The effect of gestational age on trial of labor after Cesarean section

Abstract

Advanced gestational age is associated with higher rates of failed TOL and uterine rupture.

Uterine rupture after previous caesarean section

“…Earlier studies, mostly of small samples, found an increased rupture risk for gestational age beyond term, possibly as result of decreased thickness of the lower uterine segment as the pregnancy progresses. [31][32][33][34] Other studies of larger samples, showed that advanced gestational age was not a significant risk factor. 35 In this study there was a significant risk associated with advanced gestational age, but this was mostly related to the higher induction rate at this gestational age.…”

Prediction of scar integrity and vaginal birth after caesarean delivery

“…In retrospective studies, the rate of uterine rupture during a trial of labour after caesarean delivery is around 1% [3][4][5][6][7][8][9][10]. These studies seem to have included only symptomatic uterine rupture.…”

“…These studies seem to have included only symptomatic uterine rupture. The following factors have been examined with regard to their ability to predict uterine rupture during a trial of labour after caesarean delivery: gestational age [4,19], maternal age [15], interdelivery interval [5,16], interpregnancy interval [7], suture technique for closing the hysterotomy [31], birth weight [18,24], previous vaginal delivery [3,6,21], induction of labour [10,28], ethnicity [22], pre-eclampsia or gestational hypertension [20], twin pregnancy [23], labour progress [27], and number of epidural doses [29]. A statistically significant association with uterine rupture was found in more than one study for the following variables: interdelivery or interpregnancy interval (higher risk with short interval, short interdelivery interval being defined as < 24months [16] or < 18 months [5], and short interpregnancy interval as < 6 months [7]), birthweight (higher risk if > 4000g) [18,24], induction of labour (higher risk) [10,32], oxytocin dose (higher risk with higher doses) [8,30], and previous vaginal delivery (lower risk of rupture if the woman ever delivered vaginally) [3,6].…”

Sezaryen Sonrası Vajinal Doğum

“…Uygulamadan önce kar/zarar oranının dikkatli değerlendirilmesi gerekir. Tüm çalışmalarda ortak payda spontan SSVD un belirgin şekilde indüksiyonla SSVD denemesinden daha düşük uterus rüptürü riski ile beraber olmasıdır 25,28,[53][54][55] .…”

“…Ancak uterin kesinin klasik kesi olması, SSVD da doğum indüksiyonu kullanımı, daha önceki sezaryen sayısının fazla olması, iki gebelik arası sürenin 18 aydan kısa olması, 4000 gr dan fazla fetus olması ve hastane doğum sayısının düşük olması (dolayısı ile deneyim) önemli risk faktörleridir. Daha önceden sezaryen öncesi veya sonrası normal doğum yapmış olmak belirgin uterin rüptür riskinde azalma ile beraberdir 55 .…”