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

Dodd, Jodie M; Crowther, Caroline A; Huertas, Erasmo; Guise, Jeanne‐Marie; Horey, Dell

doi:10.1002/14651858.cd004224.pub2

Cited by 56 publications

(54 citation statements)

References 53 publications

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“…This large retrospective Australian study confirmed the findings of many studies that the lowest risk for uterine rupture occurs among women with no labour (0-0.2% generally but 1.9% in one meta-analysis of studies in the 1980s), and risks are higher for a trial of labour (0.3-2.1%, with higher risks in earlier years 4,[12][13][14][15][16][17] (Table 2). Our study found lower absolute risks for uterine rupture than the study by Lydon-Rochelle et al…”

Section: Discussionsupporting

confidence: 85%

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Risk of uterine rupture in Australian women attempting vaginal birth after one prior caesarean section: a retrospective population‐based cohort study

Dekker

Chan

Luke

et al. 2010

BJOG

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Objective Higher risks of uterine rupture have been reported among women attempting vaginal birth after caesarean (VBAC) particularly following induction with prostaglandins, compared with women who do not labour. This study aimed to estimate these risks as well as that associated with oxytocin use.Design Population-based retrospective cohort study involving all women who had their first births by caesarean. In their second birth, risks of uterine rupture among women without labour and women who had labour augmented or induced were compared with women who gave birth after spontaneous labour.Setting Four Australian states in 1998-2000.Population Women on pregnancy outcome databases with a second birth after a prior caesarean for their first birth.Methods From 29 008 women identified from the databases, those with uterine rupture were identified and validated using hospital case records.Main outcome measure Uterine rupture.Results The risk of complete uterine rupture among women without labour was 0.01%. The risk in spontaneous labour without augmentation was 0.15%, considerably higher when there was augmentation with oxytocin (1.91%). The risk with induction of labour was 0.54% for oxytocin alone, 0.68% for prostaglandin alone, 0.63% without either and 0.88% when they were combined. Compared with spontaneous labour, risks were increased three-to five-fold for any induction, six-fold for prostaglandin combined with oxytocin and 14-fold for augmentation with oxytocin.Conclusions Careful consideration should be given to the use of oxytocin for augmentation of labour or induction by any method for women with a previous caesarean in view of increased risks of uterine rupture.Keywords Uterine rupture, vaginal birth after caesarean.Please cite this paper as: Dekker G, Chan A, Luke C, Priest K, Riley M, Halliday J, King J, Gee V, O'Neill M, Snell M, Cull V, Cornes S. Risk of uterine rupture in Australian women attempting vaginal birth after one prior caesarean section: a retrospective population-based cohort study.

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Section: Discussionsupporting

confidence: 85%

“…The recent Cochrane reviews by Dodd et al 12,13 concluded that no randomised controlled trials had been completed up to 2006.…”

Section: Discussionmentioning

confidence: 99%

Risk of uterine rupture in Australian women attempting vaginal birth after one prior caesarean section: a retrospective population‐based cohort study

Dekker

Chan

Luke

et al. 2010

BJOG

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“…Women with a previous caesarean delivery have generally been encouraged to attempt a trial of labour in subsequent pregnancies, 69 but recent reports of an increased risk of morbidity, particularly owing to uterine rupture, are thought to have contributed to a marked decrease in some countries in the number of women attempting vaginal birth after caesarean section. 70 …”

Section: Hellp/ellp Syndromementioning

confidence: 99%

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Knight

Acosta

Brocklehurst

et al. 2016

Programme Grants Appl Res

101

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BackgroundStudies of maternal mortality have been shown to result in important improvements to women’s health. It is now recognised that in countries such as the UK, where maternal deaths are rare, the study of near-miss severe maternal morbidity provides additional information to aid disease prevention, treatment and service provision.ObjectivesTo (1) estimate the incidence of specific near-miss morbidities; (2) assess the contribution of existing risk factors to incidence; (3) describe different interventions and their impact on outcomes and costs; (4) identify any groups in which outcomes differ; (5) investigate factors associated with maternal death; (6) compare an external confidential enquiry or a local review approach for investigating quality of care for affected women; and (7) assess the longer-term impacts.MethodsMixed quantitative and qualitative methods including primary national observational studies, database analyses, surveys and case studies overseen by a user advisory group.SettingMaternity units in all four countries of the UK.ParticipantsWomen with near-miss maternal morbidities, their partners and comparison women without severe morbidity.Main outcome measuresThe incidence, risk factors, management and outcomes of uterine rupture, placenta accreta, haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, severe sepsis, amniotic fluid embolism and pregnancy at advanced maternal age (≥ 48 years at completion of pregnancy); factors associated with progression from severe morbidity to death; associations between severe maternal morbidity and ethnicity and socioeconomic status; lessons for care identified by local and external review; economic evaluation of interventions for management of postpartum haemorrhage (PPH); women’s experiences of near-miss maternal morbidity; long-term outcomes; and models of maternity care commissioned through experience-led and standard approaches.ResultsWomen and their partners reported long-term impacts of near-miss maternal morbidities on their physical and mental health. Older maternal age and caesarean delivery are associated with severe maternal morbidity in both current and future pregnancies. Antibiotic prescription for pregnant or postpartum women with suspected infection does not necessarily prevent progression to severe sepsis, which may be rapidly progressive. Delay in delivery, of up to 48 hours, may be safely undertaken in women with HELLP syndrome in whom there is no fetal compromise. Uterine compression sutures are a cost-effective second-line therapy for PPH. Medical comorbidities are associated with a fivefold increase in the odds of maternal death from direct pregnancy complications. External reviews identified more specific clinical messages for care than local reviews. Experience-led commissioning may be used as a way to commission maternity services.LimitationsThis programme used observational studies, some with limited sample size, and the possibility of uncontrolled confounding cannot be excluded.ConclusionsImplementation of the findings of this research could prevent both future severe pregnancy complications as well as improving the outcome of pregnancy for women. One of the clearest findings relates to the population of women with other medical and mental health problems in pregnancy and their risk of severe morbidity. Further research into models of pre-pregnancy, pregnancy and postnatal care is clearly needed.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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“…Only two prospective cohort studies and no randomised controlled trials were identified comparing the VBAC vs ERCD for women with a single prior C-delivery. Hence, there is a paucity of quality information available to assist women and their caregivers regarding the optimal mode of birth [8]. Added to this, no single individual or combination of factors in antenatal or the early intra-partum period are sufficiently sensitive or specific for clinical prediction of UR in women undergoing TOL after one prior C-delivery [121].…”

Section: Decision Making About Mode Of Deliverymentioning

confidence: 99%

“…Planned ERCD and planned vaginal birth for women with a prior C-delivery are both associated with benefits and harms. Until randomised controlled trials are undertaken, the current evidence drawn from non-randomised controlled trials should be interpreted with caution [8].…”

Section: Introductionmentioning

confidence: 99%

Current evidence in the management of previous caesarean section: clinical review

Muppala

Najia

2007

Eur Clinics Obstet Gynaecol

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The safety of women undergoing childbirth with prior caesarean delivery is a major public health concern. Most of the earlier studies focused on the success rate of vaginal birth after caesarean section; later focus shifted to maternal and neonatal safety, and presently, each factor that would influence the outcome of trial of labour is being considered on both the success and the safety of vaginal birth following caesarean delivery. The contribution of induction of labour to uterine rupture is not entirely clear. Although large multi-center randomised trials comparing planned elective repeat caesarean delivery vs vaginal delivery following prior caesarean delivery are required for conclusive evidence; current evidence suggests that, in properly selected women, vaginal birth can be safely achieved if adequate facilities to monitor the foetus and immediate caesarean can be performed. Unbiased evidence-based information should be given to patients in making decisions about mode of delivery based on individual characteristics. The purpose of this review is to understand each factor that would influence the success and safety of vaginal birth after caesarean delivery.

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

Cited by 56 publications

References 53 publications

Risk of uterine rupture in Australian women attempting vaginal birth after one prior caesarean section: a retrospective population‐based cohort study

Risk of uterine rupture in Australian women attempting vaginal birth after one prior caesarean section: a retrospective population‐based cohort study

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Current evidence in the management of previous caesarean section: clinical review

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