An Evaluation of the Relative Risks of a Trial of Labor Versus Elective Repeat Cesarean Section

Hadley, Carolyn B.; Mennuti, Michael T.; Gabbe, Steven G.

doi:10.1055/s-2007-999844

Cited by 10 publications

(1 citation statement)

References 6 publications

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“…This figure includes all neonatal deaths and is the lowest reported result in this country. It remains to be seen if our results in later years substantiate the findings of Shy et al, 16 who concluded that in contemporary practice mortality rates were essentially equal for both delivery practices, and Hadley et al, 19 who showed no statistically significant difference in maternal and neonatal morbidity between the two methods of delivery, that is, elective cesarean section versus vaginal delivery. There were four perinatal deaths associated with rupture of the uterine scar in our series.…”

Section: Discussionsupporting

confidence: 84%

Delivery Following Cesarean Section and Perinatal Mortality

Meehan

Burke²,

Casey³

et al. 1989

Amer J Perinatol

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The perinatal mortality in 1498 patients with one or more previous cesarean section scars delivered between 1972 and 1982 was analyzed. Repeat elective cesarean section was performed in 654 (44%) patients and 844 (56%) were subjected to a "trial of scar." Successful vaginal delivery occurred in 702 (83%) patients and 142 (17%) had emergency repeat operations. There were 46 perinatal deaths, giving a perinatal mortality rate (PMR) of 30.3/1000. It was lowest in patients who electively had a cesarean section (10.6/1000). The corrected PMR was twice as high in the trial of scar group. The PMR for the overall hospital population (27,072 babies) during the study period was 22.5/1000. There were four perinatal deaths in association with dehiscence of the uterine scar. The PMR in trial of scar patients decreased from 40/1000 to less than 20/1000 without a major change in policy. Meanwhile the unit cesarean section rate increased from 5 to 10%, but the repeat section rate was consistent at around 38.5%. Regional analgesia was used in 192 patients, for repeat section in five and trial of scar in 187. Oxytocin was given to 546 (65%) patients. Scar rupture is considered the major contraindication to a trial of scar, but emphasis was not laid on the possible increased perinatal mortality with this procedure before the 1980s. In view of the improvement in the PMR and the added risk to the mother with cesarean delivery, we advocate a policy of trial of scar with informed consent in selected cases.

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Section: Discussionsupporting

confidence: 84%

Delivery Following Cesarean Section and Perinatal Mortality

Meehan

Burke²,

Casey³

et al. 1989

Amer J Perinatol

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Planned elective repeat caesarean section versus planned vaginal birth for women with a previous caesarean birth

Dodd

Crowther

Huertas³

et al. 2004

Cochrane Database of Systematic Reviews

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Planned elective repeat caesarean section and planned vaginal birth after caesarean section for women with a prior caesarean birth are both associated with benefits and harms. Evidence for these care practices is drawn from non-randomised studies, associated with potential bias. Any results and conclusions must therefore be interpreted with caution. Randomised controlled trials are required to provide the most reliable evidence regarding the benefits and harms of both planned elective repeat caesarean section and planned vaginal birth for women with a previous caesarean birth.

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