Mode of delivery after a previous cesarean birth, and associated maternal and neonatal morbidity

Abstract

Although absolute rates of adverse outcomes are low, attempted vaginal birth after cesarean delivery continues to be associated with higher relative rates of severe morbidity and mortality in mothers and infants. Temporal worsening of infant outcomes after attempted vaginal birth after cesarean delivery highlights the need for greater care in selecting candidates, and more careful monitoring of labour and delivery.

Severe Maternal Morbidity in Canada: Temporal Trends and Regional Variations, 2003-2016

“…Severe uterine rupture: Rates of uterine rupture associated with red cell transfusion, procedures to the uterus or hysterectomy were relatively rare but showed a significant rise between 2003 and 2016. Uterine rupture is strongly associated with attempted vaginal birth after caesarean delivery (VBAC), but the rising trend in severe uterine rupture noted in this study does not appear to be related to increases in attempted VBAC (which decreased from 34.0% in 2003 to 31.4% in 2014 [40]). Rather, the rise may have been related to changes in selection of candidates for attempted VBAC and/or changes in the expertise of health care providers [40].…”

“…The rising trend in severe uterine rupture noted in this study does not appear to be related to increases in attempted vaginal birth after Caesarean section (VBAC; which decreased from 34.0% in 2003 to 31.4% in 2014). 40 Rather, the rise may have been related to changes in the selection of candidates for attempted VBAC or changes in the expertise of health care providers because severe neonatal complications following attempted VBAC also increased over the study period. 40 Finally, the rise in cerebrovascular accidents appears to be unrelated to increases in maternal age.…”

“…40 Rather, the rise may have been related to changes in the selection of candidates for attempted VBAC or changes in the expertise of health care providers because severe neonatal complications following attempted VBAC also increased over the study period. 40 Finally, the rise in cerebrovascular accidents appears to be unrelated to increases in maternal age. A recent study by the Canadian Perinatal Surveillance System showed that most strokes occurred in the postpartum period and were strongly associated with hypertensive disorders of pregnancy, 41 a finding indicating a need for improved management of hypertensive disorders, especially in the postpartum period.…”

Contemporary Issues in Women's Health

“…There has been an increased trend in recent years to opt for an elective repeat cesarean, with declining numbers of women choosing or being supported for a trial of labor. Canadian investigators conducted a study comparing maternal and neonatal outcomes following attempted vaginal birth after cesarean (VBAC) delivery or elective repeat cesarean delivery …”

“…The new WHO guideline included 56 evidence‐based recommendations; of these, 26 were newly developed recommendations and 30 were recommendations integrated from existing WHO guidelines. These included having a companion of choice during labor and delivery; ensuring respectful care and good communication between women and healthcare providers; maintaining privacy and confidentiality; and allowing women to make decisions about their pain management, labor, and delivery positions during the process of childbirth.…”