Intrapartum cesarean delivery and the risk of perinatal complications in women with and without a single prior cesarean delivery

Abstract

Objective To determine maternal and neonatal complications associated with an intrapartum cesarean delivery (CD) with and without a history of a previous CD. Methods A retrospective cohort study of all women who underwent an unplanned intrapartum CD following a trial of labor in a university‐affiliated tertiary hospital, between 2009 and 2016. Perinatal outcomes of women with and without a history of a previous CD were compared. Composite adverse maternal outcome included one or more of the following: postpartum hemorrhage, need for blood transfusion, or cesarean hysterectomy. Composite adverse neonatal outcome included one or more of the following: 5‐min Apgar score <7, neonatal seizure, need for intubation, meconium‐aspiration‐syndrome, or hypoxic‐ischemic encephalopathy. Results During the study period, 42 275 women attempted vaginal delivery. Of them, 2229 (5.3%) women underwent an unplanned intrapartum CD and met inclusion criteria: 337 (15.1%) with (study group) and 1892 (84.9%) without (control group) a previous CD. Women without a previous CD were younger and were characterized by higher rates of nulliparity and induction of labor compared with women with a previous CD. Other demographic and obstetrical characteristics did not differ between the groups. Indications for CD were also comparable between the groups. Uterine rupture complicated 2.3% of trials of labor among women with a previous CD. Adverse maternal (2.7% vs 2.9%, P = 1.0) and neonatal (3.9% vs 4.3%, P = 0.88) outcomes were comparable between the groups. After adjusting for potential confounders, a previous CD was not associated independently with adverse maternal outcomes (adjusted odds ratio [aOR] 0.86, 95% confidence interval [CI] 0.31–2.38; P = 0.78) or neonatal outcomes (aOR 0.79, 95% CI 0.36–1.75; P = 0.56). Conclusion Our study provides evidence that perinatal outcomes of intrapartum CD delivery among women with a previous CD do not differ from those in women without a previous CD. These findings might improve the consultation and informed decision‐making process for couples considering a trial of labor after CD.

Unintended lower‐segment hysterotomy extension at cesarean delivery and the risk for uterine rupture during a subsequent trial of labor

“…Dehiscence of uterine scar was defined as an incomplete uterine scar disruption where the serosa remains intact and the fetus, placenta, and umbilical cord remain contained within the uterine cavity 7 …”

“…Nevertheless, TOLAC is not without risks. An unsuccessful TOLAC (one that results in an urgent cesarean delivery), carries a greater risk of maternal morbidity, including postpartum hemorrhage, hysterectomy, uterine rupture, operative injury, and greater risks of neonatal morbidity, than a repeat elective cesarean 5–7 . Hence, patient selection is imperative.…”

Development and validation of a prediction model for intrapartum cesarean delivery based on the artificial neural networks approach: a protocol for a prospective nested case–control study

“…Intrapartum caesarean delivery refers to the caesarean section that occurred after the onset of labour. 1 Although it can resolve dystocia and save maternal and newborn’ lives on some occasions, it is a consensus that obstetricians and midwives should be active in preventing intrapartum caesarean delivery for its short-term and long-term adverse outcomes. 2 Intrapartum caesarean delivery can increase the mothers’ risks of infection, severe postpartum haemorrhage, scarred uterus, prolonged postpartum recovery, increased healthcare costs and next caesarean section in a subsequent pregnancy.…”

“…Intrapartum caesarean delivery refers to the caesarean section that occurred after the onset of labour 1. Although it can resolve dystocia and save maternal and newborn’ lives on some occasions, it is a consensus that obstetricians and midwives should be active in preventing intrapartum caesarean delivery for its short-term and long-term adverse outcomes 2.…”