbal U. Correlation Between Previous Caesarean Section and Adverse Maternal Outcomes Accordingly With Robson Classification: Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 8:740000. [PMID: 35096855 PMCID: PMC8795992 DOI: 10.3389/fmed.2021.740000] [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: 07/12/2021] [Accepted: 11/29/2021] [Indexed: 11/20/2022] Open
Abstract
Background: The increasing rates of Caesarean section (CS) beyond the WHO standards (10–15%) pose a significant global health concern. Objective: Systematic review and meta-analysis to identify an association between CS history and maternal adverse outcomes for the subsequent pregnancy and delivery among women classified in Robson classification (RC). Search Strategy: PubMed/Medline, EbscoHost, ProQuest, Embase, Web of Science, BIOSIS, MEDLINE, and Russian Science Citation Index databases were searched from 2008 to 2018. Selection Criteria: Based on Robson classification, studies reporting one or more of the 14 adverse maternal outcomes were considered eligible for this review. Data Collection: Study design data, interventions used, CS history, and adverse maternal outcomes were extracted. Main Results: From 4,084 studies, 28 (n = 1,524,695 women) met the inclusion criteria. RC group 5 showed the highest proportion among deliveries followed by RC10, RC7, and RC8 (67.71, 32.27, 0.02, and 0.001%). Among adverse maternal outcomes, hysterectomy had the highest association after preterm delivery OR = 3.39 (95% CI 1.56–7.36), followed by Severe Maternal Outcomes OR = 2.95 (95% CI 1.00–8.67). We identified over one and a half million pregnant women, of whom the majority were found to belong to RC group 5. Conclusions: Previous CS was observed to be associated with adverse maternal outcomes for the subsequent pregnancies. CS rates need to be monitored given the prospective risks which may occur for maternal and child health in subsequent births.
Collapse
Affiliation(s)
- Shazia Jamshed
- Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Sultan Zainal Abidin (UniSZA), Kuala Terengganu, Malaysia.,Qualitative Research-Methodological Application in Health Sciences Research Group, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Malaysia
| | - Shuo-Chen Chien
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan
| | - Afifa Tanweer
- Department of Nutrition Sciences, School of Health Sciences, University of Management and Technology, Lahore, Pakistan
| | - Rahma-Novita Asdary
- Masters Program in Department of Global Health & Development, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Muhammad Hardhantyo
- Graduate Program of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan.,Faculty of Health Science, Universitas Respati Yogyakarta, Depok, Indonesia.,Center for Health Policy and Management, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Depok, Indonesia
| | - David Greenfield
- The Simpson Centre for Health Services Research, South Western Sydney Clinical School, University of New South Wales (UNSW) Medicine, Sydney, NSW, Australia.,Linéaire Projects, Sydney, NSW, Australia
| | - Chia-Hui Chien
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan.,Office of Public Affairs, Taipei Medical University, Taipei, Taiwan
| | - Shuen-Fu Weng
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.,Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wen-Shan Jian
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan.,School of Health Care Administration, School of Gerontology Health Management, Graduate Institute of Data Science, Research Center for Artificial Intelligence in Medicine, Taipei Medical University, Taipei, Taiwan
| | - Usman Iqbal
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan.,Masters Program in Department of Global Health & Development, College of Public Health, Taipei Medical University, Taipei, Taiwan.,Ph.D. Program in Depatment of Global Health & Health Security, College of Public Health, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
9
|
Wan S, Yang M, Pei J, Zhao X, Zhou C, Wu Y, Sun Q, Wu G, Hua X. Pregnancy outcomes and associated factors for uterine rupture: an 8 years population-based retrospective study. BMC Pregnancy Childbirth 2022; 22:91. [PMID: 35105342 PMCID: PMC8805328 DOI: 10.1186/s12884-022-04415-6] [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: 05/25/2021] [Accepted: 01/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background Uterine rupture is an obstetrical emergency with serious undesired complications for laboring mothers resulting in fatal maternal and neonatal outcomes. The aim of this study was to assess the incidence of uterine rupture, its association with previous uterine surgery and vaginal birth after caesarean section (VBAC), and the maternal and perinatal implications. Methods This is a population-based retrospective study. All pregnant women treated for ruptured uterus in one center between 2013 and 2020 were included. Their information retrieved from the medical records department were reviewed retrospectively. Results A total of 209,112 deliveries were included and 41 cases of uterine rupture were identified. The incidence of uterine rupture was 1.96/10000 births. Among the 41 cases, 16 (39.0%) had maternal and fetal complications. There were no maternal deaths secondary to uterine rupture, while perinatal fatality related to uterine rupture was 7.3%. Among all cases, 38 (92.7%) were scarred uterus and 3 (7.3%) were unscarred uterus. The most common cause of uterine rupture was previous cesarean section, while cases with a history of laparoscopic myomectomy were more likely to have serious adverse outcomes, such as fetal death. 24 (59.0%) of the ruptures occurred in anterior lower uterine segment. Changes in Fetal heart rate monitoring were the most reliable signs for rupture. Conclusions Incidence of uterine rupture in the study area, Shanghai, China was consistent with developed countries. Further improvements in obstetric care and enhanced collaboration with referring health facilities were needed to ensure maternal and perinatal safety. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04415-6.
Collapse
Affiliation(s)
- Sheng Wan
- Department of Obstetrics, Shanghai First Maternity and infant hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China
| | - Mengnan Yang
- Department of Obstetrics, Shanghai First Maternity and infant hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China
| | - Jindan Pei
- Department of Obstetrics, Shanghai First Maternity and infant hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China
| | - Xiaobo Zhao
- Department of Obstetrics, Shanghai First Maternity and infant hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China
| | - Chenchen Zhou
- Department of Obstetrics, Shanghai First Maternity and infant hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China
| | - Yuelin Wu
- Department of Obstetrics, Shanghai First Maternity and infant hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China
| | - Qianqian Sun
- Department of Obstetrics, Shanghai First Maternity and infant hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China
| | - Guizhu Wu
- Department of Gynecology, Shanghai First Maternity and infant hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China.
| | - Xiaolin Hua
- Department of Obstetrics, Shanghai First Maternity and infant hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China.
| |
Collapse
|
10
|
Koppes DM, van Hees MSF, Koenders VM, Oudijk MA, Bekker MN, Franssen MTM, Smits LJ, Hermens R, van Kuijk SMJ, Scheepers HC. Nationwide implementation of a decision aid on vaginal birth after cesarean: a before and after cohort study. J Perinat Med 2021; 49:783-790. [PMID: 34049425 DOI: 10.1515/jpm-2021-0007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/26/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Woman with a history of a previous cesarean section (CS) can choose between an elective repeat CS (ERCS) and a trial of labor (TOL), which can end in a vaginal birth after cesarean (VBAC) or an unplanned CS. Guidelines describe women's rights to make an informed decision between an ERCS or a TOL. However, the rates of TOL and vaginal birth after CS varies greatly between and within countries. The objective of this study is to asses nation-wide implementation of counselling with a decision aid (DA) including a prediction model, on intended delivery compared to care as usual. We hypothesize that this may result in a reduction in practice variation without an increase in cesarean rates or complications. METHODS In a multicenter controlled before and after cohort study we evaluate the effect of nation-wide implementation of a DA. Practice variation was defined as the standard deviation (SD) of TOL percentages. RESULTS A total of 27 hospitals and 1,364 women were included. A significant decrease was found in practice variation (SD TOL rates: 0.17 control group vs. 0.10 intervention group following decision aid implementation, p=0.011). There was no significant difference in the ERCS rate or overall CS rates. A 21% reduction in the combined maternal and perinatal adverse outcomes was seen. CONCLUSIONS Nationwide implementation of the DA showed a significant reduction in practice variation without an increase in the rate of cesarean section or complications, suggesting an improvement in equality of care.
Collapse
Affiliation(s)
- Dorothea M Koppes
- Department of Obstetrics and Gynecology, Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Obstetrics and Gynecology, GROW-School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Merel S F van Hees
- Department of Obstetrics and Gynecology, Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Obstetrics and Gynecology, GROW-School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | | | - Martijn A Oudijk
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Mireille N Bekker
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maureen T M Franssen
- Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, The Netherlands
| | - Luc J Smits
- Department of Epidemiology, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Rosella Hermens
- Scientific Centre for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Hubertina C Scheepers
- Department of Obstetrics and Gynecology, Maastricht University Medical Center+, Maastricht, The Netherlands
| |
Collapse
|
11
|
Vankan E, van Kuijk SMJ, Nijhuis JG, Aardenburg R, Delemarre FMC, Dirksen CD, van Dooren IM, Kuppens SMI, Kwee A, Langenveld J, Schoorel EN, Smits LJ, Hermens RP, Scheepers HC. External validation of a prediction model on vaginal birth after caesarean in a The Netherlands: a prospective cohort study. J Perinat Med 2021; 49:357-363. [PMID: 33155996 DOI: 10.1515/jpm-2020-0308] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 10/18/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Discussing the individual probability of a successful vaginal birth after caesarean (VBAC) can support decision making. The aim of this study is to externally validate a prediction model for the probability of a VBAC in a Dutch population. METHODS In this prospective cohort study in 12 Dutch hospitals, 586 women intending VBAC were included. Inclusion criteria were singleton pregnancies with a cephalic foetal presentation, delivery after 37 weeks and one previous caesarean section (CS) and preference for intending VBAC. The studied prediction model included six predictors: pre-pregnancy body mass index, previous vaginal delivery, previous CS because of non-progressive labour, Caucasian ethnicity, induction of current labour, and estimated foetal weight ≥90th percentile. The discriminative and predictive performance of the model was assessed using receiver operating characteristic curve analysis and calibration plots. RESULTS The area under the curve was 0.73 (CI 0.69-0.78). The average predicted probability of a VBAC according to the prediction model was 70.3% (range 33-92%). The actual VBAC rate was 71.7%. The calibration plot shows some overestimation for low probabilities of VBAC and an underestimation of high probabilities. CONCLUSIONS The prediction model showed good performance and was externally validated in a Dutch population. Hence it can be implemented as part of counselling for mode of delivery in women choosing between intended VBAC or planned CS after previous CS.
Collapse
Affiliation(s)
- Emy Vankan
- Maastricht Universitair Medisch Centrum, GROW-School for Oncology and Developmental Biology, Department of Obstetrics and Gynecology, Maastricht, Netherlands
| | - Sander M J van Kuijk
- Maastricht University Medical Centre, Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht, Limburg, Netherlands
| | - Jan G Nijhuis
- Maastricht University Medical Centre, Obstetrics and Gynecology, Maastricht, Limburg, Netherlands
| | - Robert Aardenburg
- Zuyderland Medical Centre Sittard-Geleen, Obstetrics and Gynecology, Sittard-Geleen, Limburg, Netherlands
| | - Friso M C Delemarre
- Elkerliek Hospital, Obstetrics and Gynecology, Helmond, Noord-Brabant, Netherlands
| | - Carmen D Dirksen
- Maastricht University Medical Centre, Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht, Limburg, Netherlands
| | - Ivo M van Dooren
- Saint Jans Hospital Weert, Obstetrics and Gynecology, Weert, Limburg, Netherlands
| | - Simone M I Kuppens
- Catharina Hospital, Obstetrics and Gynecology, Eindhoven, North Brabant, Netherlands
| | - Anneke Kwee
- University Medical Centre Utrecht, Obstetrics, Utrecht, Netherlands
| | - Josje Langenveld
- Zuyderland Medical Centre Heerlen, Obstetrics and Gynecology, Heerlen, Limburg, Netherlands
| | - Ellen N Schoorel
- Maastricht University Medical Centre, GROW- School for Oncology and Developmental Biology, Department of Obstetrics and Gynaecology, Maastricht, Limburg, Netherlands
| | - Luc J Smits
- Maastricht University Medical Centre, Caphri School for Public Health and Primary Care, Maastricht, Limburg, Netherlands
| | - Rosella P Hermens
- Radboudumc, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, Gelderland, Netherlands
| | - Hubertina C Scheepers
- Maastricht University Medical Centre, Obstetrics and Gynaecology, Maastricht, Netherlands
| |
Collapse
|
12
|
Bullough S, Southward J, Sharp A. Vaginal prostaglandin E 2 versus double-balloon catheter for induction of labour for vaginal birth after caesarean section: A retrospective cohort study. Eur J Obstet Gynecol Reprod Biol 2021; 259:90-94. [PMID: 33610830 DOI: 10.1016/j.ejogrb.2021.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare the success of the double-balloon catheter (DBC) versus prostaglandin gel (PGE2) for induction of labour in women with one previous caesarean section. DESIGN Retrospective cohort study using routinely collected maternity data in a Tertiary NHS hospital, North West England, UK. Women with a live singleton cephalic pregnancy induced using DBC or PGE2 after one previous birth by caesarean section from 1st April 2017 to 1st July 2019 were included. The core outcomes assessed were the inability to perform artificial rupture of membranes, requirement of oxytocin, vaginal birth and uterine rupture. RESULTS 208 women met the inclusion criteria, 127 were induced using the DBC and 81 using PGE2. The two groups were well matched for demographics and characteristics. Women induced for prolonged ruptured membranes with PGE2 were excluded from the study leaving 127 managed with DBC and 69 with PGE2. There were no significant differences observed between the two groups. Vaginal birth rates were 52.7% for the DBC and 66.6% for the PGE2 (relative risk 0.79 (confidence interval 0.63-1.00); P = 0.05). A single uterine rupture was reported following DBC usage. CONCLUSIONS The DBC and PGE2 appear to be equally effective for induction of labour in women with one previous caesarean section.
Collapse
Affiliation(s)
- Siân Bullough
- Harris Wellbeing Research Centre, University of Liverpool and Liverpool Women's Hospital, Members of Liverpool Health Partners, United Kingdom; Liverpool Women's Hospital, Member of Liverpool Health Partners, United Kingdom.
| | - Jessica Southward
- Liverpool Women's Hospital, Member of Liverpool Health Partners, United Kingdom
| | - Andrew Sharp
- Harris Wellbeing Research Centre, University of Liverpool and Liverpool Women's Hospital, Members of Liverpool Health Partners, United Kingdom; Liverpool Women's Hospital, Member of Liverpool Health Partners, United Kingdom
| |
Collapse
|
13
|
Zipori Y, Ben-David C, Lauterbach R, Weissman A, Beloosesky R, Ginsberg Y, Weiner Z, Khatib N. Vaginal birth after cesarean in women with pre-labor rupture of membranes at term. J Matern Fetal Neonatal Med 2020; 35:4065-4070. [PMID: 33183111 DOI: 10.1080/14767058.2020.1846703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Women with a successful vaginal birth after cesarean delivery (VBAC) have less morbidity than women undergoing repeat cesarean delivery. Although several scores and models predict VBAC success, none focus on pregnant women with pre-labor rupture of membranes (PROM). We evaluated different clinical variables that might predict the likelihood of VBAC success in women with PROM. STUDY DESIGN A retrospective, 5-year study in a large referral center from December 2013 to December 2018. Inclusion criteria were women with singleton pregnancy, at or beyond 37 weeks' gestation, admitted with spontaneous PROM, with one previous cesarean delivery that consented trial of labor. Exclusion criteria were history of two cesarean deliveries, multiple gestations or obstetrical contraindications for TOLAC, including maternal request for repeat cesarean delivery. Variables associated with successful VBA C were identified using multivariate logistic regression. RESULTS Of 302 women in the cohort, 74.8% (226/302) delivered vaginally (successful VBAC) and 25.2% (76/302) by repeat CD (failed TOLAC). Multiple logistic regression showed that duration of PROM-to-delivery time was the only significant factor associated with successful TOLAC (78% delivered vaginally within 24 h and 93.3% within 36 h), while none of the other variables (maternal age, gravidity, BMI, gestational and birthweight at delivery, effacement or station at admission, previous indication for cesarean delivery, time interval between previous and current delivery, presence of meconium-stained liquor, and documented temperature >38 °C) were associated with the prediction of successful VBAC. CONCLUSION Women with spontaneous pre-labor PROM and previous cesarean delivery have high success rates of VBAC. The only significant variable associated with successful TOLAC in women with spontaneous PROM at term was the duration of PROM-to-delivery time. Our findings suggest that the success rate of VBAC is likely multifactorial, not-necessarily related to a specific underlying factor, and in the absence of contraindications, a fair trial of labor after cesarean delivery is justified.
Collapse
Affiliation(s)
- Yaniv Zipori
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Chen Ben-David
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Roy Lauterbach
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Amir Weissman
- High-Risk Pregnancy Unit, Lin Medical Center, Clalit Health Services, Haifa, Israel
| | - Ron Beloosesky
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.,Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yuval Ginsberg
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Zeev Weiner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.,Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nizar Khatib
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| |
Collapse
|
14
|
Meyer R, Hendin N, Zamir M, Mor N, Levin G, Sivan E, Aran D, Tsur A. Implementation of machine learning models for the prediction of vaginal birth after cesarean delivery. J Matern Fetal Neonatal Med 2020; 35:3677-3683. [PMID: 33103511 DOI: 10.1080/14767058.2020.1837769] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Accurate prediction of vaginal birth after cesarean is crucial for selecting women suitable for a trial of labor after cesarean (TOLAC). We sought to develop a machine learning (ML) model for prediction of TOLAC success and to compare its accuracy with that of the MFMU model. METHODS All consecutive singleton TOLAC deliveries from a tertiary academic medical center between February 2017 and December 2018 were included. We developed models using the following ML algorithms: random forest (RF), regularized regression (GLM), and eXtreme gradient-boosted decision trees (XGBoost). For developing the ML models, we disaggregated BMI into height and weight. Similarly, we disaggregated prior arrest of progression into prior arrest of dilatation and prior arrest of descent. We applied a nested cross-validation approach, using 100 random splits of the data to training (80%, 792 samples) and testing sets (20%, 197 samples). We used the area under the precision-recall curve (AUC-PR) as a measure of accuracy. RESULTS Nine hundred and eighty-nine TOLAC deliveries were included in the analysis with an observed TOLAC success rate of 85.6%. The AUC-PR in the RF, XGBoost and GLM models were 0.351±0.028, 0.350±0.028 and 0.336±0.024, respectively, compared to 0.325±0.067 for the MFMU-C. The algorithms performed significantly better than the MFMU-C (p-values = .0002, .0004, .0393 for RF, XGBoost, GLM respectively). In the XGBoost model, eight variables were sufficient for accurate prediction. In all ML models, previous vaginal delivery and height were among the three most important predictors of TOLAC success. Prior arrest of descent contributed to prediction more than prior arrest of dilatation, maternal height contributed more than weight. CONCLUSION All ML models performed significantly better than the MFMU-C. In the XGBoost model, eight variables were sufficient for accurate prediction. Prior arrest of descent and maternal height contribute to prediction more than prior arrest of dilation and maternal weight.
Collapse
Affiliation(s)
- Raanan Meyer
- Department of Obstetrics and Gynecology, The Sheba Medical Center, Tel Hashomer, Israel.,School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Natav Hendin
- School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Michal Zamir
- School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Nizan Mor
- School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Gabriel Levin
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Eyal Sivan
- Department of Obstetrics and Gynecology, The Sheba Medical Center, Tel Hashomer, Israel.,School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Dvir Aran
- Lorry I. Lokey Interdisciplinary Center for Life Sciences & Engineering, Technion-Israel Institute of Technology, Haifa, Israel
| | - Abraham Tsur
- Department of Obstetrics and Gynecology, The Sheba Medical Center, Tel Hashomer, Israel.,School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.,Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
15
|
Liao Q, Luo J, Zheng L, Han Q, Liu Z, Qi W, Yang T, Yan J. Establishment of an antepartum predictive scoring model to identify candidates for vaginal birth after cesarean. BMC Pregnancy Childbirth 2020; 20:639. [PMID: 33081753 PMCID: PMC7574429 DOI: 10.1186/s12884-020-03231-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 09/02/2020] [Indexed: 11/15/2022] Open
Abstract
Background Evidence-based medicine has shown that successful vaginal birth after cesarean (VBAC) is associated with fewer complications than an elective repeat cesarean. Although spontaneous vaginal births and reductions in cesarean delivery (CD) rates have been advocated, the risk factors for VBAC complications remain unclear and failed trials of labor (TOL) can lead to adverse pregnancy outcomes. Methods To construct an antepartum predictive scoring model for VBAC. Retrospective analysis of charts from 1062 women who underwent TOL at no less than 28 gestational weeks with vertex singletons and no more than one prior CD. Results We constructed our scoring model based on the following variables: maternal age, previous vaginal delivery, interdelivery interval (time between prior cesarean and the following delivery), presence of prior cesarean TOL, dystocia as prior CD indication, intertuberous diameter, maternal predelivery body mass index, gestational age at delivery, estimated fetal weight, and hypertensive disorders. Previous vaginal delivery was the most influential variable. The nomogram showed an area under the curve of 77.7% (95% confidence interval, 73.8–81.5%; sensitivity, 78%; specificity, 70%; cut-off, 13 points). The Kappa value to judge the consistency of the results between the predictive model and the actual results was 0.71(95% confidence interval 0.65–0.77) indicating strong consistency. We used the cut-off to divide the VBAC women into two groups according to the success of the TOL. The maternal and neonatal outcomes such as labor time, number of deliveries by midwives, postpartum hemorrhage, uterine rupture, neonatal asphyxia, puerperal infection were significantly different between the two groups. Conclusions Our predictive scoring model incorporates easily ascertainable variables and can be used to personalize antepartum counselling for successful TOLs after cesareans.
Collapse
Affiliation(s)
- Qiuping Liao
- Department of Gynecology and Obstetrics, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Daoshan Road 18, Gulou District, Fujian, 350000, Fuzhou, China
| | - Jinying Luo
- Department of Gynecology and Obstetrics, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Daoshan Road 18, Gulou District, Fujian, 350000, Fuzhou, China
| | - Lianghui Zheng
- Department of Gynecology and Obstetrics, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Daoshan Road 18, Gulou District, Fujian, 350000, Fuzhou, China
| | - Qing Han
- Department of Gynecology and Obstetrics, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Daoshan Road 18, Gulou District, Fujian, 350000, Fuzhou, China
| | - Zhaodong Liu
- Department of Gynecology and Obstetrics, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Daoshan Road 18, Gulou District, Fujian, 350000, Fuzhou, China
| | - Wei Qi
- Department of Gynecology and Obstetrics, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Daoshan Road 18, Gulou District, Fujian, 350000, Fuzhou, China
| | - Tingting Yang
- Department of Gynecology and Obstetrics, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Daoshan Road 18, Gulou District, Fujian, 350000, Fuzhou, China
| | - Jianying Yan
- Department of Gynecology and Obstetrics, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Daoshan Road 18, Gulou District, Fujian, 350000, Fuzhou, China.
| |
Collapse
|
16
|
Lipschuetz M, Guedalia J, Rottenstreich A, Novoselsky Persky M, Cohen SM, Kabiri D, Levin G, Yagel S, Unger R, Sompolinsky Y. Prediction of vaginal birth after cesarean deliveries using machine learning. Am J Obstet Gynecol 2020; 222:613.e1-613.e12. [PMID: 32007491 DOI: 10.1016/j.ajog.2019.12.267] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 12/30/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Efforts to reduce cesarean delivery rates to 12-15% have been undertaken worldwide. Special focus has been directed towards parturients who undergo a trial of labor after cesarean delivery to reduce the burden of repeated cesarean deliveries. Complication rates are lowest when a vaginal birth is achieved and highest when an unplanned cesarean delivery is performed, which emphasizes the need to assess, in advance, the likelihood of a successful vaginal birth after cesarean delivery. Vaginal birth after cesarean delivery calculators have been developed in different populations; however, some limitations to their implementation into clinical practice have been described. Machine-learning methods enable investigation of large-scale datasets with input combinations that traditional statistical analysis tools have difficulty processing. OBJECTIVE The aim of this study was to evaluate the feasibility of using machine-learning methods to predict a successful vaginal birth after cesarean delivery. STUDY DESIGN The electronic medical records of singleton, term labors during a 12-year period in a tertiary referral center were analyzed. With the use of gradient boosting, models that incorporated multiple maternal and fetal features were created to predict successful vaginal birth in parturients who undergo a trial of labor after cesarean delivery. One model was created to provide a personalized risk score for vaginal birth after cesarean delivery with the use of features that are available as early as the first antenatal visit; a second model was created that reassesses this score after features are added that are available only in proximity to delivery. RESULTS A cohort of 9888 parturients with 1 previous cesarean delivery was identified, of which 75.6% of parturients (n=7473) attempted a trial of labor, with a success rate of 88%. A machine-learning-based model to predict when vaginal delivery would be successful was developed. When features that are available at the first antenatal visit are used, the model showed a receiver operating characteristic curve with area under the curve of 0.745 (95% confidence interval, 0.728-0.762) that increased to 0.793 (95% confidence interval, 0.778-0.808) when features that are available in proximity to the delivery process were added. Additionally, for the later model, a risk stratification tool was built to allocate parturients into low-, medium-, and high-risk groups for failed trial of labor after cesarean delivery. The low- and medium-risk groups (42.4% and 25.6% of parturients, respectively) showed a success rate of 97.3% and 90.9%, respectively. The high-risk group (32.1%) had a vaginal delivery success rate of 73.3%. Application of the model to a cohort of parturients who elected a repeat cesarean delivery (n=2145) demonstrated that 31% of these parturients would have been allocated to the low- and medium-risk groups had a trial of labor been attempted. CONCLUSION Trial of labor after cesarean delivery is safe for most parturients. Success rates are high, even in a population with high rates of trial of labor after cesarean delivery. Application of a machine-learning algorithm to assign a personalized risk score for a successful vaginal birth after cesarean delivery may help in decision-making and contribute to a reduction in cesarean delivery rates. Parturient allocation to risk groups may help delivery process management.
Collapse
Affiliation(s)
- Michal Lipschuetz
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel; Obstetrics & Gynecology Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Joshua Guedalia
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Amihai Rottenstreich
- Obstetrics & Gynecology Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Sarah M Cohen
- Obstetrics & Gynecology Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Doron Kabiri
- Obstetrics & Gynecology Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Gabriel Levin
- Obstetrics & Gynecology Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Simcha Yagel
- Obstetrics & Gynecology Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - Ron Unger
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Yishai Sompolinsky
- Obstetrics & Gynecology Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| |
Collapse
|
17
|
Odejinmi F, Strong S, Sideris M, Mallick R. Caesarean section in women following an abdominal myomectomy: a choice or a need? Facts Views Vis Obgyn 2020; 12:57-60. [PMID: 32696025 PMCID: PMC7363247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Delivery options following both open and laparoscopic myomectomy remains a controversial topic and opinions vary between obstetricians and gynaecologists. The historical advice of planned caesarean section before 39-weeks persists despite the movement towards the minimal access approach for myomectomy. The main concern remains the small, but potentially catastrophic risk of uterine rupture. Unfortunately, there remains a paucity of data assessing factors that can affect the uterine integrity following laparoscopic myomectomy, such as number, size and type of fibroids, uterine cavity breach and electro-cautery usage. Despite this, the cited 1% overall risk of rupture following myomectomy is similar to the quoted risk following trial of labour after caesarean section, and a successful and safe vaginal delivery can be achieved in as high as 90%. Patient choice and informed consent are essential in the holistic approach to managing these women and safely supporting their delivery choices.
Collapse
Affiliation(s)
- F Odejinmi
- Whipps Cross Hospital, Barts Health NHS Trust, Whipps Cross Road, Leytonstone, London, E11 1NR
| | - S Strong
- Whipps Cross Hospital, Barts Health NHS Trust, Whipps Cross Road, Leytonstone, London, E11 1NR
| | - M Sideris
- Whipps Cross Hospital, Barts Health NHS Trust, Whipps Cross Road, Leytonstone, London, E11 1NR
| | - R Mallick
- Princess Royal Hospital, Brighton and Sussex University Hospitals NHS Trust, Lewes Road, Haywards Heath, RH16 4EX
| |
Collapse
|
18
|
Trial of labor after cesarean in older women who never delivered vaginally. Eur J Obstet Gynecol Reprod Biol 2019; 245:89-93. [PMID: 31891896 DOI: 10.1016/j.ejogrb.2019.12.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/19/2019] [Accepted: 12/22/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Maternal age is an established determinant of successful trial of labor after cesarean (TOLAC). While an increasing proportion of parturients are aged 40 years and older, and previously underwent a cesarean section, little data regarding TOLAC success for this age group is available. This study assessed TOLAC success, and its associated characteristics, among women >40 years who never delivered vaginally. STUDY DESIGN A retrospective case-control study of all women who never delivered vaginally aged ≥40 years with a history of previous cesarean delivery, who delivered at our hospital during 2006-2017. Maternal, neonatal, and delivery characteristics were compared between women with successful and unsuccessful TOLAC. RESULTS Of 335 older women who never delivered vaginally with a history of one cesarean delivery, 61 (18.2 %) elected TOLAC (18.2 %); the median age was 41[40-42] years and the inter-delivery interval 34 [25-50] months. Overall, 38/61 (62.3 %) had a successful TOLAC. Women with successful TOLAC had a higher rate of a non-recurrent indication for cesarean delivery in their previous cesarean delivery (42.1 % vs. 13.0 %, P = 0.01), whereas dysfunctional labor at previous delivery was more common in the failed TOLAC group (47.8 % vs. 15.8 %, P = 0.007). Failed TOLAC was associated with the presence of gestational diabetes (13.0 % vs. 0 %, P = 0.02) and having a comorbidity (47.8 % vs. 21.0 %, P = 0.02). Induction of labor at TOLAC was more common in the failed TOLAC group (34.8 % vs. 2.6 %, P < 0.001). Birthweight was higher in the failed TOLAC group (3330 vs. 3107 g, P = 0.04), as well as the birthweight difference between deliveries (212 g vs. 82 g, P = 0.03). Neonatal and maternal outcomes were comparable between groups, except for longer length of stay (5 vs. 4 days, P = 0.04) in the failed TOLAC group. In a multivariable logistic regression analysis, only two factors were independently associated with TOLAC failure: previous cesarean delivery due to dysfunctional labor (OR [95 % CI]: 13.40 (1.29, 138.71), P = 0.03) and higher inter-delivery birthweight difference (OR [95 % CI]: 1.18 (1.11, 1.39), P = 0.02). CONCLUSIONS TOLAC in older women who never delivered vaginally is associated with a moderate success rate. The indication for cesarean delivery at the first delivery and inter-delivery birthweight difference were identified as having strong predictive value for TOLAC outcome.
Collapse
|
19
|
Sun J, Yan X, Yuan A, Huang X, Xiao Y, Zou L, Liu D, Huang T, Zheng Z, Li Y. Effect of epidural analgesia in trial of labor after cesarean on maternal and neonatal outcomes in China: a multicenter, prospective cohort study. BMC Pregnancy Childbirth 2019; 19:498. [PMID: 31842795 PMCID: PMC6916071 DOI: 10.1186/s12884-019-2648-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The trial of labor after cesarean section (TOLAC) is a relatively new technique in mainland of China, and epidural analgesia is one of the risk factors for uterine rupture. This study aimed to evaluate the effect of epidural analgesia on primary labor outcome [success rate of vaginal birth after cesarean (VBAC)], parturient complications and neonatal outcomes after TOLAC in Chinese multiparas based on a strictly uniform TOLAC indication, management and epidural protocol. METHODS A total of 423 multiparas undergoing TOLAC were enrolled in this study from January 2017 to February 2018. Multiparas were divided into two groups according to whether they received epidural analgesia (study group, N = 263) or not (control group, N = 160) during labor. Maternal delivery outcomes and neonatal characteristics were recorded and evaluated using univariate analysis, multivariable logistic regression and propensity score matching (PSM). RESULTS The success rate of VBAC was remarkably higher (85.55% vs. 69.38%, p < 0.01) in study group. Epidural analgesia significantly shortened initiating lactation period and declined Visual Analogue Score (VAS). It also showed more superiority in neonatal umbilical arterial blood pH value. After matching by PSM, multivariable logistic regression revealed that the correction of confounding factors including epidural analgesia, cervical Bishop score at admission and spontaneous onset of labor were still shown as promotion probability in study group (OR = 4.480, 1.360, and 10.188, respectively; 95%CI = 2.025-10.660, 1.113-1.673, and 2.875-48.418, respectively; p < 0.001, p = 0.003, and p < 0.001, respectively). CONCLUSIONS Epidural analgesia could reduce labor pain, and no increased risk of postpartum bleeding or uterine rupture, as well as adverse effects in newborns were observed. The labor duration of multiparas was increased, but within acceptable range. In summary, epidural analgesia may be safe for both mother and neonate in the three studied hospitals. TRIAL REGISTRATION Chineses Clinical Trial Register, ChiCTR-ONC-17010654. Registered February 16th, 2017.
Collapse
Affiliation(s)
- Jing Sun
- Department of Anesthesiology, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, No.2004 Hongli Road, Futian District, Shenzhen, 518028, Guangdong, China
| | - Xuetao Yan
- Department of Anesthesiology, Bao'an Maternal and Child Health Hospital, Jinan University, Shenzhen, 518100, China
| | - Aiwu Yuan
- Department of Anesthesiology, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City, Shenzhen, 518172, China
| | - Xiaolei Huang
- Department of Anesthesiology, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, No.2004 Hongli Road, Futian District, Shenzhen, 518028, Guangdong, China
| | - Yuci Xiao
- Department of Anesthesiology, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, No.2004 Hongli Road, Futian District, Shenzhen, 518028, Guangdong, China
| | - Liwei Zou
- Department of Anesthesiology, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, No.2004 Hongli Road, Futian District, Shenzhen, 518028, Guangdong, China
| | - Danyong Liu
- Department of Anesthesiology, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, No.2004 Hongli Road, Futian District, Shenzhen, 518028, Guangdong, China
| | - Ting Huang
- Department of Obstetrics, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, Guangdong, China
| | - Zhao Zheng
- Department of Anesthesiology, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, No.2004 Hongli Road, Futian District, Shenzhen, 518028, Guangdong, China
| | - Yuantao Li
- Department of Anesthesiology, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, No.2004 Hongli Road, Futian District, Shenzhen, 518028, Guangdong, China.
| |
Collapse
|
20
|
de Souza HCC, Perdoná GSC, Marcolin AC, Oyeneyin LO, Oladapo OT, Mugerwa K, Souza JP. Development of caesarean section prediction models: secondary analysis of a prospective cohort study in two sub-Saharan African countries. Reprod Health 2019; 16:165. [PMID: 31727102 PMCID: PMC6854746 DOI: 10.1186/s12978-019-0832-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 10/30/2019] [Indexed: 11/25/2022] Open
Abstract
Background Caesarean section is recommended in situations in which vaginal birth presents a greater likelihood of adverse maternal or perinatal outcomes than normal. However, it is associated with a higher risk of complications, especially when performed without a clear medical indication. Since labour attendants have no standardised clinical method to assist in this decision, statistical tools developed based on multiple labour variables may be an alternative. The objective of this paper was to develop and evaluate the accuracy of models for caesarean section prediction using maternal and foetal characteristics collected at admission and through labour. Method This is a secondary analysis of the World Health Organization’s Better Outcomes in Labour Difficulty prospective cohort study in two sub-Saharan African countries. Data were collected from women admitted for labour and childbirth in 13 hospitals in Nigeria as well as Uganda between 2014 and 2015. We applied logistic regression to develop different models to predict caesarean section, based on the time when intrapartum assessment was made. To evaluate discriminatory capacity of the various models, we calculated: area under the curve, diagnostic accuracy, positive predictive value, negative predictive value, sensitivity and specificity. Results A total of 8957 pregnant women with 12.67% of caesarean births were used for model development. The model based on labour admission characteristics showed an area under the curve of 78.70%, sensitivity of 63.20%, specificity of 78.68% and accuracy of 76.62%. On the other hand, the models that applied intrapartum assessments performed better, with an area under the curve of 93.66%, sensitivity of 80.12%, specificity of 89.26% and accuracy of 88.03%. Conclusion It is possible to predict the likelihood of intrapartum caesarean section with high accuracy based on labour characteristics and events. However, the accuracy of this prediction is considerably higher when based on information obtained throughout the course of labour.
Collapse
Affiliation(s)
- Hayala C C de Souza
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900 - Vila Monte Alegre, Ribeirão Preto, SP, Brazil.
| | - Gleici S C Perdoná
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900 - Vila Monte Alegre, Ribeirão Preto, SP, Brazil
| | - Alessandra C Marcolin
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900 - Vila Monte Alegre, Ribeirão Preto, SP, Brazil
| | - Lawal O Oyeneyin
- Department of Obstetrics & Gynaecology, University of Medical Sciences Teaching Hospital, Medical Village, Laje Road, Ondo City, Ondo State, Nigeria
| | - Olufemi T Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 27, CH-1211, Geneva, Switzerland
| | - Kidza Mugerwa
- Department of Obstetrics and Gynaecology, Makerere University, Kampala, Uganda
| | - João Paulo Souza
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900 - Vila Monte Alegre, Ribeirão Preto, SP, Brazil
| |
Collapse
|
21
|
Liu Y, Zhu W, Le S, Wu W, Huang Q, Cheng W. Using healthcare failure mode and effect analysis as a method of vaginal birth after caesarean section management. J Clin Nurs 2019; 29:130-138. [PMID: 31532033 PMCID: PMC7328791 DOI: 10.1111/jocn.15069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 09/03/2019] [Accepted: 09/03/2019] [Indexed: 12/01/2022]
Abstract
Aims and objectives This research was conducted to explore the effectiveness of employing the healthcare failure mode and effect analysis method in the management of trial of labour after caesarean, with the aims of increasing vaginal birth after caesarean section rate and reducing potential risks that might cause severe complications. Background Previously high caesarean section rate in China and the “two children” policy leads to the situation where multiparas are faced with the choice of another caesarean or trial of labour after caesarean. Despite evidences showing the benefits of vaginal birth after caesarean, obstetricians and midwives in China tend to be conservative due to limited experience and insufficient clinical routines. Thus, its management needs further optimisation in order to make the practice safe and sound. Design A prospective quality improvement programme using the healthcare failure mode and effect analysis. Methods With the structured methodology of healthcare failure mode and effect analysis, we determined core processes of antepartum and intrapartum management, conducted risk priority numbers and devised remedial protocols for failure modes with high risks. The programme was then implemented as a clinical routine under the agreement of the institutional review board and vaginal birth after caesarean success rates were compared before and after the quality improvement programme, both descriptively and statistically. Standards for Quality Improvement Reporting Excellence 2.0 checklist was chosen on reporting the study process. Results Seventy failure modes in seven core processes were identified in the management process, with 14 redressed for actions. The 1‐year follow‐up trial of labour after caesarean and vaginal birth after caesarean rate was increased compared with the previous 3 years, with a vaginal birth after caesarean rate of 86.36%, whereas the incidence of uterine rupture was not compromised. Conclusions The application of healthcare failure mode and effect analysis can not only promote trial of labour after caesarean and vaginal birth after caesarean rate, but also maintaining a low risk of uterine rupture. Relevance to clinical practice This modified vaginal birth after caesarean management protocol has been shown effective in increasing its successful rate, which can be continued for further comparison of severe complications to the previous practice.
Collapse
Affiliation(s)
- Ying Liu
- International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.,Institute of Embryo-Fetal Original Adult Disease, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Zhu
- International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.,Institute of Embryo-Fetal Original Adult Disease, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shiguan Le
- Department of Surgery and War Surgery, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Wenxian Wu
- International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.,Institute of Embryo-Fetal Original Adult Disease, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qun Huang
- International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.,Institute of Embryo-Fetal Original Adult Disease, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiwei Cheng
- International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.,Institute of Embryo-Fetal Original Adult Disease, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
22
|
Wu Y, Kataria Y, Wang Z, Ming WK, Ellervik C. Factors associated with successful vaginal birth after a cesarean section: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2019; 19:360. [PMID: 31623587 PMCID: PMC6798397 DOI: 10.1186/s12884-019-2517-y] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 09/20/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Evidence for the relationship between maternal and perinatal factors and the success of vaginal birth after cesarean section (VBAC) is conflicting. We aimed to systematically analyze published data on maternal and fetal factors for successful VBAC. METHODS A comprehensive search of Medline, Embase, and the Cumulative Index to Nursing and Allied Health Literature, from each database's inception to March 16, 2018. Observational studies, identifying women with a trial of labor after one previous low-transverse cesarean section were included. Two reviewers independently abstracted the data. Meta-analysis was performed using the random-effects model. Risk of bias was assessed by the Newcastle-Ottawa Scale. RESULTS We included 94 eligible observational studies (239,006 pregnant women with 163,502 VBAC). Factors were associated with successful VBAC with the following odds ratios (OR;95%CI): age (0.92;0.86-0.98), obesity (0.50;0.39-0.64), diabetes (0.50;0.42-0.60), hypertensive disorders complicating pregnancy (HDCP) (0.54;0.44-0.67), Bishop score (3.77;2.17-6.53), labor induction (0.58;0.50-0.67), macrosomia (0.56;0.50-0.64), white race (1.39;1.26-1.54), previous vaginal birth before cesarean section (3.14;2.62-3.77), previous VBAC (4.71;4.33-5.12), the indications for the previous cesarean section (cephalopelvic disproportion (0.54;0.36-0.80), dystocia or failure to progress (0.54;0.41-0.70), failed induction (0.56;0.37-0.85), and fetal malpresentation (1.66;1.38-2.01)). Adjusted ORs were similar. CONCLUSIONS Diabetes, HDCP, Bishop score, labor induction, macrosomia, age, obesity, previous vaginal birth, and the indications for the previous CS should be considered as the factors affecting the success of VBAC.
Collapse
Affiliation(s)
- Yanxin Wu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, 510000, People's Republic of China
- Department of Laboratory Medicine, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02215, USA
| | - Yachana Kataria
- Department of Laboratory Medicine, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02215, USA
| | - Zilian Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, 510000, People's Republic of China.
| | - Wai-Kit Ming
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, 510000, People's Republic of China.
| | - Christina Ellervik
- Department of Laboratory Medicine, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02215, USA.
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
23
|
Vankan E, Schoorel E, van Kuijk S, Nijhuis J, Hermens R, Scheepers H. The effect of the use of a decision aid with individual risk estimation on the mode of delivery after a caesarean section: A prospective cohort study. PLoS One 2019; 14:e0222499. [PMID: 31557177 PMCID: PMC6763212 DOI: 10.1371/journal.pone.0222499] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 05/20/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE After one previous caesarean section (CS), pregnant women can deliver by elective repeat CS or have a trial of labor which can end in a vaginal birth after caesarean (VBAC) or an unplanned CS. Despite guidelines describing women's rights to make an informed choice, trial of labor and VBAC rates vary greatly worldwide. Many women are inadequately informed due to caregivers' fear of an increase in CS rates in a high VBAC rate setting. We compared counseling with a decision aid (DA) including a prediction model on VBAC to care as usual. We hypothesize that counselling with the DA does not decrease VBAC rates. In addition, we aimed to study the effects on unplanned CS rate, patient involvement in decision-making and elective repeat CS rates. METHODS We performed a prospective cohort study. From 2012 to 2014, 483 women in six hospitals, where the DA was used (intervention group), were compared with 441 women in six matched hospitals (control group). Women with one previous CS, pregnant of a singleton in cephalic presentation, delivering after 37 weeks 0 days were eligible for inclusion. RESULTS There was no significant difference in VBAC rates between the intervention (45%) and control group (46%) (adjusted odds ratio 0,92 (95% Confidence interval 0.69-1.23)). In the intervention group more women (42%) chose an elective repeat CS compared to the control group (31%) (adjusted odds ratio 1.6 (95% Confidence interval 1.18-2.17)). Of women choosing trial of labor, in the intervention group 77% delivered vaginally compared to 67% in the control group, resulting in an unplanned CS adjusted odds ratio of 0,57 (0.40-0.82) in the intervention group. In the intervention group, more women reported to be involved in decision-making (98% vs. 68%, P< 0.001). CONCLUSIONS Implementing a decision aid with a prediction model for risk selection suggests unchanged VBAC rates, but 40% reduction in unplanned CS rates, increase in elective repeat CS and improved patient involvement in decision-making.
Collapse
Affiliation(s)
- Emy Vankan
- GROW-School for Oncology and Developmental Biology, Department of Obstetrics and Gynaecology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Ellen Schoorel
- GROW-School for Oncology and Developmental Biology, Department of Obstetrics and Gynaecology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Sander van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Jan Nijhuis
- GROW-School for Oncology and Developmental Biology, Department of Obstetrics and Gynaecology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Rosella Hermens
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Hubertina Scheepers
- GROW-School for Oncology and Developmental Biology, Department of Obstetrics and Gynaecology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | |
Collapse
|
24
|
Lin J, Hou Y, Ke Y, Zeng W, Gu W. Establishment and validation of a prediction model for vaginal delivery after cesarean and its pregnancy outcomes-Based on a prospective study. Eur J Obstet Gynecol Reprod Biol 2019; 242:114-121. [PMID: 31580963 DOI: 10.1016/j.ejogrb.2019.09.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/16/2019] [Accepted: 09/19/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To explore factors that can be used to predict successful vaginal births after cesarean (VBAC) and its outcome. METHODS This is a prospective study involving women with a previous low-segment cesarean section, singleton pregnancy and cephalic presentation who desire for vaginal trial delivery. Delivery modes were observed and the pregnancy outcomes were followed up. The data were analyzed to identify the factors associated with the success of vaginal births after cesarean (VBAC). Then, there were elaborated the models, and their predictive capacity was determined by receiver-operator curve (ROC). RESULTS The multivariate logistic regression showed Bishop's score and spontaneous labour independently influenced vaginal births after cesarean (VBAC) success. The prediction model is established and validated. The fitting degree and prediction accuracy of the model is good. The vaginal births after cesarean (VBAC) group had less postpartum hemorrhage (Median 270 ml vs. 300 ml, P < 0.05), a lower puerperal infection rate (1.62% vs 5.88%, P < 0.01), and shorter postpartum hospitalization (Median 2 days vs. 3 days, P < 0.01) than the trial of labor after cesarean (TOLAC)-failure groups. It also had less postpartum hemorrhage (Median 270 ml vs. 320 ml, P < 0.01), a lower puerperal infection rate (1.62% vs 6.23%, P < 0.05), and shorter postpartum hospitalization (Median 2 days vs. 3 days, P < 0.01) than the elective repeat cesarean section (ERCS) groups. The use of labor analgesia in the vaginal births after cesarean (VBAC) group had no effect on pregnancy outcomes. CONCLUSION The predictive factors are conducive to making rational choices about delivery mode and should improve pregnancy outcomes.
Collapse
Affiliation(s)
- Jing Lin
- Department of Gynecology and Obstetrics, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yanyan Hou
- Department of Gynecology and Obstetrics, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yiling Ke
- Department of Gynecology and Obstetrics, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Weijian Zeng
- Department of Gynecology and Obstetrics, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Gu
- Department of Gynecology and Obstetrics, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| |
Collapse
|
25
|
Fishel Bartal M, Sibai BM, Ilan H, Fried M, Rahav R, Alexandroni H, Schushan Eisan I, Hendler I. Trial of labor after cesarean (TOLAC) in women with premature rupture of membranes . J Matern Fetal Neonatal Med 2019; 33:2976-2982. [PMID: 30652525 DOI: 10.1080/14767058.2019.1566312] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: The aim of this study was to assess the success rate of a trial of labor after a previous cesarean section (TOLAC) in the settings of premature rupture of membranes (PROM) and to compare conservative management with spontaneous labor and induction of labor.Methods: This was a retrospective cohort study conducted in a single tertiary care center between January 2011 and March 2017. Women with singleton pregnancy and a previous cesarean section (CS) who presented with PROM and underwent TOLAC were included. Outcomes and rate of successful vaginal delivery after induction of labor were compared to conservative treatment and spontaneous labor.Results: Among 830 women who met the inclusion criteria, 723 (87.1%) had a spontaneous onset of labor following PROM and 107 (12.9%) had an induction of labor. The rate of successful TOLAC was similar between the groups (75.7 vs. 81.6%, respectively, p = .22). However, induction of labor was associated with an increased risk for uterine rupture (1.87 vs. 0.96%, p < .001), operative complications (6.7 vs. 2.3%, p < .001), and composite maternal postpartum complications (21.4 vs. 10.7%, respectively, p = .014) compared to conservative management with spontaneous initiation of labor. There was no difference in neonatal outcome between the groups.Conclusion: Induction of labor following PROM in women with a previous CS is associated with high successful vaginal delivery rate. However, the risk for uterine rupture and operative and maternal complications is significantly increased compared to spontaneous initiation of labor.
Collapse
Affiliation(s)
- Michal Fishel Bartal
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Baha M Sibai
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal Fetal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UT Health), Houston, TX, USA
| | - Hadas Ilan
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moran Fried
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roni Rahav
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Heli Alexandroni
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Irit Schushan Eisan
- Department of Neonatology, The Edmond and Lily Safra Children's Hospital and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Israel Hendler
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
26
|
Xing Y, Qi X, Wang X, Yang F. Development of a Modified Score System as Prediction Model for Successful Vaginal Birth After Cesarean Delivery. Clin Transl Sci 2019; 12:53-57. [PMID: 30548202 PMCID: PMC6342239 DOI: 10.1111/cts.12603] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 11/06/2018] [Indexed: 11/28/2022] Open
Abstract
This study was designed to establish a modified prediction score system to improve the safety and success rate of vaginal birth after cesarean delivery (VBAC). We recruited 406 patients (between January 2012 and December 2016) and generated a modified score system in predicting the success rate of VBAC. All patients were required to sign informed consent forms. There were 87.2% of patients who had successful VBAC deliveries and 12.8% patients who had repeated cesarean sections. We conducted multivariable logistic regression and found seven variables that were associated with VBAC success, including previous primary indication of cesarean delivery (odds ratio (OR), 2.1; 95% confidence interval (CI), 1.4-3.0), previous vaginal birth history (OR, 2.5; 95% CI, 1.8-3.8), < 40 years of age (OR, 2.1; 95% CI, 1.2-3.3), < 20 kg weight gain (OR, 1.5; 95% CI, 1.2-2.3), no labor induction (OR, 1.9; 95% CI, 1.5-2.9), high score of pelvic/birth weight (OR, 1.4; 95% CI, 1.1-2.1), and Bishop score (OR, 1.3; 95% CI, 1.2-1.4). After adjustment for optimism, the area under the receiver operating characteristic curve (AUC-ROC) was 0.849 (95% CI, 0.78-0.89), and the modified VBAC score was positively correlated with the success rate of trial of labor after cesarean delivery (TOLAC). A valid and useful score system was established to predict VBAC success rate.
Collapse
Affiliation(s)
- Yan‐Ping Xing
- The Second Department of ObstetricsCangzhou Central HospitalCangzhouYunhe District, Hebei ProvinceChina
| | - Xin‐Ying Qi
- The Second Department of ObstetricsCangzhou Central HospitalCangzhouYunhe District, Hebei ProvinceChina
| | - Xue‐Zhen Wang
- The Second Department of ObstetricsCangzhou Central HospitalCangzhouYunhe District, Hebei ProvinceChina
| | - Feng‐Zhen Yang
- The Second Department of ObstetricsCangzhou Central HospitalCangzhouYunhe District, Hebei ProvinceChina
| |
Collapse
|
27
|
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.
Collapse
|
28
|
Hicklin KT, Ivy JS, Wilson JR, Cobb Payton F, Viswanathan M, Myers ER. Simulation model of the relationship between cesarean section rates and labor duration. Health Care Manag Sci 2018; 22:635-657. [PMID: 29995263 DOI: 10.1007/s10729-018-9449-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 06/13/2018] [Indexed: 11/25/2022]
Abstract
Cesarean delivery is the most common major abdominal surgery in many parts of the world, and it accounts for nearly one-third of births in the United States. For a patient who requires a C-section, allowing prolonged labor is not recommended because of the increased risk of infection. However, for a patient who is capable of a successful vaginal delivery, performing an unnecessary C-section can have a substantial adverse impact on the patient's future health. We develop two stochastic simulation models of the delivery process for women in labor; and our objectives are (i) to represent the natural progression of labor and thereby gain insights concerning the duration of labor as it depends on the dilation state for induced, augmented, and spontaneous labors; and (ii) to evaluate the Friedman curve and other labor-progression rules, including their impact on the C-section rate and on the rates of maternal and fetal complications. To use a shifted lognormal distribution for modeling the duration of labor in each dilation state and for each type of labor, we formulate a percentile-matching procedure that requires three estimated quantiles of each distribution as reported in the literature. Based on results generated by both simulation models, we concluded that for singleton births by nulliparous women with no prior complications, labor duration longer than two hours (i.e., the time limit for labor arrest based on the Friedman curve) should be allowed in each dilation state; furthermore, the allowed labor duration should be a function of dilation state.
Collapse
Affiliation(s)
- Karen T Hicklin
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Julie S Ivy
- Edward P. Fitts Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC, 27695, USA
| | - James R Wilson
- Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC, 27695, USA
| | - Fay Cobb Payton
- College of Management, North Carolina State University, Raleigh, NC, 27695, USA
| | | | - Evan R Myers
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, 27710, USA
| |
Collapse
|
29
|
Manzanares S, Ruiz-Duran S, Pinto A, Pineda A, Puertas A. An integrated model with classification criteria to predict vaginal delivery success after cesarean section. J Matern Fetal Neonatal Med 2018; 33:236-242. [PMID: 29886811 DOI: 10.1080/14767058.2018.1488166] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Background: Cesarean delivery (CD) is the most frequently performed surgical procedure worldwide. Trial of labor after cesarean (TOLAC) is associated with an increase in perinatal complications related to uterine rupture. However, in general, vaginal birth after cesarean (VBAC) is considered safe and women have less morbidity than those who undergo an elective repeat CD.Objective: To develop an integrated model with the best performance criteria for predicting vaginal delivery success after CD.Study design: Retrospective observational study including 2367 women who underwent a TOLAC. A predictive model using classification and regression tree modeling was constructed to predict vaginal delivery using maternal demographic, medical history, and labor predictors.Results: Vaginal delivery was best predicted by spontaneous onset of labor, estimated fetal weight <3775 g, maternal body mass index <25, previous CD as an elective or for fetal distress reasons, and interdelivery interval <2290 days. The algorithm showed a sensitivity of 75%, a specificity of 53%, and the area under the curve was 0.69.Conclusions: The classification and regression tree algorithm can be used to develop a predictive model for the success of TOLAC.
Collapse
Affiliation(s)
- Sebastian Manzanares
- Department of Obstetrics & Gynaecology, Virgen de las Nieves University Hospital, Granada, Spain
| | - Susana Ruiz-Duran
- Department of Obstetrics & Gynaecology, Virgen de las Nieves University Hospital, Granada, Spain
| | - Andrea Pinto
- Department of Obstetrics & Gynaecology, Virgen de las Nieves University Hospital, Granada, Spain
| | - Alicia Pineda
- Department of Obstetrics & Gynaecology, Virgen de las Nieves University Hospital, Granada, Spain
| | - Alberto Puertas
- Department of Obstetrics & Gynaecology, Virgen de las Nieves University Hospital, Granada, Spain
| |
Collapse
|
30
|
Sovio U, Smith GCS. Blinded ultrasound fetal biometry at 36 weeks and risk of emergency Cesarean delivery in a prospective cohort study of low-risk nulliparous women. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:78-86. [PMID: 28452133 DOI: 10.1002/uog.17513] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/19/2017] [Accepted: 04/21/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To compare the association between risk of emergency Cesarean delivery (CD) and non-customized vs customized ultrasound estimated fetal weight (EFW) at 36 weeks' gestation, determine whether addition of ultrasound EFW to a model based on maternal characteristics alone improved prediction of emergency CD, assess the screening performance of a multivariable model using both EFW and maternal characteristics to predict emergency CD, and determine whether women at high predicted risk of emergency CD based on this model had higher risk of maternal and perinatal morbidity compared with screen-negative women. METHODS We studied 3047 low-risk (no pre-existing medical conditions or acquired complications of pregnancy) nulliparous women from the prospective Pregnancy Outcome Prediction study (Cambridge, UK) cohort, who underwent ultrasound EFW at ∼36 weeks' gestation. Both the women and their clinicians were blinded to fetal biometry results. Emergency CD was defined as delivery by Cesarean section in pregnancies in which the date of delivery had not been prearranged. Additional candidate predictors of emergency CD evaluated were maternal age, height, body mass index (BMI), weight gain, fetal abdominal circumference growth velocity and fetal sex. External validation of the predictive model was performed using routinely collected data from 55 337 births in Scotland between 2003 and 2008. Women with an estimated risk of emergency CD ≥ 40% were defined as screen positive. RESULTS Blinded EFW was associated strongly with the risk of emergency CD (coefficient for increase of 1 SD in EFW, 0.39 (95% CI, 0.30-0.48); odds ratio (OR), 1.48 (95% CI, 1.35-1.62)). The coefficient for customized EFW was similar (0.42 (95% CI, 0.33-0.51); OR, 1.53 (95% CI, 1.39-1.67)); hence, for simplicity, non-customized EFW was employed subsequently. A multivariable logistic regression model combining maternal characteristics (age, height, BMI and weight gain between 12 and 36 weeks) was moderately predictive of emergency CD (area under the receiver-operating characteristics curve (AUC) = 0.68). Addition of blinded EFW to the model increased the AUC to 0.71 and improved prediction (likelihood-ratio test P < 0.0001). Based on this model, 189 (6.2%) women were screen positive and 48% of these delivered by CD. Screen-positive women had elevated risks of severe postpartum hemorrhage (relative risk (RR), 2.49; 95% CI, 1.83-3.38), any adverse neonatal outcome (RR, 1.86; 95% CI, 1.22-2.82) and severe adverse neonatal outcome (RR, 4.03; 95% CI, 1.35-12.03) compared with screen-negative women. The risks of these events were also higher compared with women who had a term CD for breech presentation. The model was similarly predictive of the risk of emergency CD and perinatal morbidity when evaluated using the dataset from Scotland. CONCLUSIONS Ultrasound EFW at 36 weeks, combined with maternal characteristics, can identify women who are at increased risk of subsequent emergency CD. These women are at increased risk of maternal and perinatal morbidity compared with women at low risk of emergency CD and those having CD for breech presentation at term. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- U Sovio
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge, UK
| | - G C S Smith
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge, UK
| |
Collapse
|
31
|
Christian P, Smith ER. Adolescent Undernutrition: Global Burden, Physiology, and Nutritional Risks. ANNALS OF NUTRITION AND METABOLISM 2018; 72:316-328. [PMID: 29730657 DOI: 10.1159/000488865] [Citation(s) in RCA: 166] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 03/12/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Adolescents, comprised of 10-19 year olds, form the largest generation of young people in our history. There are an estimated 1.8 billion adolescents in the world, with 90% residing in low- and middle-income countries. The burden of disease among adolescents has its origins in infectious and injury-related causes, but nutritional deficiencies, suboptimal linear growth, and undernutrition are major public health problems, even as overweight may be on the rise in many contexts. Summary and Key Messages: Girls are most vulnerable to the influences of cultural and gender norms, which often discriminate against them. Dietary patterns and physical activity, in addition to schooling and countervailing social norms for early marriage, influence health and nutritional well-being of adolescents. Nutrient requirements - -including those for energy, protein, iron, calcium, and -others - increase in adolescence to support adequate growth and development. In settings where dietary intakes are suboptimal, anemia and micronutrient deficiencies are high. Endocrine factors are essential for promoting normal adolescent growth and are sensitive to undernutrition. Growth velocity increases during puberty when peak height velocity occurs and catch-up is possible; in girls, about 15-25% of adult height is attained. A premature pregnancy can halt linear growth and increase the risk of adverse birth outcomes. Research is needed to fill the huge data gaps related to nutrition and growth during adolescence, in addition to testing interventions during this second window of opportunity to enhance growth and development, improve human capital, and to end the intergenerational cycle of growth failure.
Collapse
Affiliation(s)
- Parul Christian
- Bill and Melinda Gates Foundation, Seattle, Washington, USA.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Emily R Smith
- Bill and Melinda Gates Foundation, Seattle, Washington, USA.,Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
32
|
de Vries B, Narayan R, McGeechan K, Santiagu S, Vairavan R, Burke M, Phipps H, Hyett J. Is sonographically measured cervical length at 37 weeks of gestation associated with intrapartum cesarean section? A prospective cohort study. Acta Obstet Gynecol Scand 2018; 97:668-676. [DOI: 10.1111/aogs.13310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 01/22/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Bradley de Vries
- RPA Women and Babies; Royal Prince Alfred Hospital; Sydney New South Wales Australia
- Obstetrics, Gynecology and Neonatology; University of Sydney; Sydney New South Wales Australia
| | - Rajit Narayan
- RPA Women and Babies; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Kevin McGeechan
- School of Public Health; University of Sydney; Sydney New South Wales Australia
| | - Stanley Santiagu
- RPA Women and Babies; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Ramesh Vairavan
- Department of Maternal Fetal Medicine; Tengku Ampuan Rahimah Hospital; Klang Malaysia
| | - Minke Burke
- Royal Hospital for Women; Sydney New South Wales Australia
| | - Hala Phipps
- RPA Women and Babies; Royal Prince Alfred Hospital; Sydney New South Wales Australia
- Obstetrics, Gynecology and Neonatology; University of Sydney; Sydney New South Wales Australia
| | - Jon Hyett
- RPA Women and Babies; Royal Prince Alfred Hospital; Sydney New South Wales Australia
- Obstetrics, Gynecology and Neonatology; University of Sydney; Sydney New South Wales Australia
| |
Collapse
|
33
|
Baranov A, Salvesen KÅ, Vikhareva O. Validation of prediction model for successful vaginal birth after Cesarean delivery based on sonographic assessment of hysterotomy scar. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:189-193. [PMID: 28233347 DOI: 10.1002/uog.17439] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/18/2017] [Accepted: 02/17/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To validate a prediction model for successful vaginal birth after Cesarean delivery (VBAC) based on sonographic assessment of the hysterotomy scar, in a Swedish population. METHODS Data were collected from a prospective cohort study. We recruited non-pregnant women aged 18-35 years who had undergone one previous low-transverse Cesarean delivery at ≥ 37 gestational weeks and had had no other uterine surgery. Participants who subsequently became pregnant underwent transvaginal ultrasound examination of the Cesarean hysterotomy scar at 11 + 0 to 13 + 6 and at 19 + 0 to 21 + 6 gestational weeks. Thickness of the myometrium at the thinnest part of the scar area was measured. After delivery, information on pregnancy outcome was retrieved from hospital records. Individual probabilities of successful VBAC were calculated using a previously published model. Predicted individual probabilities were divided into deciles. For each decile, observed VBAC rates were calculated. To assess the accuracy of the prediction model, receiver-operating characteristics curves were constructed and the areas under the curves (AUC) were calculated. RESULTS Complete sonographic data were available for 120 women. Eighty (67%) women underwent trial of labor after Cesarean delivery (TOLAC) with VBAC occurring in 70 (88%) cases. The scar was visible in all 80 women at the first-trimester scan and in 54 (68%) women at the second-trimester scan. AUC was 0.44 (95% CI, 0.28-0.60) among all women who underwent TOLAC and 0.51 (95% CI, 0.32-0.71) among those with the scar visible sonographically at both ultrasound examinations. CONCLUSION The prediction model demonstrated poor accuracy for prediction of successful VBAC in our Swedish population. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- A Baranov
- Department of Obstetrics and Gynecology, Skåne University Hospital Malmö, Lund University, Malmö, Sweden
| | - K Å Salvesen
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynecology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - O Vikhareva
- Department of Obstetrics and Gynecology, Skåne University Hospital Malmö, Lund University, Malmö, Sweden
| |
Collapse
|
34
|
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.
Collapse
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
| |
Collapse
|
35
|
Prah J, Kudom A, Afrifa A, Abdulai M, Sirikyi I, Abu E. Caesarean section in a primary health facility in Ghana: Clinical indications and feto-maternal outcomes. J Public Health Afr 2017; 8:704. [PMID: 29416842 PMCID: PMC5793048 DOI: 10.4081/jphia.2017.704] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/06/2017] [Accepted: 07/07/2017] [Indexed: 11/23/2022] Open
Abstract
There is great concern about the increasing rise in the rate of caesarean section in both developed and developing countries. This study was to ascertain the prevalence and compare outcomes of elective and emergency caesarean sections among women who deliver at the University of Cape Coast Hospital, Ghana. This retrospective study reviewed records of 645 women who delivered through caesarean sections during the period of January 2014 and December 2015. The prevalence of caesarean section was 26.9%. There was a significantly higher rate of adverse fetal outcomes (P=0.016) among babies born through emergency caesarean section. There were 12 (1.9%) women who had caesarean section done based on maternal request. The caesarean section rate found in this study was high. The lack of availability of technology for diagnosing fetal distress found in this study could possibly lead to over diagnosis of fetal distress. Thus availability of such diagnostic technology could reduce the high caesarean section rate. The high numbers of women requesting caesarean section without medical indication should be investigated and the motivation factors identified so as to curb the practice.
Collapse
Affiliation(s)
- James Prah
- University of Cape Coast Hospital, Cape Coast
| | - Andreas Kudom
- Department of Conservation Biology and Entomology, University of Cape Coast
| | - Alex Afrifa
- University of Cape Coast Hospital, Cape Coast
| | | | | | - Emmanuel Abu
- Department of Optometry, School of Allied Health Sciences, University of Cape Coast, Ghana
| |
Collapse
|
36
|
|
37
|
Nakamura K, Hayashi S, Sasahara J, Okamoto Y, Ishii K, Mitsuda N. Labor after cesarean delivery managed without induction or augmentation of labor. Birth 2017; 44:363-368. [PMID: 28464342 DOI: 10.1111/birt.12293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 03/18/2017] [Accepted: 03/20/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study aimed to describe the perinatal outcomes of women opting for vaginal birth after cesarean delivery (VBAC) managed without induction or augmentation of labor. METHODS This was a retrospective cohort study of candidates for VBAC at a tertiary center in Japan from April 2003 to March 2012. Women with singleton gestations and one prior low-transverse cesarean delivery who intended VBAC at 36 weeks of gestation were identified as candidates for VBAC and included in the study. Participants were managed without induction or augmentation of labor. Maternal characteristics and perinatal outcomes were obtained from medical records. Factors associated with successful VBAC were analyzed with a multivariable logistic regression model. RESULTS Of 333 candidates for VBAC, 242 (72.7%) had vaginal birth, 49 (14.7%) had repeat cesarean delivery with spontaneous labor, and 42 (12.6%) had repeat cesarean delivery without spontaneous labor. The rate of uterine rupture was 0.3% (1/333). Prior vaginal delivery and nonrecurring indications for prior cesarean delivery were associated with successful VBAC. CONCLUSIONS Management of candidates for VBAC without induction or augmentation of labor resulted in a high VBAC rate and favorable perinatal outcomes. Such restrictive VBAC policies may be an acceptable alternative to standard management or abandonment of VBAC.
Collapse
Affiliation(s)
- Kohei Nakamura
- Department of Obstetrics and Gynecology, Shimane University Faculty of Medicine, Shimane, Japan
| | - Shusaku Hayashi
- Department of Maternal-Fetal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Jun Sasahara
- Department of Maternal-Fetal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Yoko Okamoto
- Department of Maternal-Fetal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Keisuke Ishii
- Department of Maternal-Fetal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Nobuaki Mitsuda
- Department of Maternal-Fetal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| |
Collapse
|
38
|
Wells JCK. The New "Obstetrical Dilemma": Stunting, Obesity and the Risk of Obstructed Labour. Anat Rec (Hoboken) 2017; 300:716-731. [PMID: 28297186 DOI: 10.1002/ar.23540] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/27/2016] [Accepted: 08/30/2016] [Indexed: 01/24/2023]
Abstract
The "obstetrical dilemma" refers to the tight fit between maternal pelvic dimensions and neonatal size at delivery. Most interest traditionally focused on its generic significance for humans, for example our neonatal altriciality and our complex and lengthy birth process. Across contemporary populations, however, the obstetrical dilemma manifests substantial variability, illustrated by differences in the incidence of cephalo-pelvic disproportion, obstructed labour and cesarean section. Beyond accounting for 12% of maternal mortality worldwide, obstructed labour also imposes a huge burden of maternal morbidity, in particular through debilitating birth injuries. This article explores how the double burden of malnutrition and the global obesity epidemic may be reshaping the obstetrical dilemma. First, short maternal stature increases the risk of obstructed labour, while early age at marriage also risks pregnancy before pelvic growth is completed. Second, maternal obesity increases the risk of macrosomic offspring. In some populations, short maternal stature may also promote the risk of gestational diabetes, another risk factor for macrosomic offspring. These nutritional influences are furthermore sensitive to social values relating to issues such as maternal and child nutrition, gender inequality and age at marriage. Secular trends in maternal obesity are substantially greater than those in adult stature, especially in low- and middle-income countries. The association between the dual burden of malnutrition and the obstetrical dilemma is therefore expected to increase, because the obesity epidemic is emerging faster than stunting is being resolved. However, we currently lack objective population-specific data on the association between maternal obesity and birth injuries. Anat Rec, 300:716-731, 2017. © 2017 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Jonathan C K Wells
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
| |
Collapse
|
39
|
Momat FKW, Zalagile PA, Mukalenge FC, Luboya ON, Kalala CT, Mashinda D, Grangé G, Mukuku O, Kaj FM, Lubamba CC, Bwama JB, Mukoko CK, Kakoma JB, Kalungwe JK. [Labour in women with scarred uterus in the Democratic Republic of the Congo: trial of scar and factors influencing the outcome]. Pan Afr Med J 2017; 27:71. [PMID: 28819492 PMCID: PMC5554639 DOI: 10.11604/pamj.2017.27.71.12499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 05/18/2017] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Our study aims to identify risks factors associated with failed trial of scar and to set a predictive score of labour in women with scarred uterus in the Democratic Republic of the Congo. METHODS We conducted a multicenter cross-sectional analytic study of patients with scarred uterus in four maternity units in the Democratic Republic of the Congo (DRC) from 1 January to 31 December 2013. Logistic regression model was used to identify factors associated with failed trial of scar. We set a predictive score based on this model in order to predict trial of scar failure in maternity units in the DRC. ROC curve was used to assess the ability of the set score to identify patients at risk for trial of scar failure. The cut off point for the predictive score was determined on the basis of the Youden-index-based optimal sensitivity and specificity. All the tests in our study were carried out by using a significance threshold of α=0.05. RESULTS Two explanatory factors in trial of scar failure were retained. They were the socio-demographic factor (maternal age) and three obstetric factors (fundal height, fetal presentation and premature rupture of membranes). Predictive score was set to predict trial of scar failure. This score was determined based on four elements: maternal age, evaluation of the gestational sac on admission, fundal height and fetal presentation. The minimum score was set at 4 and the maximum score was set at 16. The threshold value was set at 7. A total score greater than or equal to 7 reflects a risk of trial of scar failure. CONCLUSION We set a predictive score to predict trial of scar failure. This score was determined based on four elements: maternal age, evaluation of the gestational sac on admission, fundal height and fetal presentation. A total score greater than or equal to 7 reflects a risk of trial of scar failure.
Collapse
Affiliation(s)
- Félix Kitenge Wa Momat
- Département de Gynécologie Obstétrique, Faculté de Médecine, Université de Lubumbashi, République Démocratique du Congo
| | - Pierre Akilimali Zalagile
- Ecole de Santé Publique, Faculté de Médecine, Université de Kinshasa, République Démocratique du Congo
| | - Faustin Chenge Mukalenge
- Département de Gynécologie Obstétrique, Faculté de Médecine, Université de Lubumbashi, République Démocratique du Congo
| | - Oscar Numbi Luboya
- Département de Pédiatrie, Faculté de Médecine, Université de Lubumbashi, République Démocratique du Congo
| | | | - Désiré Mashinda
- Ecole de Santé Publique, Faculté de Médecine, Université de Kinshasa, République Démocratique du Congo
| | - Gilles Grangé
- Département de Gynécologie Obstétrique, Hôpitaux Universitaires Paris Centre, France
| | - Olivier Mukuku
- Département de Pédiatrie, Faculté de Médecine, Université de Lubumbashi, République Démocratique du Congo
| | - Fanny Malonga Kaj
- Département de Gynécologie Obstétrique, Cliniques Universitaires de Lubumbashi, République Démocratique du Congo
| | - Chamy Cham Lubamba
- Département de Gynécologie Obstétrique, Hôpital Général de Référence Sendwe, Lubumbashi, République Démocratique du Congo
| | - Joseph Bagambe Bwama
- Département de Gynécologie Obstétrique, Hôpital de l'Amitié Sino-Congolais, Kinshasa, République Démocratique du Congo
| | - Célestin Kayembe Mukoko
- Département de Gynécologie Obstétrique, Hôpital Général de Référence de Bipemba, Mbuji-Mayi, République Démocratique du Congo
| | - Jean Baptiste Kakoma
- Département de Gynécologie Obstétrique, Faculté de Médecine, Université de Lubumbashi, République Démocratique du Congo
| | - Justin Kizonde Kalungwe
- Département de Gynécologie Obstétrique, Faculté de Médecine, Université de Lubumbashi, République Démocratique du Congo
| |
Collapse
|
40
|
Baranov A, Gratacós E, Vikhareva O, Figueras F. Validation of the prediction model for success of vaginal birth after cesarean delivery at the university hospital in Barcelona. J Matern Fetal Neonatal Med 2017; 30:2998-3003. [DOI: 10.1080/14767058.2016.1271407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Anton Baranov
- Department of Obstetrics and Gynecology, Skåne University Hospital Malmö, Lund University, Sweden
| | - Eduard Gratacós
- BCNatal – Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Olga Vikhareva
- Department of Obstetrics and Gynecology, Skåne University Hospital Malmö, Lund University, Sweden
| | - Francesc Figueras
- BCNatal – Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| |
Collapse
|
41
|
Gonsalves H, Al-Riyami N, Al-Dughaishi T, Gowri V, Al-Azri M, Salahuddin A. Use of Intracervical Foley Catheter for Induction of Labour in Cases of Previous Caesarean Section: Experience of a single tertiary centre in Oman. Sultan Qaboos Univ Med J 2016; 16:e445-e450. [PMID: 28003890 DOI: 10.18295/squmj.2016.16.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 07/19/2016] [Accepted: 08/02/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate rates of success and perinatal complications of labour induction using an intracervical Foley catheter among women with a previous Caesarean delivery at a tertiary centre in Oman. METHODS This retrospective cohort study included 68 pregnant women with a history of a previous Caesarean section who were admitted for induction via Foley catheter between January 2011 and December 2013 to the Sultan Qaboos University Hospital, Muscat, Oman. Patient data were collected from electronic and delivery ward records. RESULTS Most women were 25-35 years old (76.5%) and 20 women had had one previous vaginal delivery (29.4%). The most common indication for induction of labour was intrauterine growth restriction with oligohydramnios (27.9%). Most women delivered after 40 gestational weeks (48.5%) and there were no neonatal admissions or complications. The majority experienced no complications during the induction period (85.3%), although a few had vaginal bleeding (5.9%), intrapartum fever (4.4%), rupture of the membranes (2.9%) and cord prolapse shortly after insertion of the Foley catheter (1.5%). However, no cases of uterine rupture or scar dehiscence were noted. Overall, the success rate of vaginal birth after a previous Caesarean delivery was 69.1%, with the remaining patients undergoing an emergency Caesarean section (30.9%). CONCLUSION The use of a Foley catheter in the induction of labour in women with a previous Caesarean delivery appears a safe option with a good success rate and few maternal and fetal complications.
Collapse
Affiliation(s)
- Hazel Gonsalves
- Department of Obstetrics & Gynaecology, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Nihal Al-Riyami
- Department of Obstetrics & Gynaecology, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Tamima Al-Dughaishi
- Department of Obstetrics & Gynaecology, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Vaidayanathan Gowri
- Department of Obstetrics & Gynaecology, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Mohammed Al-Azri
- Department of Family Medicine & Public Health, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Ayesha Salahuddin
- Department of Obstetrics & Gynaecology, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| |
Collapse
|
42
|
Kramer KL, Veile A, Otárola-Castillo E. Sibling Competition & Growth Tradeoffs. Biological vs. Statistical Significance. PLoS One 2016; 11:e0150126. [PMID: 26938742 PMCID: PMC4777386 DOI: 10.1371/journal.pone.0150126] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 02/09/2016] [Indexed: 11/18/2022] Open
Abstract
Early childhood growth has many downstream effects on future health and reproduction and is an important measure of offspring quality. While a tradeoff between family size and child growth outcomes is theoretically predicted in high-fertility societies, empirical evidence is mixed. This is often attributed to phenotypic variation in parental condition. However, inconsistent study results may also arise because family size confounds the potentially differential effects that older and younger siblings can have on young children's growth. Additionally, inconsistent results might reflect that the biological significance associated with different growth trajectories is poorly understood. This paper addresses these concerns by tracking children's monthly gains in height and weight from weaning to age five in a high fertility Maya community. We predict that: 1) as an aggregate measure family size will not have a major impact on child growth during the post weaning period; 2) competition from young siblings will negatively impact child growth during the post weaning period; 3) however because of their economic value, older siblings will have a negligible effect on young children's growth. Accounting for parental condition, we use linear mixed models to evaluate the effects that family size, younger and older siblings have on children's growth. Congruent with our expectations, it is younger siblings who have the most detrimental effect on children's growth. While we find statistical evidence of a quantity/quality tradeoff effect, the biological significance of these results is negligible in early childhood. Our findings help to resolve why quantity/quality studies have had inconsistent results by showing that sibling competition varies with sibling age composition, not just family size, and that biological significance is distinct from statistical significance.
Collapse
Affiliation(s)
- Karen L. Kramer
- Department of Anthropology, University of Utah, Salt Lake City, Utah 84112, United States of America
| | - Amanda Veile
- Department of Anthropology, Purdue University, West Lafayette, Indiana, United States of America
| | - Erik Otárola-Castillo
- Department of Anthropology, Purdue University, West Lafayette, Indiana, United States of America
| |
Collapse
|
43
|
Prediction of vaginal birth after cesarean delivery. Int J Gynaecol Obstet 2016; 133:297-300. [PMID: 26952353 DOI: 10.1016/j.ijgo.2015.09.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 09/10/2015] [Accepted: 02/01/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To examine factors associated with successful vaginal birth after cesarean (VBAC) and to validate a previously established prediction model. METHODS In a retrospective study, data were obtained for women with one prior low-transverse cesarean procedure who underwent a trial of labor with a cephalic singleton pregnancy at term at one UK hospital between January 2000 and August 2013. Univariate analysis and logistic regression analysis were used to identify maternal demographic characteristics significantly associated with successful VBAC and factors independently associated with this outcome, respectively. A prediction model was built, and predicted probabilities were compared with observed frequencies. For validation, probabilities were also calculated by a previous prediction model. RESULTS Overall, 1463 women formed the cohort. Successful vaginal delivery was achieved in 1050 (71.8%) women. The only factors significantly associated with unsuccessful VBAC were Asian (odds ratio [OR] 1.59, 95% confidence interval [CI] 1.14-2.23) or African (OR 1.80, 95% CI 1.23-2.64) ethnic origin, and previous cesarean for failure to progress (OR 6.39, 95% CI 4.81-8.49). The predicted and observed probability of successful VBAC were well correlated (Spearman ρ, 0.905; P=0.002). The established prediction model was less accurate. CONCLUSION Previous cesarean performed for failure to progress and Asian/African ethnic origin were associated with unsuccessful VBAC. The performance of a previous prediction model was inferior.
Collapse
|
44
|
Kleinrouweler CE, Cheong-See FM, Collins GS, Kwee A, Thangaratinam S, Khan KS, Mol BWJ, Pajkrt E, Moons KG, Schuit E. Prognostic models in obstetrics: available, but far from applicable. Am J Obstet Gynecol 2016; 214:79-90.e36. [PMID: 26070707 DOI: 10.1016/j.ajog.2015.06.013] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 05/20/2015] [Accepted: 06/01/2015] [Indexed: 12/18/2022]
Abstract
Health care provision is increasingly focused on the prediction of patients' individual risk for developing a particular health outcome in planning further tests and treatments. There has been a steady increase in the development and publication of prognostic models for various maternal and fetal outcomes in obstetrics. We undertook a systematic review to give an overview of the current status of available prognostic models in obstetrics in the context of their potential advantages and the process of developing and validating models. Important aspects to consider when assessing a prognostic model are discussed and recommendations on how to proceed on this within the obstetric domain are given. We searched MEDLINE (up to July 2012) for articles developing prognostic models in obstetrics. We identified 177 papers that reported the development of 263 prognostic models for 40 different outcomes. The most frequently predicted outcomes were preeclampsia (n = 69), preterm delivery (n = 63), mode of delivery (n = 22), gestational hypertension (n = 11), and small-for-gestational-age infants (n = 10). The performance of newer models was generally not better than that of older models predicting the same outcome. The most important measures of predictive accuracy (ie, a model's discrimination and calibration) were often (82.9%, 218/263) not both assessed. Very few developed models were validated in data other than the development data (8.7%, 23/263). Only two-thirds of the papers (62.4%, 164/263) presented the model such that validation in other populations was possible, and the clinical applicability was discussed in only 11.0% (29/263). The impact of developed models on clinical practice was unknown. We identified a large number of prognostic models in obstetrics, but there is relatively little evidence about their performance, impact, and usefulness in clinical practice so that at this point, clinical implementation cannot be recommended. New efforts should be directed toward evaluating the performance and impact of the existing models.
Collapse
|
45
|
Mone F, Harrity C, Mackie A, Segurado R, Toner B, McCormick TR, Currie A, McAuliffe FM. Vaginal birth after caesarean section prediction models: a UK comparative observational study. Eur J Obstet Gynecol Reprod Biol 2015; 193:136-9. [DOI: 10.1016/j.ejogrb.2015.07.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 07/24/2015] [Accepted: 07/28/2015] [Indexed: 12/31/2022]
|
46
|
Sinclair JL, Brown HC. Active management of spontaneous labour versus routine care in women who have had one or more previous caesarean sections. Hippokratia 2015. [DOI: 10.1002/14651858.cd010046.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Joanna L Sinclair
- Tunbridge Wells Hospital; Department of Obstetrics and Gynaecology; Tonbridge Road Tunbridge Wells Kent UK TN2 4QJ
| | - Heather C Brown
- Royal Sussex County Hospital; Department of Obstetrics and Gynaecology; Eastern Road Brighton UK BN2 5BE
| |
Collapse
|
47
|
Fagerberg MC, Maršál K, Källén K. Predicting the chance of vaginal delivery after one cesarean section: validation and elaboration of a published prediction model. Eur J Obstet Gynecol Reprod Biol 2015; 188:88-94. [DOI: 10.1016/j.ejogrb.2015.02.031] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Revised: 01/25/2015] [Accepted: 02/19/2015] [Indexed: 12/01/2022]
|
48
|
Heinrich S, Irouschek A, Prottengeier J, Ackermann A, Schmidt J. Adverse airway events in parturient compared with non-parturient patients. Is there a difference? Results from a quality management project. J Obstet Gynaecol Res 2015; 41:1032-9. [PMID: 25772267 DOI: 10.1111/jog.12677] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 12/18/2014] [Indexed: 11/30/2022]
Abstract
AIM The fear of airway problems often leads to prolonged attempts to obtain neuroaxial (spinal anesthesia or epidural anesthesia) anesthesia in obstetric anesthesia. The aim of this institutional quality management study was to revisit existing anesthesia care in the obstetric department, focusing on the frequency of delayed or failed neuroaxial anesthesia as well as the risk of airway problems in parturient and non-obstetric patients. METHODS The clinical records from 8 consecutive years (2005-2013) were analyzed retrospectively. Cases of cesarean delivery with general anesthesia were analyzed and compared with an age-matched group of female patients undergoing non-obstetric abdominal or gynecological surgery with rapid sequence induction. Poor laryngeal visualization (Cormack-Lehane grade III or IV) and failed intubation were recorded. RESULTS The records of 6393 cesarean deliveries including 851 with general anesthesia were analyzed. In 175 cases insufficient or delayed onset of regional anesthesia led to requirement for general anesthesia. The rate of poor laryngoscopic view in parturient women undergoing cesarean delivery was 14/851, and 4/814 in the reference group (P = 0.023). Failed intubation occurred in three patients undergoing cesarean delivery (0.4%) and in one non-obstetric patient (0.1%; P = 0.339). CONCLUSION The rate of failed intubations in patients undergoing cesarean delivery may be equivalent to non-obstetric patients. In time-challenging cesarean deliveries, delay of conversion from non-successful neuroaxial anesthesia to general anesthesia in order to avoid adverse airway events does not appear to be justified.
Collapse
Affiliation(s)
- Sebastian Heinrich
- Department of Anesthesia, University Hospital Erlangen, Erlangen, Germany
| | - Andrea Irouschek
- Department of Anesthesia, University Hospital Erlangen, Erlangen, Germany
| | | | - Andreas Ackermann
- Department of Anesthesia, University Hospital Erlangen, Erlangen, Germany
| | - Joachim Schmidt
- Department of Anesthesia, University Hospital Erlangen, Erlangen, Germany
| |
Collapse
|
49
|
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.
Collapse
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
| |
Collapse
|
50
|
Abstract
Gordon C. Smith discusses the study by Katy Kozhimannil and colleagues that examines variations in cesarean section rates in the US and argues for the need for high-quality routine data collection to better understand the reasons for these variations. Please see later in the article for the Editors' Summary.
Collapse
Affiliation(s)
- Gordon C. S. Smith
- Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, United Kingdom
- NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge, United Kingdom
| |
Collapse
|