Planned mode of birth after previous caesarean section and special educational needs in childhood: a population‐based record linkage cohort study

Fitzpatrick, Kathryn; Kurinczuk, Jennifer J; Quigley, Maria

doi:10.1111/1471-0528.16828

Cited by 5 publications

(5 citation statements)

References 37 publications

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“…Greater dilation and more favorable cervical conditions were also relevant factors in studies by Maroyi et al 29 in the Democratic Republic of Congo; Fitzpatrick et al 30 , in Scotland; and Mi et al 31 , in China. These studies included women from various nationalities, featuring diverse physical and social backgrounds, along with distinct obstetric cultures.…”

Section: Discussionmentioning

confidence: 84%

Características de mulheres com uma ou mais cesáreas anteriores no nascer no Brasil

Alvarenga,

Gama,

Nakamura-Pereira

2023

Rev. saúde pública

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OBJETIVO: Analisar descritivamente as parturientes brasileiras com cesariana anterior e apontar os fatores associados ao parto vaginal após cesárea (Vaginal Birht After Cesarean– VBAC) no Brasil. MÉTODOS: Foram utilizados dados de mulheres com uma, duas ou três e mais cesáreas da pesquisa Nascer no Brasil. As diferenças entre categorias foram avaliadas pelo teste de quiquadrado (χ2). As variáveis que apresentaram diferença significativa (< 0,05) foram incluídas em regressão logística. RESULTADOS: Do total de 23.894 mulheres, 20,9% tinham cesárea anterior. A maior parte (85,1%) foi submetida a outra cesárea, 75,5% antes do início do trabalho de parto. A porcentagem de VBAC foi de 14,9%, uma taxa de sucesso de 60,8%. Mulheres com três cesáreas ou mais apresentaram maior vulnerabilidade social. As chances de VBAC foram maiores entre aquelas decididas pelo parto vaginal no fim da gestação, com parto vaginal anterior, indução de parto, admitidas com mais de 4 centímetros de dilatação e sem companheiro. Assistência no sistema privado, ter duas cesáreas ou mais, complicações obstétricas e decisão por cesariana no final da gestação diminuíram as chances de VBAC. Faixa etária, escolaridade, adequação do pré-natal e razão da cesárea anterior não apresentaram diferença significativa. CONCLUSÃO: A maior parte das mulheres com cesárea anterior no Brasil é encaminhada para uma nova cirurgia, e o maior número de cesáreas está associado à maior iniquidade social. Os fatores associados ao VBAC foram decisão pelo parto vaginal no fim da gestação, parto vaginal anterior, maior dilatação cervical na internação, indução, atendimento no sistema público de saúde, ausência de complicações obstétricas e ausência de companheiro. São necessárias ações de estímulo ao VBAC, visando reduzir taxas globais de cesarianas e suas consequências para a saúde materno-infantil.

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Section: Discussionmentioning

confidence: 84%

Características de mulheres com uma ou mais cesáreas anteriores no nascer no Brasil

Alvarenga,

Gama,

Nakamura-Pereira

2023

Rev. saúde pública

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“…Twenty-eight were population-based studies ( 34 , 36 , 38 , 41 – 43 , 45 , 50 , 51 , 53 – 56 , 58 – 60 , 63 – 65 , 67 , 69 – 71 , 73 , 75 – 78 ), while 13 recruited subjects from a single ( 32 , 37 , 39 , 44 , 46 – 48 , 57 , 61 , 62 , 68 , 72 , 74 ) and six from multiple centers ( 33 , 35 , 40 , 49 , 52 , 66 ). Eighteen of the studies were conducted in mainland Europe ( 34 , 37 , 39 , 41 , 43 , 46 , 48 , 49 , 51 , 56 – 58 , 60 , 62 , 63 , 66 – 68 ), 10 in the United States ( 35 , 40 , 42 , 45 , 52 , 55 , 59 , 70 , 71 , 77 ), six in the United Kingdom ( 53 , 54 , 65 , 75 , 76 <...…”

Section: Resultsmentioning

confidence: 99%

“…Two population-based studies ( 54 , 76 ), both conducted in Scotland, were the only studies identified that assessed the effect of planned VBAC compared to ERCS on the child’s neurological development. One of the studies ( 54 ) reported that there was no significant difference in the risk of learning disability or cerebral palsy among around 8,000 singleton school-aged children born at term following a planned VBAC compared to an ERCS, although this study did find an increased risk of learning disability associated with repeat cesarean after an unsuccessful VBAC compared to successful VBAC (3.7% vs. 2.3%, aOR 1.64, 95% CI 1.17–2.29).…”

Section: Resultsmentioning

confidence: 99%

“…One of the studies (54) reported that there was no significant difference in the risk of learning disability or cerebral palsy among around 8,000 singleton school-aged children born at term following a planned VBAC compared to an ERCS, although this study did find an increased risk of learning disability associated with repeat cesarean after an unsuccessful VBAC compared to successful VBAC (3.7% vs. 2.3%, aOR 1.64, 95% CI 1.17-2.29). The other study (76) of nearly 45,000 children found little evidence of an association between planned mode of birth after previous cesarean section and special educational needs in childhood (age 4-11 years) beyond a small absolute increased risk of sensory impairment seen for planned VBAC with labor induction compared to ERCS (1.18% vs. 0.78%, aOR 1.60, 95% CI 1.09-2.34) that may be the result of performing multiple comparisons or residual confounding.…”

Section: Neurodevelopmentmentioning

confidence: 96%

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Planned mode of birth after previous cesarean section: A structured review of the evidence on the associated outcomes for women and their children in high-income setting

2022

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In many high-income settings policy consensus supports giving pregnant women who have had a previous cesarean section a choice between planning an elective repeat cesarean section (ERCS) or planning a vaginal birth after previous cesarean (VBAC), provided they have no contraindications to VBAC. To help women make an informed decision regarding this choice, clinical guidelines advise women should be counseled on the associated risks and benefits. The most recent and comprehensive review of the associated risks and benefits of planned VBAC compared to ERCS in high-income settings was published in 2010 by the US Agency for Healthcare Research and Quality (AHRQ). This paper describes a structured review of the evidence in high-income settings that has been published since the AHRQ review and the literature in high-income settings that has been published since 1980 on outcomes not included in the AHRQ review. Three databases (MEDLINE, EMBASE, and PsycINFO) were searched for relevant studies meeting pre-specified eligible criteria, supplemented by searching of reference lists. Forty-seven studies were identified as meeting the eligibility criteria and included in the structured review. The review suggests that while planned VBAC compared to ERCS is associated with an increased risk of various serious birth-related complications for both the mother and her baby, the absolute risk of these complications is small for either birth approach. The review also found some evidence that planned VBAC compared to ERCS is associated with benefits such as a shorter length of hospital stay and a higher likelihood of breastfeeding. The limited evidence available also suggests that planned mode of birth after previous cesarean section is not associated with the child’s subsequent risk of experiencing adverse neurodevelopmental or health problems in childhood. This information can be used to manage and counsel women with previous cesarean section about their subsequent birth choices. Collectively, the evidence supports existing consensus that there are risks and benefits associated with both planned VBAC and ERCS, and therefore women without contraindications to VBAC should be given an informed choice about planned mode of birth after previous cesarean section. However, further studies into the longer-term effects of planned mode of birth after previous cesarean section are needed along with more research to address the other key limitations and gaps that have been highlighted with the existing evidence.

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“…The existing evidence suggests that while planned VBAC compared to ERCS is associated with an increased risk of various serious birth-related complications for both the woman and her baby, the absolute risk of birth-related complications is small for either birth approach [ 9 – 12 ]. Also, while repeat cesarean section has been linked to an increased risk of maternal complications in subsequent pregnancies such as morbidly adherent placenta [ 10 ], we have recently found little evidence to support an association between planned mode of birth after previous cesarean section and special education needs in childhood, a marker of neurodevelopmental adversity in the child [ 13 ]. However, there remains a lack of evidence about the effect of this choice on other important long-term outcomes including women’s subsequent risk of experiencing pelvic floor disorders [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Planned mode of birth after previous cesarean section and risk of undergoing pelvic floor surgery: A Scottish population-based record linkage cohort study

et al. 2022

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Background The global rise in cesarean sections has led to increasing numbers of pregnant women with a history of previous cesarean section. Policy in many high-income settings supports offering these women a choice between planned elective repeat cesarean section (ERCS) or planned vaginal birth after previous cesarean (VBAC), in the absence of contraindications to VBAC. Despite the potential for this choice to affect women’s subsequent risk of experiencing pelvic floor disorders, evidence on the associated effects to fully counsel women is lacking. This study investigated the association between planned mode of birth after previous cesarean section and the woman’s subsequent risk of undergoing pelvic floor surgery. Methods and findings A population-based cohort study of 47,414 singleton term births in Scotland between 1983 to 1996 to women with 1 or more previous cesarean sections was conducted using linked Scottish national routine datasets. Cox regression was used to investigate the association between planned as well as actual mode of birth and women’s subsequent risk of having any pelvic floor surgery and specific types of pelvic floor surgery adjusted for sociodemographic, maternal medical, and obstetric-related factors. Over a median of 22.1 years of follow-up, 1,159 (2.44%) of the study population had pelvic floor surgery. The crude incidence rate of any pelvic floor surgery per 1,000 person-years was 1.35, 95% confidence interval (CI) 1.27 to 1.43 in the overall study population, 1.75, 95% CI 1.64 to 1.86 in the planned VBAC group and 0.66, 95% CI 0.57 to 0.75 in the ERCS group. Planned VBAC compared to ERCS was associated with a greater than 2-fold increased risk of the woman undergoing any pelvic floor surgery (adjusted hazard ratio [aHR] 2.38, 95% CI 2.03 to 2.80, p < 0.001) and a 2- to 3-fold increased risk of the woman having surgery for pelvic organ prolapse or urinary incontinence (aHR 3.17, 95% CI 2.47 to 4.09, p < 0.001 and aHR 2.26, 95% CI 1.79 to 2.84, p < 0.001, respectively). Analysis by actual mode of birth showed these increased risks were only apparent in the women who actually had a VBAC, with the women who needed an in-labor non-elective repeat cesarean section having a comparable risk of pelvic floor surgery to those who had an ERCS. The main limitation of this study is the potential for misclassification bias. Conclusions This study suggests that among women with previous cesarean section giving birth to a singleton at term, planned VBAC compared to ERCS is associated with an increased risk of the woman subsequently undergoing pelvic floor surgery including surgery for pelvic organ prolapse and urinary incontinence. However, these risks appear to be only apparent in women who actually give birth vaginally as planned, highlighting the role of vaginal birth rather than labor in pelvic floor dysfunction requiring surgery. The findings provide useful additional information to counsel women with previous cesarean section about the risks and benefits associated with their future birth choices.

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Planned mode of birth after previous caesarean section and special educational needs in childhood: a population‐based record linkage cohort study

Cited by 5 publications

References 37 publications

Características de mulheres com uma ou mais cesáreas anteriores no nascer no Brasil

Características de mulheres com uma ou mais cesáreas anteriores no nascer no Brasil

Planned mode of birth after previous cesarean section: A structured review of the evidence on the associated outcomes for women and their children in high-income setting

Planned mode of birth after previous cesarean section and risk of undergoing pelvic floor surgery: A Scottish population-based record linkage cohort study

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