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

Abstract

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 ...

An Alternative to Repeat Cesarean Section

“…Популяционное шотландское исследование (2019) показало, что роды через естественные родовые пути, особенно индуцированные, в сравнении с элективным КС ассоциированы с повышением риска (р < 0,05) таких осложнений, как разрыв матки (0,24% и 0,40% соответственно), необходимость в гемотрансфузии (1,14% и 0,50%), послеродовой сепсис (0,27% и 0,17%), неблагоприятные перинатальные исходы (7,99% и 6,37%) и т. д. [20]. Однако очевидно, что абсолютный риск данных осложнений крайне низок, и это созвучно результатам других исследований [10,21].…”

“…В сочетании с интранатальными механизмами инициа-ции адаптационно-регуляторных механизмов плода, определяющих его будущее здоровье и жизнедеятельность [22], это невозможно переоценить. Следует учитывать также, что КС ассоциировано с серьезными кратко-и долгосрочными осложнениями как для матери, так и для ребенка [3,7,20].…”

Socio-demographic profile and maternal-fetal prognosis of emergency caesarean section versus caesarean section programmed on scar uterus

“…Other authors have found results similar to ours: postoperative morbidity was more pronounced in patients who had an emergency cesarean than in those who had a scheduled cesarean. The difference was statistically significant (p <0.001), Ugwe E et al, in his work reported 7.6% of parietal infection in the group of caesareans made in emergencies against 1.4% for scheduled cesareans, Kathryn E et al 39,41,46 In 2019 also found in his study that the risk of having a puerperal infection was significant during cesarean after attempting the vaginal route than in scheduled cesarean, London MB et al 35 In 2004 reported that the complication that dominated the postpartum period was endometritis in the group of caesarean sections performed in an emergency after attempted vaginal delivery. In this work, we did not record maternal deaths in the two groups during the study period, we justify this by the immediate and adequate management by cesarean section of those parturients who came in emergency when their cesarean section should be scheduled.…”

Satisfaction and maternal postnatal adjustments following different modes of delivery

“…Our study correlates with study done by Fitzpatrick KA et al in UK, wherein women embark for a repeat caesarean section with a history of previous caesarean section. 4 Though the maternal and perinatal morbidity is present with VBAC the absolute risk of adverse outcomes is small and this information can be used to counsel and manage the increasing number of women with previous caesarean section. 4…”

“…4 Though the maternal and perinatal morbidity is present with VBAC the absolute risk of adverse outcomes is small and this information can be used to counsel and manage the increasing number of women with previous caesarean section. 4…”