Perinatal outcome in births after a previous cesarean section at high trial of labor rates

Lehmann, Sjur; Baghestan, Elham; Børdahl, Per E.; Irgens, Lorentz M.; Rasmussen, Svein

doi:10.1111/aogs.13458

Cited by 8 publications

(23 citation statements)

References 30 publications

(50 reference statements)

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“…Around one‐third of the deliveries included in this study were performed in units with <1500 yearly deliveries (Table ). Higher TOLAC rates, but not higher TOLAC failure rates, have been observed in larger units compared with smaller . Hence, in some of the conditions studied, referral to a larger, tertiary institution might be a possible strategy to maintain a high TOLAC rate without excessive failure risk.…”

Section: Discussionmentioning

confidence: 84%

“…In the log binominal models, unclassified deliveries were excluded, and missing model data were handled by restriction. The adjustment variables were selected based on previous review studies of medical and nonmedical factors affecting TOLAC and TOLAC failure . We used IBM SPSS software version 20.0.…”

Section: Methodsmentioning

confidence: 99%

“…A high TOLAC rate, eg around 70% as observed in Norway, warrants close attention to the TOLAC failure rate, particularly in risk pregnancies . The objective of the present study was to explore medical conditions as risk factors for TOLAC and TOLAC failure, in a population with a high TOLAC rate.…”

Section: Introductionmentioning

confidence: 96%

See 2 more Smart Citations

Trial of labor after cesarean section in risk pregnancies: A population‐based cohort study

Lehmann

Baghestan

Børdahl

et al. 2019

Acta Obstet Gynecol Scand

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Introduction:In most pregnancies after a cesarean section, a trial of labor is an option. The objective of the study was to explore trial of labor and its failure in pregnancies with medical risk conditions, in a population with a high trial of labor rate. Material and methods:In a cohort study (n = 57 109), using data from the Medical Birth Registry of Norway 1989-2014, women with a second delivery after a first pregnancy cesarean section were included. Preterm, multiple, and non-cephalic deliveries were excluded. The outcomes were trial of labor and failed trial of labor, assessed as rates and relative risk, using deliveries without risk conditions as reference. Temporal trends were assessed by 3-year periods. The exposures were selected medical risk conditions, ie previous offspring death, labor dystocia, diabetes, heart conditions, chronic hypertension, chronic kidney disease, rheumatoid arthritis, thyroid disease, asthma, prepregnancy psychiatric conditions, epilepsy, obesity, gestational diabetes, eclampsia and preeclampsia, gestational hypertension, major malformations, second-pregnancy psychiatric conditions, assisted reproduction, macrosomia, and small-for-gestational-age neonates. Induced onset of labor was compared with spontaneous onset of labor for each condition studied. Results:In risk pregnancies (n = 31 994) the trial of labor rate was 64.9% and failure rate was 27.6%, compared with 74.6% and 16.4% in pregnancies without any of the risk conditions studied (n = 25 115). The lowest trial of labor rates were observed in diabetes type 1 (49.5%), diabetes type 2 (46.7%), maternal heart conditions (54.5%), and pregnancy-related psychiatric conditions (19.7%). The highest failure rates were observed in diabetes type 1 (43.1%), diabetes type 2 (40.3%), maternal obesity (36.9%), gestational diabetes (36.0%), and offspring macrosomia (43.0%). Induced labor was associated with failed trial of labor (P < .05), whereas after spontaneous labor, failure rates were less than 40% in all conditions studied. Conclusions:In conditions with high rates of failed trial of labor, eg diabetes, macrosomia, and obesity, a planned cesarean section might be a better option than a trial of labor, particularly if induction of delivery might be needed. K E Y W O R D Scesarean section, cohort study, induction of labor, risk pregnancy, trial of labor | 895 LEHMANN Et AL.

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Section: Discussionmentioning

confidence: 84%

Section: Methodsmentioning

confidence: 99%

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Trial of labor after cesarean section in risk pregnancies: A population‐based cohort study

Lehmann

Baghestan

Børdahl

et al. 2019

Acta Obstet Gynecol Scand

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“…Particularly, we used external verification of the widely used Grobman's model, to add corresponding features before delivery, and achieved superior predictive ability. Based on a clear trend of benefits from the successful vaginal delivery among those trials of labor after cesarean section, it is evident that VBAC failure exacerbates many risks, including bleeding, increased blood transfusions, uterine rupture and endometritis, as well as infant asphyxia or perinatal death [8,17,18]. Consequently, obstetricians prefer a more conservative approach during TOLAC to avoid medical disputes owing to the complex physician-patient relationship as well as the associated high work-related stress.…”

Section: Discussionmentioning

confidence: 99%

Prediction of vaginal birth after cesarean delivery in Southeast China: a retrospective cohort study

Zhang

Zheng

Cheng

et al. 2020

BMC Pregnancy Childbirth

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Background We aimed to develop and validate a nomogram for effective prediction of vaginal birth after cesarean (VBAC) and guide future clinical application. Methods We retrospectively analyzed data from hospitalized pregnant women who underwent trial of labor after cesarean (TOLAC), at the Fujian Provincial Maternity and Children’s Hospital, between October 2015 and October 2017. Briefly, we included singleton pregnant women, at a gestational age above 37 weeks who underwent a primary cesarean section, in the study. We then extracted their sociodemographic data and clinical characteristics, and randomly divided the samples into training and validation sets. We employed the least absolute shrinkage and selection operator (LASSO) regression to select variables and construct VBAC success rate in the training set. Thereafter, we validated the nomogram using the concordance index (C-index), decision curve analysis (DCA), and calibration curves. Finally, we adopted the Grobman’s model to perform comparisons with published VBAC prediction models. Results Among the 708 pregnant women included according to inclusion criteria, 586 (82.77%) patients were successfully for VBAC. Multivariate logistic regression models revealed that maternal height (OR, 1.11; 95% CI, 1.04 to 1.19), maternal BMI at delivery (OR, 0.89; 95% CI, 0.79 to 1.00), fundal height (OR, 0.71; 95% CI, 0.58 to 0.88), cervix Bishop score (OR, 3.27; 95% CI, 2.49 to 4.45), maternal age at delivery (OR, 0.90; 95% CI, 0.82 to 0.98), gestational age (OR, 0.33; 95% CI, 0.17 to 0.62) and history of vaginal delivery (OR, 2.92; 95% CI, 1.42 to 6.48) were independently associated with successful VBAC. The constructed predictive model showed better discrimination than that from the Grobman’s model in the validation series (c-index 0.906 VS 0.694, respectively). On the other hand, decision curve analysis revealed that the new model had better clinical net benefits than the Grobman’s model. Conclusions VBAC will aid in reducing the rate of cesarean sections in China. In clinical practice, the TOLAC prediction model will help improve VBAC’s success rate, owing to its contribution to reducing secondary cesarean section.

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“…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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Perinatal outcome in births after a previous cesarean section at high trial of labor rates

Abstract: We observed higher risk of offspring mortality and lower 5-minute Apgar score in TOLAC than in non-TOLAC. Possible causes and preventive measures should be explored.

Cited by 8 publications

References 30 publications

Trial of labor after cesarean section in risk pregnancies: A population‐based cohort study

Trial of labor after cesarean section in risk pregnancies: A population‐based cohort study

Prediction of vaginal birth after cesarean delivery in Southeast China: a retrospective cohort study

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

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