Vaginal Birth After Cesarean

Abstract

had good-quality or fair-quality evidence relating to uterine rupture. Four studies reported uterine rupture outcomes for both TOL and ERCD and included 47,202 patients, in whom 154 uterine ruptures occurred; 148 ruptures (96%) were in the TOL group. The risk of uterine rupture for all women with a prior cesarean delivery was 0.30% (CI, 0.23%-0.41%) with risks in the TOL and ERCD groups reported as 0.47% (CI, 0.28%-0.77%) and 0.026% (CI, 0.009%-0.082%), respectively. Eight cohort studies (402,059 patients) with a moderate grade of evidence compared risks for hysterectomy between TOL and ERCD groups. The risk of hysterectomy was <0.3% in women with a prior cesarean delivery; the risks between TOL and ERCD were not significantly different (0.17% and 0.28%, respectively; RR 0.65; CI, 0.40-1.06). Nine cohort studies (401,307 patients) had moderate-grade evidence on the rate of transfusion between TOL and ERCD. The overall rates of transfusion did not differ significantly, with rates of 0.9% for TOL and 1.2% for ERCD (RR, 0.81; CI, 0.57-1.15). One study found that the route of delivery influenced the need for transfusion and may be mediated by maternal comorbid conditions. Evidence for hemorrhage was low-grade because of inconsistent and imprecise methods of defining and reporting the occurrence of this complication. From 6 studies involving 47,754 women, the risk rates for hemorrhage with ERCD ranged from 0.3% to 29% and no comparison could be done because of the poor quality of the data. Twenty-two studies with 354,060 patients reported infectious complications, with no significant differences in risk between TOL and ERCD 4.6% (CI, 1.5%-13.5%) and 3.2% (CI, 1.3%-7.3%), respectively. The 4 studies reporting surgical injury and including 53,282 patients had insufficient data to evaluate, with a low grade of evidence. As reported in 8 cohort studies, hospital length of stay was 3.9 d in patients undergoing ERCD and 2.6 d after TOL.Short-term neonatal outcomes included perinatal mortality, respiratory conditions, hypoxic-ischemic encephalopathy, sepsis, trauma, Apgar scores, and neonatal intensive care unit admission. With a moderate grade of evidence, 5 studies reported on perinatal deaths among 75,899 infants. These studies reported only on populations that delivered at term and recorded perinatal mortality through the first 7 d of life. The rate was significantly increased by TOL (0.13%; CI, 0.06%-0.30%) compared with ERCD (0.05%; CI, 0.007%-0.38%). Six studies reported neonatal death (within first 28 d) and included 108,328 infants. The rate of death for TOL was 0.11% (CI, 0.06%-0.20%) compared with 0.06% (CI, 0.02-0.15%) for ERCD, a significant difference. A subanalysis of the data showed that the rates of neonatal mortality were higher in women with high-risk conditions and those with indications for a repeat CD. Respiratory conditions were reported in 6 studies involving 5599 infants. The grade of evidence was low for the 3 studies that compared bag/mask ventilation and 3 other studies that examined transient tac...

Women-centred interventions to increase vaginal birth after caesarean section (VBAC): A systematic review

“…Rising rates of caesarean section (CS) is an issue of particular concern in the global maternity care field (EURO-PERISTAT, 2013), due to the increased adverse maternal and neonatal outcomes associated with CS (Morrison et al, 1995;Guise et al, 2010;Marshall et al, 2011).…”

“…Maternal mortality has been shown, through a systematic review and meta-analysis of 203 research reports (Guise et al, 2010), to be significantly increased with elective repeat CS (ERCS) compared with elective VBAC (1.34 versus 0.38 per 10,000). Planned VBAC, however, significantly increases perinatal mortality (13 per 10,000) compared with ERCS (5 per 10,000), though it should be noted that absolute rates of both mortalities are low (Guise et al, 2010).…”

The experience of vaginal birth after cesarean delivery in the Maternity home No 13 of Saint Petersburg

“…Метаанализы показали преимущество естественных родов против повторного кесарева сечения как спо-соба снижения риска предлежания и врастания плаценты в последующую беременность и, как следствие, материнской смертности. При этом риски гистерэктомии, гемотрансфузии и по-слеродового эндометрита существенно не раз-личались [4]. В России, к сожалению, многие акуше-ры не рискуют предлагать беременной есте-ственные роды при наличии рубца на матке, а врачи амбулаторного звена часто с ранних сроков беременности настраивают пациенток на абдоминальное родоразрешение.…”

Are Women’s and Obstetricians, Views on Mode of Delivery Following a Previous Cesarean Section Really OCEANS Apart?

“…It is unclear as to which is the safer mode of delivery for these women [1,2]. The National Institute for Health and Care Excellence (NICE) [3] in the UK therefore, having evaluated the evidence, recommends that after discussion of the relative risks and benefits of both modes of delivery, maternal preferences should guide their subsequent decision.…”

“…This may be influenced by fear of litigation and concerns that VBAC may not be as safe as was originally thought [2,8].…”