Labour characteristics of women achieving successful vaginal birth after caesarean section in three European countries

Grylka‐Baeschlin, Susanne; Clarke, Mike; Begley, Cecily; Daly, Déirdre; Healy, Patricia; Nicoletti, Jane; Devane, Declan; Morano, Sandra; Krause, Gérard; Karch, André; Savage, Gerard; Groß, Mechthild M.

doi:10.1016/j.midw.2019.03.013

Cited by 8 publications

(5 citation statements)

References 30 publications

(43 reference statements)

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“…In keeping with previous studies ( 19 , 20 ), our data showed that a previous vaginal birth is a strong predictor of the success of VBAC. Information about previous vaginal births must be included in any consultation of a patient asking for VBAC.…”

Section: Discussionsupporting

confidence: 92%

Risk factor analysis in women who underwent trial of labor after cesarean section: a multicenter study in Germany

Gitas¹,

Alkatout²,

Ertan³

et al. 2022

J Turkish German Gynecol Assoc

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Objective: Rising caesarean delivery (CD) rates throughout the world are accompanied with high rates of severe maternal complications. The aim of the present study was to analyze the outcome of trial of labor after caesarean section (TOLAC) in a Western population and identify factors associated with the success of vaginal birth after caesarean section (VBAC). Material and Methods: A retrospective study was performed at two large obstetric departments in Germany from 2008 to 2018. Women with singleton pregnancies, a history of only one previous CD with a low transverse incision, a viable fetus in cephalic presentation, and gestational age >32 weeks were included in the study. The characteristics and outcome of successful VBAC and failed TOLAC were compared. A subgroup analysis addressed gestational age, interpregnancy interval, fetal macrosomia, body mass index, and maternal age. Results: Of 1,546 patients, 62.3% achieved VBAC while 37.7% had a secondary CD. Independent factors associated with the success of TOLAC were a history of vaginal birth in previous pregnancies (p<0.001) and the use of oxytocin (p<0.001), whereas preterm birth between gestational week 32 and 37 signified a higher risk of failed TOLAC (p=0.04). The success of VBAC did not differ significantly for patients older than 40 years of age, those with a shorter interpregnancy interval than 12 months, and fetal macrosomia with birth weight exceeding 4000 grams. Maternal and neonatal outcomes were poorer in women with failed TOLAC. Conclusion: Nearly two thirds of women with a history of CD achieve VBAC in Germany. Previous vaginal birth and the augmentation of labor with oxytocin are positively associated with the achievement of VBAC and no major perinatal complications. The decision to have a TOLAC should be encouraged in the majority of patients. Further studies are needed to evaluate the feasibility of TOLAC in preterm delivery.

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Section: Discussionsupporting

confidence: 92%

Risk factor analysis in women who underwent trial of labor after cesarean section: a multicenter study in Germany

Gitas¹,

Alkatout²,

Ertan³

et al. 2022

J Turkish German Gynecol Assoc

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“…The odds ratio for women with PROM to have a failed TOLAC was 4.47 (Table 5). There are limited studies into the impact of PROM on successful TOLAC, two previous studies found PROM was associated with positive outcomes [33,34]. This study found PROM was associated with increased risk of failed TOLAC (OR: 4.47, p < 0.01).…”

Section: Discussionmentioning

confidence: 67%

Reasons for previous Cesarean deliveries impact a woman’s independent decision of delivery mode and the success of trial of labor after Cesarean

Uno

Mayama

Yoshihara

et al. 2020

BMC Pregnancy Childbirth

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Background: Cesarean delivery rates are increasing globally with almost half of them occurring due to a previous Cesarean delivery. A trial of labor after Cesarean (TOLAC) is considered a safe procedure, but most eligible women instead undergo Cesarean before 39 weeks of gestation. Lack of education about TOLAC is often associated with increased repeat Cesarean. To reveal the safety and feasibility of TOLAC, we conducted this observational, prospective study with women's independent decisions. We aimed to clarify the relationship between their chosen mode of delivery and the reason for their previous Cesarean. Additionally, we have tried to identify maternal and obstetric factors associated with failed TOLAC to improve its success rate. Methods: This was a prospective, observational study of 1086 pregnant women with at least one previous Cesarean delivery. Of these, 735 women met our TOLAC criteria (Table 1), and then, could choose TOLAC or repeat Cesarean after receiving detailed explanations regarding the risks and benefits of both procedures. The primary outcomes were the number of successful TOLAC procedures and 5-min Apgar scores < 7 for the trial of labor after Cesarean group and elective Cesarean group. We collected the maternal and neonatal data including the reasons of previous Cesarean. Results: In total, 64.1% of women chose TOLAC. The success rate was 91.3%. The uterine rupture rate was 0.6%. There were no significant differences in the rate of Apgar scores at 5 min < 7 between both groups. Histories of experience of labor in previous Cesarean delivery were observed in 30 and 50% of women who chose TOLAC and repeat Cesarean, respectively (p < 0.05). Factors related to failed TOLAC included ≥40 weeks of gestation (odds: 5.47, 95% CI: 2.55-11.70) and prelabor rupture of membranes (PROM) (odds: 4.47, 95% CI: 2.07-9.63).Conclusions: TOLAC is a favorable delivery option for both mothers and neonates when women meet criteria and choose after receiving detailed explanations. Women who experience PROM or ≥ 40 weeks of gestation, their modes of delivery should be reconsulted.

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“…As 75% of all women entering labour and planning a VBAC in this study, had a successful VBAC, the avoidance of elective CS is key in increasing VBAC rates [34]. In terms of safety, there were two full uterine ruptures .…”

Section: Discussionmentioning

confidence: 81%

OptiBIRTH: a cluster randomised trial of a complex intervention to increase vaginal birth after caesarean section

Clarke

Devane

Gross

et al. 2020

BMC Pregnancy Childbirth

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Background: Despite evidence supporting the safety of vaginal birth after caesarean section (VBAC), rates are low in many countries. Methods: OptiBIRTH investigated the effects of a woman-centred intervention designed to increase VBAC rates through an unblinded cluster randomised trial in 15 maternity units with VBAC rates < 35% in Germany, Ireland and Italy. Sites were matched in pairs or triplets based on annual birth numbers and VBAC rate, and randomised, 1:1 or 2:1, intervention versus control, following trial registration. The intervention involved evidence-based education of clinicians and women with one previous caesarean section (CS), appointment of opinion leaders, audit/peer review, and joint discussions by women and clinicians. Control sites provided usual care. Primary outcome was annual hospital-level VBAC rates before the trial (2012) versus final year of the trial (2016). Between April 2014 and October 2015, 2002 women were recruited (intervention 1195, control 807), with mode-of-birth data available for 1940 women. Results: The OptiBIRTH intervention was feasible and safe across hospital settings in three countries. There was no statistically significant difference in the change in the proportion of women having a VBAC between intervention sites (25.6% in 2012 to 25.1% in 2016) and control sites (18.3 to 22.3%) (odds ratio adjusted for differences between intervention and control groups (2012) and for homogeneity in VBAC rates at sites in the countries: 0.87, 95% CI: 0.67, 1.14, p = 0.32 based on 5674 women (2012) and 5284 (2016) with outcome data. Among recruited women with birth data, 4/1147 perinatal deaths > 24 weeks gestation occurred in the intervention group (0.34%) and 4/782 in the control group (0.51%), and two uterine ruptures (one per group), a rate of 1:1000.(Continued on next page)

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Labour characteristics of women achieving successful vaginal birth after caesarean section in three European countries

Cited by 8 publications

References 30 publications

Risk factor analysis in women who underwent trial of labor after cesarean section: a multicenter study in Germany

Risk factor analysis in women who underwent trial of labor after cesarean section: a multicenter study in Germany

Reasons for previous Cesarean deliveries impact a woman’s independent decision of delivery mode and the success of trial of labor after Cesarean

OptiBIRTH: a cluster randomised trial of a complex intervention to increase vaginal birth after caesarean section

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