176: Risk of maternal morbidity with increasing number of repeat cesareans

Abstract

increased costs and probably adverse events related to analgesia. We aimed to examine whether an ECV attempt followed by a repeat attempt under spinal anesthesia (SA) in cases of failure only, still increases the success rate compared with one step without analgesia. STUDY DESIGN: A retrospective study conducted at a single university teaching hospital on data from January 2009 to December 2015. All women with non-vertex singleton gestation, at >37 weeks who had an ECV attempt without SA were included. Women who had a failed ECV were offered a repeat attempt under SA between 38 to 39 weeks. Women who refused a second attempt were offered a scheduled CD at 39 to 40 weeks. The primary outcome was the incidence of vertex presentation at delivery. Secondary outcomes were the rate of successful repeat attempt and CD rate. RESULTS: Of all 213 ECV attempts without analgesia, 145 (68.1%) were successful. Of the reminder 68 women who had a failed first attempt, 5 (7.3%) had subsequent spontaneous version to cephalic presentation, 5 (7.3%) delivered at another institution and 13 (19.1%) went into spontaneous labor. Among the reminder 45 (66.2%) women, 17 refused a second attempt and 28 agreed for a second attempt with SA. Successful ECV with SA occurred in 11 women (39.3%) and all had vertex presentation at delivery compared to none (0%) of the 17 who refused a second attempt (p¼0.003). The CD rate was 64.3% compared to 100% respectively (p¼0.007). CONCLUSION: Repeat ECV with SA after first attempt failure increased the rate of vertex presentation at birth and decreased the CD rate. This 2 steps approach compared to neuraxial analgesia for all, require fewer recourses and costs and probably encompasses fewer adverse events related to SA since not all women need to be exposed.

Evaluation of Hospital Cesarean Delivery–Related Profits and Rates in the United States

“…17 Furthermore, the likelihood of maternal morbidity increases for mothers who repeatedly undergo cesarean delivery. [18][19][20] Healthy People 2020-a framework designed to address health disparities across the US-calls for a 10% relative decrease in primary cesarean deliveries among low-risk women, with the goal of lowering the cesarean rate to 23.9%. 21 While an official midprogram review is not yet available, it is estimated that the US will not meet this goal.…”

“…Compared with vaginal delivery, however, the procedure is associated with a higher risk of various maternal complications, such as maternal infection and subsequent pregnancy complications, and a higher likelihood of rehospitalization within 6 weeks of delivery . Furthermore, the likelihood of maternal morbidity increases for mothers who repeatedly undergo cesarean delivery …”