Vaginal Delivery After Previous Cesarean Delivery: A Continuing Controversy

Zinberg, Stanley

doi:10.1097/00003081-200109000-00013

Cited by 22 publications

(7 citation statements)

References 27 publications

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“…Despite extensive study into the safety and efficacy of VBAC, controversy continues on how best to conduct a trial of labour, as uterine rupture is life threatening to both mother and child 7 . Analyses of multiple confounding variables suggest the maternal morbidity and mortality rates associated with the elective caesarean delivery of women with a uterine scar is two to four times lower than those who attempt vaginal delivery 8,9 . The most commonly suggested cause of uterine rupture in women attempting VBAC—increased uterine activity—is consistent with the well‐documented early and frequent requirement for oxytocin augmentation during the active phase of labour 10 .…”

Section: Introductionmentioning

confidence: 69%

Rupture of the uterine scar during term labour: contractility or biochemistry?

Buhimschi

Patel

et al. 2004

BJOG

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Objective Vaginal birth after a prior low transverse caesarean section (VBAC) is advocated as a safe and effective method to reduce the total caesarean section rate. However, the risk of uterine rupture has dampened the enthusiasm of practising clinicians for VBAC. Uterine rupture occurs more frequently in women receiving prostaglandins in preparation for the induction of labour. We hypothesised that similar to the cervix, prostaglandins induces biochemical changes in the uterine scar favouring dissolution, predisposing the uterus to rupture at the scar of the lower segment as opposed to elsewhere. Design We tested aspects of this hypothesis by investigating the location of uterine rupture associated with prostaglandins and compared it with the sites of rupture in the absence of prostaglandins. Settings Two North American University Hospitals.Population Twenty-six women with a prior caesarean section, experiencing uterine rupture in active labour.Methods Retrospective review of all pregnancies complicated by uterine rupture at two North American teaching hospitals from 1991 to 2000. Main outcome measure Site of the uterine rupture.Results Thirty-four women experienced rupture after a previous caesarean section with low transverse uterine incision. Ten of the women who ruptured (29%) received prostaglandins for cervical ripening (dinoprostone: n ¼ 8 or misoprostol: n ¼ 2) followed by either spontaneous contractions (n ¼ 3) or oxytocin augmentation during labour (n ¼ 7). In 16 women (47%), oxytocin alone was sufficient for the induction/augmentation of labour. Eight (23%) women ruptured at term before reaching the active phase of labour in the absence of pro-contractile agents or attempted VBAC. There were no differences among the groups in terms of age, body mass index, parity, gestational age, fetal weight or umbilical cord pH measurements. Women treated with prostaglandins experienced rupture at the site of their old scar more frequently than women in the oxytocin-alone group whose rupture tended to occur remote from their old scar (prostaglandins 90% vs oxytocin 44%; OR: 11.6, 95% CI: 1.2 -114.3). Conclusion Women in active labour treated with prostaglandins for cervical ripening appear more likely to rupture at the site of their old scar than women augmented without prostaglandins. We propose that prostaglandins induce local, biochemical modifications that weaken the scar, predisposing it to rupture.

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Section: Introductionmentioning

confidence: 69%

Rupture of the uterine scar during term labour: contractility or biochemistry?

Buhimschi

Patel

et al. 2004

BJOG

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“…A summary of published evidence to date with recommendations for midwifery practice has been recently published 30 . As others have recently described, perhaps it is time to move back toward a middle ground where carefully selected and managed, low‐risk, well‐informed clients are offered the choice of VBAC with staff well prepared to handle emergencies 31,32 …”

Section: Resultsmentioning

confidence: 99%

Vaginal Birth After Cesarean Section: A Pilot Study of Outcomes in Women Receiving Midwifery Care

Avery

Carr

Burkhardt

2004

J Midwife Womens Health

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A recent trend discouraging or not offering women a choice to labor after a cesarean birth has resulted in higher cesarean birth rates and lower rates of vaginal birth after cesarean birth (VBAC). The few studies describing midwifery practice have demonstrated favorable outcomes; however, the studies are too small to thoroughly evaluate critical outcomes. In this retrospective descriptive study, clinical outcome data were obtained from eight midwifery practices. The aims were to collect, aggregate, and analyze data from multiple midwifery practices and then describe outcomes. Usable data representing 649 trials of labor were submitted. Overall, 72% (range 64%-100%) of women gave birth vaginally. Mean infant birth weight was 3,501 (SD = 534) g, and the mean Apgar scores were 7.99 (SD = 1.4; median 8) at 1 minute and 8.84 (SD = 0.8; median 9) at 5 minutes. Only 5.3% (n = 14) of infants were admitted to the neonatal intensive care unit. This small retrospective study demonstrates similar outcomes to those reported in the current literature. A larger prospective study to carefully describe midwifery care outcomes using a common data collection method is needed to provide evidence for determining the continuation of VBAC as part of midwifery care.

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“…Most importantly, because we examined changes in cesarean rates among women at "no indicated risk" over time, there is no reason to expect that bias would result in a change in reporting of these variables at different time periods. 16 The changes in the VBAC rate have been associated with a vigorous debate in the obstetrical literature, and the last 20 years have been marked by shifts in practice guidelines for VBACs [17][18][19][20][21][22] ; however, there is no comparable literature on primary cesareans, even though the changes in the primary rate have a greater impact on the overall cesarean rate. Notably, the primary cesarean rate decreased from 1989 to 1996 and then increased from 1996 to 2003 for essentially every medical risk factor and labor and/or delivery complication.…”

Section: Discussionmentioning

confidence: 99%