Maternal and newborn outcomes after a prior cesarean birth by planned mode of delivery and history of prior vaginal birth in British Columbia: a retrospective cohort study

Bickford, Celeste; Janssen, Patricia A.

doi:10.9778/cmajo.20140055

Cited by 9 publications

(42 citation statements)

References 20 publications

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“…We also found evidence that the mother’s risk of having either a postnatal hospital stay greater than 5 days or an overnight readmission to hospital within 42 days of birth was significantly reduced for women who had a planned VBAC compared to ERCS only if they had any prior vaginal births. This apparent protective effect of prior vaginal delivery is consistent with several previous studies [39,46,47] and might be explained by women with a prior vaginal delivery having less complicated and possibly quicker labors that are more likely to result in a successful VBAC compared to women without a prior vaginal birth [16].…”

Section: Discussionsupporting

confidence: 90%

“…The AHRQ review [16] also found evidence that planned VBAC is associated with an increased risk of blood transfusion, but only when the meta-analysis was confined to the four identified studies of women delivered at term rather than any gestational age (pooled estimates: 0.7% for planned VBAC versus 0.5% for ERCS, RR 1.30, 95% CI 1.15–1.47). Since the AHRQ review, although a number of studies have found no significant difference in the risk of blood transfusion between women who had planned VBAC and those that had an ERCS [36,40,42,43], a few of the larger studies have reported an elevated risk of this outcome for planned VBAC [39,44,45].…”

Section: Discussionmentioning

confidence: 99%

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Planned mode of delivery after previous cesarean section and short-term maternal and perinatal outcomes: A population-based record linkage cohort study in Scotland

et al. 2019

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BackgroundPolicy consensus in high-income countries supports offering pregnant women with previous cesarean section a choice between planning an elective repeat cesarean section (ERCS) or attempting a vaginal birth, known as a planned vaginal birth after previous cesarean (VBAC), provided they do not have contraindications to planned VBAC. However, robust comprehensive information on the associated outcomes to counsel eligible women about this choice is lacking. This study investigated the short-term maternal and perinatal outcomes associated with planned mode of delivery after previous cesarean section among women delivering a term singleton and considered eligible to have a planned VBAC.Methods and findingsA population-based cohort of 74,043 term singleton births in Scotland between 2002 and 2015 to women with one or more previous cesarean sections was conducted using linked Scottish national datasets. Logistic or modified Poisson regression, as appropriate, was used to estimate the effect of planned mode of delivery on maternal and perinatal outcomes adjusted for sociodemographic, maternal medical, and obstetric-related characteristics. A total of 45,579 women gave birth by ERCS, and 28,464 had a planned VBAC, 28.4% of whom went on to have an in-labor nonelective repeat cesarean section. Compared to women delivering by ERCS, those who had a planned VBAC were significantly more likely to have uterine rupture (0.24%, n = 69 versus 0.04%, n = 17, adjusted odds ratio [aOR] 7.3, 95% confidence interval [CI] 3.9–13.9, p < 0.001), a blood transfusion (1.14%, n = 324 versus 0.50%, n = 226, aOR 2.3, 95% CI 1.9–2.8, p < 0.001), puerperal sepsis (0.27%, n = 76 versus 0.17%, n = 78, aOR 1.8, 95% CI 1.3–2.7, p = 0.002), and surgical injury (0.17% versus 0.09%, n = 40, aOR 3.0, 95% CI 1.8–4.8, p < 0.001) and experience adverse perinatal outcomes including perinatal death, admission to a neonatal unit, resuscitation requiring drugs and/or intubation, and an Apgar score < 7 at 5 minutes (7.99%, n = 2,049 versus 6.37%, n = 2,570, aOR 1.6, 95% CI 1.5–1.7, p < 0.001). However, women who had a planned VBAC were more likely than those delivering by ERCS to breastfeed at birth or hospital discharge (63.6%, n = 14,906 versus 54.5%, n = 21,403, adjusted risk ratio [aRR] 1.2, 95% CI 1.1–1.2, p < 0.001) and were more likely to breastfeed at 6–8 weeks postpartum (43.6%, n = 10,496 versus 34.5%, n = 13,556, aRR 1.2, 95% CI 1.2–1.3, p < 0.001). The effect of planned mode of delivery on the mother’s risk of having a postnatal stay greater than 5 days, an overnight readmission to hospital within 42 days of birth, and other puerperal infection varied according to whether she had any prior vaginal deliveries and, in the case of length of postnatal stay, also varied according to the number of prior cesarean sections. The study is mainly limited by the potential for residual confounding and misclassification bias.ConclusionsAmong women considered eligible to have a planned VBAC, planned VBAC compared to ERCS is associated with an increased risk ...

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Planned mode of delivery after previous cesarean section and short-term maternal and perinatal outcomes: A population-based record linkage cohort study in Scotland

et al. 2019

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“…Twenty-eight were population-based studies ( 34 , 36 , 38 , 41 – 43 , 45 , 50 , 51 , 53 – 56 , 58 – 60 , 63 – 65 , 67 , 69 – 71 , 73 , 75 – 78 ), while 13 recruited subjects from a single ( 32 , 37 , 39 , 44 , 46 – 48 , 57 , 61 , 62 , 68 , 72 , 74 ) and six from multiple centers ( 33 , 35 , 40 , 49 , 52 , 66 ). Eighteen of the studies were conducted in mainland Europe ( 34 , 37 , 39 , 41 , 43 , 46 , 48 , 49 , 51 , 56 – 58 , 60 , 62 , 63 , 66 – 68 ), 10 in the United States ( 35 , 40 , 42 , 45 , 52 , 55 , 59 , 70 , 71 , 77 ), six in the United Kingdom ( 53 , 54 , 65 , 75 , 76 <...…”

Section: Resultsmentioning

confidence: 99%

“…Uterine rupture was variably defined amongst these studies and the reported absolute risk of rupture varied from 0.00 to 4.76% for planned VBAC and 0.00–2.92% for ERCS. Sixteen of the studies ( 34 , 36 , 40 , 48 , 50 , 51 , 55 , 56 , 58 , 64 , 65 , 70 , 72 , 73 , 77 , 78 ) (seven restricted to women with one prior cesarean) reported an increased risk of uterine rupture for planned VBAC compared to ERCS (relative effect ranging from 1.39 to 243.98), with the highest risks generally apparent when labor was induced and/or augmented. However, one of the studies reported that the risk was only significantly elevated amongst women without a prior vaginal birth ( 50 ).…”

Section: Resultsmentioning

confidence: 99%

“…Sixteen of the studies ( 34 , 36 , 40 , 48 , 50 , 51 , 55 , 56 , 58 , 64 , 65 , 70 , 72 , 73 , 77 , 78 ) (seven restricted to women with one prior cesarean) reported an increased risk of uterine rupture for planned VBAC compared to ERCS (relative effect ranging from 1.39 to 243.98), with the highest risks generally apparent when labor was induced and/or augmented. However, one of the studies reported that the risk was only significantly elevated amongst women without a prior vaginal birth ( 50 ). The remaining predominately small studies found no significant difference in the risk of this outcome for planned VBAC compared to ERCS ( 33 , 37 , 39 , 46 , 47 , 49 , 52 , 62 , 66 , 68 , 74 ) (eight restricted to women with one prior cesarean) or reported no cases at all of uterine rupture ( 35 , 44 , 57 , 61 ) (two restricted to women with one prior cesarean) ( Figure 1 ).…”

Section: Resultsmentioning

confidence: 99%

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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

2022

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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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Toward normal birth–but at what cost?

Dietz

Campbell

2016

American Journal of Obstetrics and Gynecology

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Maternal and newborn outcomes after a prior cesarean birth by planned mode of delivery and history of prior vaginal birth in British Columbia: a retrospective cohort study

Cited by 9 publications

References 20 publications

Planned mode of delivery after previous cesarean section and short-term maternal and perinatal outcomes: A population-based record linkage cohort study in Scotland

Planned mode of delivery after previous cesarean section and short-term maternal and perinatal outcomes: A population-based record linkage cohort study in Scotland

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

Toward normal birth–but at what cost?

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