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Fruscalzo A, Rossetti E, Londero AP. Trial of Labor after Three or More Previous Cesarean Sections:
Systematic Review and Meta-Analysis of Observational Studies. Z Geburtshilfe Neonatol 2022; 227:96-105. [PMID: 36455615 DOI: 10.1055/a-1965-4125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Abstract
Aims To assess the success rate and prevalence of maternal or neonatal
complications in women undergoing a trial of labor after three or more
(≥3) previous cesarean sections (CSs).
Methods A systematic literature review and meta-analysis was conducted
from inception to May 2022 in Medline, Scopus, ENBASE, ClinicalTrials.gov, and
the Cochrane Central Register of Controlled Trials and Reviews. Items detailing
success rate and complications in women with a history of≥3 previous CSs
were considered. Selected articles were evaluated for quality, heterogeneity,
and publication bias. A pooled prevalence or odds ratio was calculated.
Findings Twelve articles were included for a total of 540 women with a
history of≥3 CSs, accounting for the 2% (CI 95%
1–4%) of the whole cohort of trial of labor. Our findings show a
0.67 (CI 95% 0.53–0.78) rate of successful vaginal delivery. A
higher success rate was observed in women having a history of a prior vaginal
delivery (0.90, CI 95% 0.77–0.96) and when prostaglandins,
peridural anesthesia or oxytocin were allowed (respectively 0.73, CI 95%
0.62–0.83, 0,73, CI 95% 0.57–0.85 and 0.73, CI
95% 0.64–0.81). Uterine rupture rate was 0.01 (CI 95%
0.00–0.01). No cases of fetal asphyxia or maternal or neonatal death
were registered.
Conclusions The success rate and low frequency of severe complications
observed seem to support a trial of labor in selected patients desiring a
natural birth. However, a potential underestimation of serious maternal and
neonatal complications should be considered in the decision-making process.
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Affiliation(s)
- Arrigo Fruscalzo
- Department of Obstetrics and Gynecology, HFR Fribourg,
Switzerland
- Faculty of Medicine, University of Münster,
Germany
| | - Emma Rossetti
- Department of Obstetrics and Gynecology, Brixen General Hospital,
Brixen, Italy
| | - Ambrogio P. Londero
- Academic Unit of Obstetrics and Gynaecology; Department of
Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant
Health, University of Genova, Italy
- Ennergi Research (non-profit organization), 33050 Lestizza, UD, Italy
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Fitzpatrick KE, Quigley MA, Kurinczuk JJ. Planned mode of birth after previous cesarean section: A structured review of the evidence on the associated outcomes for women and their children in high-income setting. Front Med (Lausanne) 2022; 9:920647. [PMID: 36148449 PMCID: PMC9486480 DOI: 10.3389/fmed.2022.920647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/08/2022] [Indexed: 12/05/2022] Open
Abstract
In many high-income settings policy consensus supports giving pregnant women who have had a previous cesarean section a choice between planning an elective repeat cesarean section (ERCS) or planning a vaginal birth after previous cesarean (VBAC), provided they have no contraindications to VBAC. To help women make an informed decision regarding this choice, clinical guidelines advise women should be counseled on the associated risks and benefits. The most recent and comprehensive review of the associated risks and benefits of planned VBAC compared to ERCS in high-income settings was published in 2010 by the US Agency for Healthcare Research and Quality (AHRQ). This paper describes a structured review of the evidence in high-income settings that has been published since the AHRQ review and the literature in high-income settings that has been published since 1980 on outcomes not included in the AHRQ review. Three databases (MEDLINE, EMBASE, and PsycINFO) were searched for relevant studies meeting pre-specified eligible criteria, supplemented by searching of reference lists. Forty-seven studies were identified as meeting the eligibility criteria and included in the structured review. The review suggests that while planned VBAC compared to ERCS is associated with an increased risk of various serious birth-related complications for both the mother and her baby, the absolute risk of these complications is small for either birth approach. The review also found some evidence that planned VBAC compared to ERCS is associated with benefits such as a shorter length of hospital stay and a higher likelihood of breastfeeding. The limited evidence available also suggests that planned mode of birth after previous cesarean section is not associated with the child’s subsequent risk of experiencing adverse neurodevelopmental or health problems in childhood. This information can be used to manage and counsel women with previous cesarean section about their subsequent birth choices. Collectively, the evidence supports existing consensus that there are risks and benefits associated with both planned VBAC and ERCS, and therefore women without contraindications to VBAC should be given an informed choice about planned mode of birth after previous cesarean section. However, further studies into the longer-term effects of planned mode of birth after previous cesarean section are needed along with more research to address the other key limitations and gaps that have been highlighted with the existing evidence.
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Fruscalzo A, Elgendi M, Gantert M. Trial of Labor and Vaginal Birth after Three Previous Cesarean Sections: Report of Two Special Cases. Z Geburtshilfe Neonatol 2022; 226:205-208. [PMID: 35008110 DOI: 10.1055/a-1642-1113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Natural childbirth could represent a deeply rooted need for many women, even in exceptional situations such as after 3 previous caesarean sections. CASE PRESENTATION The first patient, a 28-year-old 6th gravida and 3rd para, first presented in the 40+3 week of pregnancy desiring a vaginal birth, after all the other hospitals in the area had refused her request. A detailed explanation of potential risks was given and, when 2 days later contractions started, she gave birth to a newborn of 4450 g spontaneously, without complications. A month later, a second woman, 42 years old, 5th gravida, 3rd para, read about the above-mentioned case on social media and decided to attempt a natural delivery after 3 caesarean sections at our hospital as well. She presented herself for the first time in the 41+1 week of pregnancy in our delivery room with an onset of labor after rupture of the membranes and gave birth on the same day, spontaneously without complications, to a 4150 g heavy healthy newborn. CONCLUSIONS The wish to attempt a spontaneous birth after 3 previous caesarean sections can be deeply anchored and should be professionally approached by obstetricians, even if counseling and management can be challenging.
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Affiliation(s)
- Arrigo Fruscalzo
- Gynecology and Obstetrics, St. Franziskus-Hospital Ahlen, Germany
| | - Marwa Elgendi
- Gynecology and Obstetrics, St. Franziskus-Hospital Ahlen, Germany
| | - Marcus Gantert
- Gynecology and Obstetrics, St. Franziskus-Hospital Ahlen, Germany
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Bayoumi YA, Alalfy M, Sharkawy M, Ali AS, Gouda HM, Hatem DL. Castor oil for labor initiation in women with a previous cesarean section: a double-blind randomized study. J Matern Fetal Neonatal Med 2021; 35:8945-8951. [PMID: 34886746 DOI: 10.1080/14767058.2021.2008350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objective: To evaluate the efficacy of castor oil in initiation of labor in women who had one previous cesarean section. This study was conducted as a trial to increase the rate of vaginal birth after cesarean (VBAC) and decrease the rate of elective repeated cesarean section (ERCS).Methods: A double-blinded randomized controlled study was conducted in an Egyptian University Hospital from July 2019 to July 2020. The participants were 70 pregnant women who had one previous cesarean section, singleton pregnancy in cephalic presentation, with a Bishop score ≤6 attempting to perform a trial of labor. Sixty mL castor oil was administered to group A and 60 mL sunflower oil was administered to group B (as a placebo) for initiation of labor at the start of week 39. Primary outcomes were the percentage of women entering the active phase of labor within 24 h after receiving castor oil or placebo and the number of successful VBAC deliveries.Results: Labor started in 16 patients (45.7%) within 24 h in the castor oil group and in 3 patients in the placebo group (8.5%), while the rate of successful VBAC was 65.7% (23 patients) in the castor oil group and 48.5% (17 patients) in the placebo group.Conclusion: Castor oil appears to be an effective, low-cost, and non-harmful method for the initiation of labor in patients with a previous cesarean section.
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Affiliation(s)
- Yomna Ali Bayoumi
- Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Mahmoud Alalfy
- Reproductive health and family planning department, National Research Centre, Aljazeerah Hospital, Dokki, Egypt
| | - Mohamed Sharkawy
- Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Ahmed S Ali
- Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | | | - Dina Latif Hatem
- Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
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Fruscalzo A, Reinecke K, Londero AP, Gantert M. Composite non-clinical interventions for a safe cesarean section rate reduction: results of a pre-post interventional study. BMC Pregnancy Childbirth 2021; 21:783. [PMID: 34798862 PMCID: PMC8603588 DOI: 10.1186/s12884-021-04245-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 10/26/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To evaluate the impact on cesarean section (CS) rate with of a program of multiple non-clinical interventions targeted at health-care professional within a hospital maternity ward. MATERIALS AND METHODS Retrospective quasi-experimental pre-post intervention study with an historical control group conducted in a second-level teaching hospital. All women who gave birth in the period 2014 to 2018 were included. A series of multiple non-clinical interventions including a dedicated team of obstetricians for delivery room and antenatal counseling, monthly internal audits and physician education by local opinion leader were prospectively introduced from September 2016. The primary outcome of the study was the CS rate. The incidences of operative vaginal delivery, 3rd-/4th-degree perineal tears and further maternal and neonatal complications were considered as secondary outcomes. RESULTS The CS rate dropped from 33.05 to 26.06% after starting the interventions (p < 0.01); in particular, the cumulative rate of CS performed during labor decreased significantly from 19.46 to 14.11% (p < 0.01). CS reduction was still statistically significant after multivariate correction (OR = 0.66, CI.95 = 0.57-0.76, p < 0.01). Results further showed an increased prevalence of 3rd-degree perineal tears (0.97% versus 2.24%, p < 0.01), present also after correcting for possible confounding factors (OR = 2.36, CI.95 = 1.48-3.76, p < 0.01). No differences were found in the rate of vaginal-operative births and further maternal complications, while the composite neonatal outcome was found to be improved (OR = 0.73, CI.95 = 0.57-0.93, p = 0.010). CONCLUSIONS The introduction of multiple non-clinical interventions can significantly reduce the CS rate. However, beside an improvement in neonatal composite outcome, a potential increase in high-degree perineal tears should be taken in account.
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Affiliation(s)
- A. Fruscalzo
- Obstetrics and Gynecology, St. Franziskus Hospital of Ahlen, Ahlen, Germany
- Present address: Obstetrics and Gynecology, University Hospital of Fribourg, Fribourg, Switzerland
| | - K. Reinecke
- Obstetrics and Gynecology, St. Franziskus Hospital of Ahlen, Ahlen, Germany
| | - A. P. Londero
- Obstetrics and Gynecology, University Hospital of Udine, Udine, Italy
- Ennergi Research (non-profit organisation), Lestizza, UD 33050 Italy
| | - M. Gantert
- Obstetrics and Gynecology, St. Franziskus Hospital of Ahlen, Ahlen, Germany
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El Hajj M, Holst L. Herbal Medicine Use During Pregnancy: A Review of the Literature With a Special Focus on Sub-Saharan Africa. Front Pharmacol 2020; 11:866. [PMID: 32581815 PMCID: PMC7296102 DOI: 10.3389/fphar.2020.00866] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/26/2020] [Indexed: 12/15/2022] Open
Abstract
Herbal medicine use has grown considerably worldwide among pregnant women, and is particularly widespread in sub-Saharan Africa. However, herbal medicines used across sub-Saharan Africa are associated with important research gaps and a lack of regulatory framework. This is particularly problematic, as herbal medicine use during pregnancy raises several concerns attributed to the herbal ingredient itself, conventional drug-herbal medicine interactions, and contamination or adulteration of herbal remedies. Moreover, several local herbal remedies used by sub-Saharan African pregnant women have never been botanically identified. In this review, an overview of the practice of herbal medicine, including the regulations, challenges and overall safety, is provided. Then, we discuss the prevalence of herbal medicine use during pregnancy across different sub-Saharan African countries, as well as the indications, adverse outcomes, and effectiveness of the most commonly used herbal medicines during pregnancy in that region.
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Affiliation(s)
- Magalie El Hajj
- Centre for International Health, University of Bergen, Bergen, Norway.,Medical Affairs, Partner 4 Health, Paris, France
| | - Lone Holst
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Centre for Pharmacy, University of Bergen, Bergen, Norway
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Fobelets M, Beeckman K, Faron G, Daly D, Begley C, Putman K. Vaginal birth after caesarean versus elective repeat caesarean delivery after one previous caesarean section: a cost-effectiveness analysis in four European countries. BMC Pregnancy Childbirth 2018; 18:92. [PMID: 29642858 PMCID: PMC5896042 DOI: 10.1186/s12884-018-1720-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 03/28/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The OptiBIRTH study incorporates a multicentre cluster randomised trial in 15 hospital sites across three European countries. The trial was designed to test a complex intervention aimed at improving vaginal birth after caesarean section (VBAC) rates through increasing women's involvement in their care. Prior to developing a robust standardised model to conduct the health economic analysis, an analysis of a hypothetical cohort was performed to estimate the costs and health effects of VBAC compared to elective repeat caesarean delivery (ERCD) for low-risk women in four European countries. METHODS A decision-analytic model was developed to estimate the costs and the health effects, measured using Quality Adjusted Life Years (QALYs), of VBAC compared with ERCD. A cost-effectiveness analysis for the period from confirmation of pregnancy to 6 weeks postpartum was performed for short-term consequences and during lifetime for long-term consequences, based on a hypothetical cohort of 100,000 pregnant women in each of four different countries; Belgium, Germany, Ireland and Italy. A societal perspective was adopted. Where possible, transition probabilities, costs and health effects were adapted from national data obtained from the respective countries. Country-specific thresholds were used to determine the cost-effectiveness of VBAC compared to ERCD. Deterministic and probabilistic sensitivity analyses were conducted to examine the uncertainty of model assumptions. RESULTS Within a 6-week time horizon, VBAC resulted in a reduction in costs, ranging from €3,334,052 (Germany) to €66,162,379 (Ireland), and gains in QALYs ranging from 6399 (Italy) to 7561 (Germany) per 100,000 women birthing in each country. Compared to ERCD, VBAC is the dominant strategy in all four countries. Applying a lifetime horizon, VBAC is dominant compared to ERCD in all countries except for Germany (probabilistic analysis, ICER: €8609/QALY). In conclusion, compared to ERCD, VBAC remains cost-effective when using a lifetime time. CONCLUSIONS In all four countries, VBAC was cost-effective compared to ERCD for low-risk women. This is important for health service managers, economists and policy makers concerned with maximising health benefits within limited and constrained resources.
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Affiliation(s)
- Maaike Fobelets
- I-CHER (Interuniversity Centre for Health Economics Research), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussels, Laarbeeklaan 103, 1090 Brussels, Belgium
- Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Katrien Beeckman
- Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
- Department of Nursing and Midwifery, Nursing and Midwifery research group, Universitair Ziekenhuis Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Gilles Faron
- Department of Obstetrics, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Déirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin, D02 T283 Ireland
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin, D02 T283 Ireland
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Koen Putman
- I-CHER (Interuniversity Centre for Health Economics Research), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussels, Laarbeeklaan 103, 1090 Brussels, Belgium
- Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
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Gilad R, Hochner H, Savitsky B, Porat S, Hochner-Celnikier D. Castor oil for induction of labor in post-date pregnancies: A randomized controlled trial. Women Birth 2017; 31:e26-e31. [PMID: 28750937 DOI: 10.1016/j.wombi.2017.06.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 05/22/2017] [Accepted: 06/06/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Castor oil is a substance used for labor induction in an inpatient setting. However, its efficacy as an agent for the induction of labor, for post-date pregnancies in an outpatient setup is unknown. OBJECTIVE Efficacy of castor oil as an agent for the induction of labor, for post-date pregnancies in outpatient settings. METHODS Eighty-one women with a low-risk post-date singleton pregnancy with a Bishop score≤7, without effective uterine contractions were randomized to the intervention, 60ml of castor oil, or the control, 60ml of sun-flower oil. The primary outcome was proportion of women entering the active phase of labor 24, 36, 48h after ingestion. Secondary outcomes included meconium stained amniotic fluid, abnormal fetal heart rate tracing, cesarean section rate, instrumental deliveries, birth weight, 5min Apgar score, chorioamnionitis, hypertensive complications, retained placenta, and post-partum hemorrhage. FINDINGS Intervention and control groups included 38 and 43 women, respectively. No differences in baseline characteristics, except for age were noted. The observed interaction between castor oil and parity was significant (pinteraction=0.02). Multiparous women in the intervention group exhibited a significant beneficial effect on entering active labor within 24, 36 and 48h after castor oil consumption compared with the placebo (Hazard Ratio=2.93, p=0.048; Hazard Ratio=3.29, p=0.026; Hazard Ratio=2.78, p=0.042 respectively). This effect was not noted among primiparous women. No differences in rate of obstetric complications or adverse neonatal outcomes were noted. CONCLUSION Castor oil is effective for labor induction, in post-date multiparous women in outpatient settings.
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Affiliation(s)
- Ronit Gilad
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Hagit Hochner
- Braun School of Public Health, Hebrew University-Hadassah, Israel
| | - Bella Savitsky
- Braun School of Public Health, Hebrew University-Hadassah, Israel
| | - Shay Porat
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Drorith Hochner-Celnikier
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
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Abreu-Silva J, Castro J, Maia C, Pinho M, Carvalho C. Trial of labour after caesarean section: Two-year analysis at a Portuguese centre. J OBSTET GYNAECOL 2017; 37:704-708. [PMID: 28325126 DOI: 10.1080/01443615.2017.1286465] [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] [Indexed: 02/05/2023]
Abstract
We conducted a retrospective study aimed at determining variables associated with a higher success rate for vaginal delivery after caesarean section, and assessing the impact of induction of labour. Secondarily, we aimed to describe our vaginal delivery and uterine rupture rates with the use of a controlled-release dinoprostone vaginal insert for cervical ripening. Of 292 women who met the inclusion criteria, induction of labour occurred in 48% (94% with dinoprostone). There was a non-significant difference between the vaginal delivery rate of spontaneous labour (57%) and induction of labour (33%), after adjusting for confounding variables. The success rate was influenced by a Bishop score ≥6, previous vaginal delivery and previous caesarean for dystocia or failed induction. There was only one case of uterine rupture, which was associated with dinoprostone use (overall rate 0.34%, 0.77% for dinoprostone). Impact statement Trial of labour after caesarean section is considered an alternative to elective repeat caesarean. Both present associated benefits and risks, the most fearsome of which is uterine rupture during labour (0.78% in term pregnancies). Induction is also possible but carries a higher risk of uterine rupture and lower success rate for vaginal birth. Prostaglandins have been of particular concern due to a higher risk of uterine scar rupture, estimated at 2% for dinoprostone; however, its use as a controlled-release vaginal insert has been under-reported. Our study confirms the reported impact of previous vaginal delivery, previous caesarean indication and Bishop score at admission on success rate for vaginal birth after caesarean. We were unable to prove a lower success rate for induction of labour after adjusting for other variables. Despite our study limitations, we report on the use of a controlled-release vaginal insert with 10mg of dinoprostone in 130 women with a uterine rupture rate of 0.77%, lower than previously reported and similar to the overall rate estimated for term pregnancies. This dinoprostone formulation may be safer than previously reported but larger studies, and preferably randomised controlled trials, are needed to confirm these findings.
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Affiliation(s)
- Joao Abreu-Silva
- a Obstetrics and Gynecology Department , Centro Hospitalar de Vila Nova de Gaia/Espinho , Vila Nova de Gaia , Portugal
| | - Jorge Castro
- a Obstetrics and Gynecology Department , Centro Hospitalar de Vila Nova de Gaia/Espinho , Vila Nova de Gaia , Portugal
| | - Catarina Maia
- a Obstetrics and Gynecology Department , Centro Hospitalar de Vila Nova de Gaia/Espinho , Vila Nova de Gaia , Portugal
| | - Manuela Pinho
- a Obstetrics and Gynecology Department , Centro Hospitalar de Vila Nova de Gaia/Espinho , Vila Nova de Gaia , Portugal
| | - Claudina Carvalho
- a Obstetrics and Gynecology Department , Centro Hospitalar de Vila Nova de Gaia/Espinho , Vila Nova de Gaia , Portugal
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10
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Fruscalzo A, Londero AP, Calcagno A, Cipriani I, Bertozzi S, Marchesoni D, Driul L. Building a Prediction Model for Vacuum-Assisted Operative Vaginal Delivery Risk. Gynecol Obstet Invest 2015; 80:246-52. [PMID: 25924682 DOI: 10.1159/000381544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 03/09/2015] [Indexed: 11/19/2022]
Abstract
AIM The objective of this study was to evaluate the risk factors for operative vaginal delivery and to propose a new nomogram for predicting the risk. METHODS We retrospectively analyzed the data of 1,955 pregnancies that occurred in our clinic between the years 2007 and 2008. Included were singleton pregnancies with labor diagnosis after the 36th gestational week in which spontaneous or operative vaginal deliveries occurred. In this study, the operative delivery was carried out exclusively by vacuum extraction. RESULTS After univariate analysis and multivariate logistic regression stepwise model selection, maternal age, nulliparity, medically assisted procreation, gestational age at birth, male fetus, epidural analgesia and medical induction of labor were found to be the most predictive variables for operative vaginal delivery. Considering these factors we propose a new nomogram for an objectified determination of the risk of operative vaginal delivery. CONCLUSIONS The new nomogram we propose could be an important tool for an objectified determination of the risk of operative vaginal delivery by vacuum extraction in individualized patient counseling.
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Affiliation(s)
- Arrigo Fruscalzo
- Clinic of Obstetrics and Gynecology, St. Franziskus Hospital, Mx00FC;nster, Germany
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11
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Laser acupuncture effect on fetal well-being during induction of labor. Lasers Med Sci 2014; 30:403-6. [DOI: 10.1007/s10103-014-1678-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 10/16/2014] [Indexed: 10/24/2022]
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12
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Wymer KM, Shih YCT, Plunkett BA. The cost-effectiveness of a trial of labor accrues with multiple subsequent vaginal deliveries. Am J Obstet Gynecol 2014; 211:56.e1-56.e12. [PMID: 24487008 DOI: 10.1016/j.ajog.2014.01.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 01/07/2014] [Accepted: 01/21/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study was to estimate costs and outcomes of subsequent trials of labor after cesarean delivery (TOLAC) compared with elective repeat cesarean deliveries (ERCD). STUDY DESIGN To compare TOLAC and ERCD, maternal and neonatal decision analytic models were built for each hypothetic subsequent delivery. We assumed that only women without previa would undergo TOLAC for their second delivery, that women with successful TOLAC would desire future TOLAC, and that women who chose ERCD would undergo subsequent ERCD. Main outcome measures were maternal and neonatal mortality and morbidity rates, direct costs, and quality-adjusted life years. Values were derived from the literature. One-way and Monte-Carlo sensitivity analyses were performed. RESULTS TOLAC was less costly and more effective for most models. A progression of decreasing incremental cost and increasing incremental effectiveness of TOLAC was found for maternal outcomes with increasing numbers of subsequent deliveries. This progression was also displayed among neonatal outcomes and was most prominent when neonatal and maternal outcomes were combined, with an incremental cost and effectiveness of -$4700.00 and .073, respectively, for the sixth delivery. Net-benefit analysis showed an increase in the benefit of TOLAC with successive deliveries for all outcomes. The maternal model of the second delivery was sensitive to cost of delivery and emergent cesarean delivery. Successive maternal models became more robust, with the models of the third-sixth deliveries sensitive only to cost of delivery. Neonatal models were not sensitive to any variables. CONCLUSION Although nearly equally effective relative to ERCD for the second delivery, TOLAC becomes less costly and more effective with subsequent deliveries.
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Affiliation(s)
- Kevin M Wymer
- Pritzker School of Medicine, University of Chicago, Chicago, IL
| | | | - Beth A Plunkett
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL.
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