Neonatal outcomes following a trial of labor after Caesarean delivery: a population-based study

Litwin, Charles E.; Czuzoj‐Shulman, Nicholas; Zakhari, Andrew; Abenhaim, Haim A.

doi:10.1080/14767058.2017.1337740

Cited by 7 publications

(18 citation statements)

References 28 publications

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“…Our study also adds to the limited evidence [16] about other measures of adverse perinatal outcome. Our findings are consistent with two large population-based studies conducted in the US [54,55] and several small non-population-based studies [36,37,56] that have reported an increased risk of various measures of neonatal morbidity or composite adverse neonatal outcome with planned VBAC compared to ERCS.…”

Section: Discussionsupporting

confidence: 92%

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: 92%

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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“…Since the AHRQ review ( 20 ) a total of 12 studies ( 33 , 40 , 42 , 46 , 50 , 51 , 59 , 64 , 65 , 70 , 72 , 77 ) (eight population-based) have reported on some form of neonatal respiratory intervention/morbidity. Two of the studies ( 42 , 72 ) did not confine their study population to term infants, although one ( 42 ) did conduct a sub-group analysis on “low-risk” women which excluded those who gave birth preterm.…”

Section: Resultsmentioning

confidence: 99%

“…Two of the studies ( 42 , 72 ) did not confine their study population to term infants, although one ( 42 ) did conduct a sub-group analysis on “low-risk” women which excluded those who gave birth preterm. Eight of the studies ( 33 , 42 , 50 , 59 , 64 , 70 , 72 , 77 ) investigated the need for some form of ventilation, reporting absolute risks ranging from 0.08 to 2.54% for planned VBAC and 0.16–2.29% for ERCS. Four of these studies ( 42 , 59 , 64 , 70 ) found ∼1.1–1.2-fold increased risk of this outcome for planned VBAC compared to ERCS, although for one of the studies ( 42 ) the increased risk was only apparent among women considered to be “low-risk” and for another of the studies ( 57 ) no significant difference was found when ventilation > 6 h was considered.…”

Section: Resultsmentioning

confidence: 99%

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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“…Regarding respiratory outcomes, Lehmann, Yang, and Kok [10,13,19] demonstrated higher rates of infant respiratory distress syndrome (IRDS) in the ERCD group. Litwin [20] described a higher need for assisted ventilation in ERCD neonates, while Studsgaard [14] reported higher neonatal depression (defined in the paper as Apgar score 5 min after birth < 7 and/or pH < 7 in vessels of the umbilical cord) in the VBAC cohort.…”

Section: Discussionmentioning

confidence: 96%

“…Only a few studies have examined the outcomes in women whose characteristics are only one prior cesarean and no prior vaginal deliveries [13,17,18]. Many studies have had more liberal inclusion criteria and included women that have had one caesarean section, but also a varying number of previous vaginal deliveries [1,6,9,11,12,14,[19][20][21]. We referred to both study types for comparison.…”

Section: Discussionmentioning

confidence: 99%

Feeding Practices, Maternal and Neonatal Outcomes in Vaginal Birth after Cesarean and Elective Repeat Cesarean Delivery

Rudzinski

Lopuszynska

Pieniak

et al. 2022

IJERPH

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Cesarean section rates are constantly rising, and the number of women with a prior cesarean considering a delivery mode for their next labor is increasing. We aimed to compare maternal and neonatal outcomes and feeding method in women undergoing vaginal birth after cesarean (VBAC) versus elective repeat cesarean delivery (ERCD). This was a retrospective cohort study of women with one prior cesarean delivery (CD) and no previous vaginal births, delivering vaginally or by a CD in a single institution between 2016 and 2018. 355 live singleton spontaneous vaginal and cesarean deliveries were included. 121 women delivered vaginally and 234 had a CD. Neonates born by a CD were more likely to have higher birth weight (p < 0.001), higher weight at discharge (p < 0.001), macrosomia (p = 0.030), lose >10% of their body mass (p = 0.001), be mixed-fed (p < 0.001), and be hospitalized longer (p < 0.001). Children born vaginally were more likely to be exclusively breastfed (p < 0.001). Women undergoing VBAC were more likely to deliver preterm (p = 0.006) and post-term (p < 0.001), present with PROM (p < 0.001), have greater PROM latency period (p < 0.001), and experience intrahepatic cholestasis of pregnancy (p = 0.029), postpartum anemia (p < 0.001), and peripartum blood loss >1 L (p = 0.049). The incidence of anemia during pregnancy was higher in the ERCD cohort (p = 0.047). Women undergoing VBAC are more likely to breastfeed their children, perhaps for the same reason they choose the vaginal method of delivery, as vaginal delivery and breastfeeding along with antibiotic use, are the most important factors decreasing the risk for future diseases in their offspring.

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Neonatal outcomes following a trial of labor after Caesarean delivery: a population-based study

Abstract: Neonatal morbidity appears slightly increased among women with a TOLAC. However, morbidity and mortality are considerably increased in cases of uterine rupture. Appropriate selection and counseling of women for TOLAC should be undertaken as to minimize uterine rupture risk.

Cited by 7 publications

References 28 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

Feeding Practices, Maternal and Neonatal Outcomes in Vaginal Birth after Cesarean and Elective Repeat Cesarean Delivery

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