Maternal and Perinatal Outcomes Associated With a Trial of Labor After Prior Cesarean Delivery

Landon, Mark B.; Hauth, John C.; Leveno, Kenneth J.; Spong, Catherine Y.; Leindecker, Sharon; Varner, Michael W.; Moawad, Atef H.; Caritis, Steve N.; Harper, Margaret; Wapner, Ronald J.; Sorokin, Yoram; Miodovnik, Menachem; Carpenter, Marshall W.; Peaceman, Alan M.; OʼSullivan, Mary J.; Sibai, Baha M.; Langer, Oded; Thorp, John M.; Ramin, Susan M.; Mercer, Brian M.; Gabbe, Steven G.

doi:10.1097/01.ogx.0000160565.07370.0e

Cited by 65 publications

(93 citation statements)

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“…Table 2 When the timing and duration of oxytocin dose is considered, increasing ranges of maximum oxytocin dose are associated with a progressively increasing risk of uterine rupture in patients attempting VBAC. This association with uterine rupture risk, estimated by time-to-event analysis, is greater in magnitude than that previously described by multivariable models that did not consider time or duration of therapy 2,4,[6][7][8][9] .…”

Section: Resultsmentioning

confidence: 68%

Higher maximum doses of oxytocin are associated with an unacceptably high risk for uterine rupture in patients attempting vaginal birth after cesarean delivery

Cahill

Waterman

Stamilio

et al. 2008

American Journal of Obstetrics and Gynecology

146

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"Higher maximum doses of oxytocin are associated with an unacceptably high risk for uterine rupture in patients attempting vaginal birth after cesarean delivery". American Journal of Obstetrics and Gynecology, 199, 1, 32.e1-32.e5. 2008 Objective: To more precisely estimate the effect of maximum oxytocin dose on uterine rupture risk in patients attempting VBAC by considering timing and duration of therapy.Study design: A nested case-control study was conducted within a multicenter, retrospective cohort study of over 25,000 women with at least one prior cesarean delivery, comparing cases of uterine rupture to controls (no rupture) while attempting VBAC. Time-to-event analyses were performed to examine the effect of maximum oxytocin dose on the risk of uterine rupture considering therapy duration, while adjusting for confounders.Results: Within the nested case-control study of 804 patients, 272 were exposed to oxytocin: 62 cases of uterine rupture and 210 controls. Maximum oxytocin ranges above 20mu/min increased the risk of uterine rupture 4-fold or greater (21-30mu/min: HR=3.92, 95%CI 1.06-14.52; 31-40mu/min: HR=4.57, 95%CI 1.00-20.82).Conclusion: These findings support a maximum oxytocin dose of 20mu/min in VBAC trials to avoid an unacceptably high risk of uterine rupture.

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Section: Resultsmentioning

confidence: 68%

Higher maximum doses of oxytocin are associated with an unacceptably high risk for uterine rupture in patients attempting vaginal birth after cesarean delivery

Cahill

Waterman

Stamilio

et al. 2008

American Journal of Obstetrics and Gynecology

146

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show abstract

“…Uterine rupture is a rare but serious complication of a trial of vaginal birth after caesarean delivery (VBAC) [1][2][3]. Therefore, VBAC should be proposed only to women who are likely to have a low risk of uterine rupture.…”

Section: A Introduction/backgroundmentioning

confidence: 99%

Prediction of scar integrity and vaginal birth after caesarean delivery

Valentin¹

2013

Best Practice & Research Clinical Obstetrics & Gynaecol

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A statistically significant association with uterine rupture during a trial of labour after caesarean delivery was found in at least two studies for the following variables: interdelivery interval (higher risk with short interval), birthweight (higher risk if > 4000g), induction of labour (higher risk), oxytocin dose (higher risk with higher doses), and previous vaginal delivery (lower risk). However, no clinically useful risk estimation model including clinical variables has been published. A thin lower uterine segment at 35-40 weeks as measured by ultrasound in women with a caesarean hysterotomy scar increases the risk of uterine rupture or dehiscence. However, no cutoff for lower uterine segment thickness can be suggested because of study heterogeneity, and because prospective validation is lacking. Large caesarean hysterotomy scar defects in nonpregnant women seen at ultrasound examination increase the risk of uterine rupture or dehiscence in subsequent pregnancy but the strength of the association is unknown. To sum up, we currently lack a method that can provide a reliable estimate of the risk of uterine rupture or dehiscence during a trial of labour in women with caesarean hysterotomy scar(s).

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“…This incidence is comparable to the recent study by Landon et al who reported 12.16%. 9 Out of the 588 patients in our study, 52.8% gave consent for a trial for VBAC as against 39.90% of the patients in the study by Landon et al and 64% by Gonen and Colleagues as shown in Table 3. 9,13 As reported in various studies the overall rate of vaginal delivery following previous caesarean delivery varies from 28% to 51%.…”

Section: Discussionmentioning

confidence: 72%

“…Data from recent studies suggest that VBAC may not be as safe as originally thought. 9,10 But reports are conflicting and these factors along with medico legal concerns have led to a decline in clinician"s attitude for offering VBAC and also women not accepting trial for VBAC in various parts of the world. 11,12 The present study evaluated the outcome and trends in patients with a history of prior LSCS who delivered in KEM Hospital from January 2015 to December 2015.…”

Section: Discussionmentioning

confidence: 99%

Maternal and foetal outcome in term patients with previous one lower segment cesarean section

Satia

Mali

Sikarwar

2016

Int J Reprod Contracept Obstet Gynecol

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Maternal and Perinatal Outcomes Associated With a Trial of Labor After Prior Cesarean Delivery

Cited by 65 publications

References 0 publications

Higher maximum doses of oxytocin are associated with an unacceptably high risk for uterine rupture in patients attempting vaginal birth after cesarean delivery

Higher maximum doses of oxytocin are associated with an unacceptably high risk for uterine rupture in patients attempting vaginal birth after cesarean delivery

Prediction of scar integrity and vaginal birth after caesarean delivery

Maternal and foetal outcome in term patients with previous one lower segment cesarean section

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