Evaluation of outcomes associated with trial of labor after cesarean delivery after a change in clinical practice guidelines in an academic hospital

Bellows, Patricia H.; Shah, Utsavi; Hawley, Lauren; Drexler, Kathleen; Gandhi, Manisha; Sangi‐Haghpeykar, Haleh; Davidson, Christina

doi:10.1080/14767058.2016.1237498

Cited by 15 publications

(9 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We found a positive correlation between Bishop's score and success of TOLAC, consistent with Francis (2005) who demonstrated a relationship between risk of cesarean delivery and unfavorable Bishop score at admission [25]. Similarly, several related studies have confirmed that the Bishop's score, at delivery, affects the success rate of TOLAC [17,26]. In the present study, the OR of Bishop's score was higher, with a relatively narrower confidence interval than that reported in previous studies (OR, 3.27; 95% CI, 2.49 to 4.55).…”

Section: Discussionsupporting

confidence: 90%

“…Particularly, we used external verification of the widely used Grobman's model, to add corresponding features before delivery, and achieved superior predictive ability. Based on a clear trend of benefits from the successful vaginal delivery among those trials of labor after cesarean section, it is evident that VBAC failure exacerbates many risks, including bleeding, increased blood transfusions, uterine rupture and endometritis, as well as infant asphyxia or perinatal death [8,17,18]. Consequently, obstetricians prefer a more conservative approach during TOLAC to avoid medical disputes owing to the complex physician-patient relationship as well as the associated high work-related stress.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Prediction of vaginal birth after cesarean delivery in Southeast China: a retrospective cohort study

Zhang

Zheng

Cheng

et al. 2020

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

Background We aimed to develop and validate a nomogram for effective prediction of vaginal birth after cesarean (VBAC) and guide future clinical application. Methods We retrospectively analyzed data from hospitalized pregnant women who underwent trial of labor after cesarean (TOLAC), at the Fujian Provincial Maternity and Children’s Hospital, between October 2015 and October 2017. Briefly, we included singleton pregnant women, at a gestational age above 37 weeks who underwent a primary cesarean section, in the study. We then extracted their sociodemographic data and clinical characteristics, and randomly divided the samples into training and validation sets. We employed the least absolute shrinkage and selection operator (LASSO) regression to select variables and construct VBAC success rate in the training set. Thereafter, we validated the nomogram using the concordance index (C-index), decision curve analysis (DCA), and calibration curves. Finally, we adopted the Grobman’s model to perform comparisons with published VBAC prediction models. Results Among the 708 pregnant women included according to inclusion criteria, 586 (82.77%) patients were successfully for VBAC. Multivariate logistic regression models revealed that maternal height (OR, 1.11; 95% CI, 1.04 to 1.19), maternal BMI at delivery (OR, 0.89; 95% CI, 0.79 to 1.00), fundal height (OR, 0.71; 95% CI, 0.58 to 0.88), cervix Bishop score (OR, 3.27; 95% CI, 2.49 to 4.45), maternal age at delivery (OR, 0.90; 95% CI, 0.82 to 0.98), gestational age (OR, 0.33; 95% CI, 0.17 to 0.62) and history of vaginal delivery (OR, 2.92; 95% CI, 1.42 to 6.48) were independently associated with successful VBAC. The constructed predictive model showed better discrimination than that from the Grobman’s model in the validation series (c-index 0.906 VS 0.694, respectively). On the other hand, decision curve analysis revealed that the new model had better clinical net benefits than the Grobman’s model. Conclusions VBAC will aid in reducing the rate of cesarean sections in China. In clinical practice, the TOLAC prediction model will help improve VBAC’s success rate, owing to its contribution to reducing secondary cesarean section.

show abstract

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Prediction of vaginal birth after cesarean delivery in Southeast China: a retrospective cohort study

Zhang

Zheng

Cheng

et al. 2020

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

show abstract

“…Again, in our study, peripartum hysterectomy, bowel, and bladder injury among major complications were observed in none of the patients. In a recent study performed [18]. This difference was found to be significant (p = 0.03).…”

Section: Discussionmentioning

confidence: 84%

Comparison of maternal-neonatal results of vaginal birth after cesarean and elective repeat cesarean delivery

et al. 2020

View full text Add to dashboard Cite

Objective: To evaluate maternal-neonatal results in women who underwent vaginal birth after cesarean (VBAC) and elective repeat cesarean delivery (ERCD). Material and methods: In a two-year retrospective cohort analysis, 423 patients with a history of prior cesarean section, singleton pregnancy with cephalic presentation and gestational age of 37-41 weeks were investigated. The maternal and perinatal outcomes of 195 patients desiring VBAC and undergoing a trial of labor after cesarean (TOLAC) attempt and 228 patients undergoing an ERCD were compared. Results: While the TOLAC attempt was successful in 141 patients (72.3%), it was unsuccessful in 54 patients. No statistically significant difference was determined between VBAC and ERCD patients regarding uterine rupture, dehiscence, post-partum hemorrhage, the need for a blood transfusion and wound site infection (p > 0.05). When the post-partum neonatal outcomes were compared, there was no statistically significant difference between VBAC and ERCD groups regarding the prevalence of admission to the neonatal intensive care unit (NICU), respiratory distress, sepsis and birth injury (p > 0.05). Conclusion: The maternal and perinatal outcomes of our study may be encouraging in favor of VBAC particularly in countries with higher cesarean rates. We think that the option of VBAC should be offered more frequently for selected appropriate patients in created safe environments.

show abstract

“…The trial of labor after cesarean (TOLAC) is an attempt to reduce CS rates. Several national medical associations have provided practice guidelines for vaginal birth after cesarean section (VBAC) [4, 5], but these differ across countries [6]. Generally speaking, VBAC is relatively safe when compared with repeat CS [7] .However, TOLAC rates have dropped significantly worldwide in recent years [8, 9].…”

Section: Introductionmentioning

confidence: 99%

Factors associated with successful vaginal birth after a cesarean section: a systematic review and meta-analysis

Kataria

Wang

et al. 2019

BMC Pregnancy Childbirth

109

View full text Add to dashboard Cite

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.

show abstract

Evaluation of outcomes associated with trial of labor after cesarean delivery after a change in clinical practice guidelines in an academic hospital

Abstract: Adoption of ACOG's TOLAC practice changes can increase VBAC rates without increasing maternal-neonatal morbidity from TOLAC.

Cited by 15 publications

References 12 publications

Prediction of vaginal birth after cesarean delivery in Southeast China: a retrospective cohort study

Prediction of vaginal birth after cesarean delivery in Southeast China: a retrospective cohort study

Comparison of maternal-neonatal results of vaginal birth after cesarean and elective repeat cesarean delivery

Factors associated with successful vaginal birth after a cesarean section: a systematic review and meta-analysis

Contact Info

Product

Resources

About