Feeding Practices, Maternal and Neonatal Outcomes in Vaginal Birth after Cesarean and Elective Repeat Cesarean Delivery

Abstract

Cesarean section rates are constantly rising, and the number of women with a prior cesarean considering a delivery mode for their next labor is increasing. We aimed to compare maternal and neonatal outcomes and feeding method in women undergoing vaginal birth after cesarean (VBAC) versus elective repeat cesarean delivery (ERCD). This was a retrospective cohort study of women with one prior cesarean delivery (CD) and no previous vaginal births, delivering vaginally or by a CD in a single institution between 2016 and 2018. 355 live singleton spontaneous vaginal and cesarean deliveries were included. 121 women delivered vaginally and 234 had a CD. Neonates born by a CD were more likely to have higher birth weight (p < 0.001), higher weight at discharge (p < 0.001), macrosomia (p = 0.030), lose >10% of their body mass (p = 0.001), be mixed-fed (p < 0.001), and be hospitalized longer (p < 0.001). Children born vaginally were more likely to be exclusively breastfed (p < 0.001). Women undergoing VBAC were more likely to deliver preterm (p = 0.006) and post-term (p < 0.001), present with PROM (p < 0.001), have greater PROM latency period (p < 0.001), and experience intrahepatic cholestasis of pregnancy (p = 0.029), postpartum anemia (p < 0.001), and peripartum blood loss >1 L (p = 0.049). The incidence of anemia during pregnancy was higher in the ERCD cohort (p = 0.047). Women undergoing VBAC are more likely to breastfeed their children, perhaps for the same reason they choose the vaginal method of delivery, as vaginal delivery and breastfeeding along with antibiotic use, are the most important factors decreasing the risk for future diseases in their offspring.

Factores predictores del éxito del parto vaginal posterior a cesárea

“…El PVPC es deseable; además, los resultados de este estudio y otras investigaciones previas han mostrado resultados exitosos y seguros (3,6,(9)(10)(11)(12) . El propósito de nuestro estudio fue identificar los factores que aumentan la tasa de éxito y reducen la morbimortalidad materna y perinatal, las cuales podrían complicar la resultante de la prueba de trabajo de parto en pacientes con cesárea previa.…”

“…La tasa de PVPC en esta investigación fue de 67,4%, lo que la ubica dentro del rango sugerido entre 60% y 80%, y es ligeramente mayor que lo encontrado en investigaciones previas (6,(8)(9)(10)(11)(12) . Las diferencias observadas en informes previos pueden reflejar los efectos de varios factores.…”

“…Aunque los resultados de este estudio indican la alta tasa de éxito de la prueba de PVPC, es necesario realizar monitoreo cercano al parto y tener disponibilidad de pabellón de emergencia para evitar complicaciones como la rotura uterina, que produce complicaciones tanto maternas como perinatales (6) . Otras complicaciones comunes incluyen hemorragia excesiva que requiere exploración quirúrgica, histerectomía y riesgo de lesión vesical, además de la posibilidad de sufrimiento fetal agudo (26) .…”

“…Otros informes han proporcionado evidencia que 60% a 80% de las pruebas de parto posterior a cesárea culminan en partos vaginales exitosos (11,12) . Sin embargo, es necesario tener cuidado, ya que pueden surgir complicaciones, especialmente en aquellos centros de atención obstétrica mal equipados y con escaso personal (6,7) .…”

Frequency of Repeat Caesarean Section at Tertiary Care Hospital

“…Conversely, the prevalence of caesarean sections is constantly increasing, and repeat caesarean sections account for the majority of the total CD rates. 12 In the past 20 years, the rate of caesarean births has risen atypically in a number of countries, including Pakistan. In this study, a total of 345 pregnant women aged 18-45 years were included, and the average age of the women was 25.83±4.15 years.…”