Trial of labor after cesarean in the low-risk obstetric population: a retrospective nationwide cohort study

Stattmiller, S; Lavecchia, Melissa; Czuzoj‐Shulman, Nicholas; Spence, Andrea R.; Abenhaim, Haim A.

doi:10.1038/jp.2016.36

Cited by 12 publications

(26 citation statements)

References 28 publications

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“…However, significant heterogeneity was apparent among the mostly small single-center studies identified, and the AHRQ review regarded the strength of evidence on maternal infection overall to be low because of the variability in how infection was defined and because the evidence was considered to be indirect and to have a high risk of bias. Although a more recent population-based study conducted in the UK reported that the risk of severe maternal sepsis did not significantly differ with planned VBAC compared to ERCS [41], a large population-based study conducted in the US found an elevated risk of puerperal sepsis and major puerperal infection with planned VBAC [45], consistent with our overall findings. However, neither of these prior studies examined whether any associations were modified by prior vaginal delivery.…”

Section: Discussionsupporting

confidence: 89%

“…The AHRQ review [16] also found evidence that planned VBAC is associated with an increased risk of blood transfusion, but only when the meta-analysis was confined to the four identified studies of women delivered at term rather than any gestational age (pooled estimates: 0.7% for planned VBAC versus 0.5% for ERCS, RR 1.30, 95% CI 1.15–1.47). Since the AHRQ review, although a number of studies have found no significant difference in the risk of blood transfusion between women who had planned VBAC and those that had an ERCS [36,40,42,43], a few of the larger studies have reported an elevated risk of this outcome for planned VBAC [39,44,45].…”

Section: Discussionmentioning

confidence: 99%

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Planned mode of delivery after previous cesarean section and short-term maternal and perinatal outcomes: A population-based record linkage cohort study in Scotland

et al. 2019

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BackgroundPolicy consensus in high-income countries supports offering pregnant women with previous cesarean section a choice between planning an elective repeat cesarean section (ERCS) or attempting a vaginal birth, known as a planned vaginal birth after previous cesarean (VBAC), provided they do not have contraindications to planned VBAC. However, robust comprehensive information on the associated outcomes to counsel eligible women about this choice is lacking. This study investigated the short-term maternal and perinatal outcomes associated with planned mode of delivery after previous cesarean section among women delivering a term singleton and considered eligible to have a planned VBAC.Methods and findingsA population-based cohort of 74,043 term singleton births in Scotland between 2002 and 2015 to women with one or more previous cesarean sections was conducted using linked Scottish national datasets. Logistic or modified Poisson regression, as appropriate, was used to estimate the effect of planned mode of delivery on maternal and perinatal outcomes adjusted for sociodemographic, maternal medical, and obstetric-related characteristics. A total of 45,579 women gave birth by ERCS, and 28,464 had a planned VBAC, 28.4% of whom went on to have an in-labor nonelective repeat cesarean section. Compared to women delivering by ERCS, those who had a planned VBAC were significantly more likely to have uterine rupture (0.24%, n = 69 versus 0.04%, n = 17, adjusted odds ratio [aOR] 7.3, 95% confidence interval [CI] 3.9–13.9, p < 0.001), a blood transfusion (1.14%, n = 324 versus 0.50%, n = 226, aOR 2.3, 95% CI 1.9–2.8, p < 0.001), puerperal sepsis (0.27%, n = 76 versus 0.17%, n = 78, aOR 1.8, 95% CI 1.3–2.7, p = 0.002), and surgical injury (0.17% versus 0.09%, n = 40, aOR 3.0, 95% CI 1.8–4.8, p < 0.001) and experience adverse perinatal outcomes including perinatal death, admission to a neonatal unit, resuscitation requiring drugs and/or intubation, and an Apgar score < 7 at 5 minutes (7.99%, n = 2,049 versus 6.37%, n = 2,570, aOR 1.6, 95% CI 1.5–1.7, p < 0.001). However, women who had a planned VBAC were more likely than those delivering by ERCS to breastfeed at birth or hospital discharge (63.6%, n = 14,906 versus 54.5%, n = 21,403, adjusted risk ratio [aRR] 1.2, 95% CI 1.1–1.2, p < 0.001) and were more likely to breastfeed at 6–8 weeks postpartum (43.6%, n = 10,496 versus 34.5%, n = 13,556, aRR 1.2, 95% CI 1.2–1.3, p < 0.001). The effect of planned mode of delivery on the mother’s risk of having a postnatal stay greater than 5 days, an overnight readmission to hospital within 42 days of birth, and other puerperal infection varied according to whether she had any prior vaginal deliveries and, in the case of length of postnatal stay, also varied according to the number of prior cesarean sections. The study is mainly limited by the potential for residual confounding and misclassification bias.ConclusionsAmong women considered eligible to have a planned VBAC, planned VBAC compared to ERCS is associated with an increased risk ...

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Planned mode of delivery after previous cesarean section and short-term maternal and perinatal outcomes: A population-based record linkage cohort study in Scotland

et al. 2019

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“…In a low risk US population, New York state, 1998-2002, the TOLAC rate declined from 58.7% to 35.7% [19]. In Canada, a TOLAC rate of 21% has been reported in low risk pregnancies [20].…”

Section: Discussionmentioning

confidence: 98%

Low risk pregnancies after a cesarean section: Determinants of trial of labor and its failure

et al. 2020

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in women with less than 11 years of education, and in women of non-western origin. The effects of health system factors, i.e. delivery unit size and administrative region were considerable, on both TOLAC and TOLAC failure. The effects of several determinants changed significantly (P < 0.05) from 1989-2002 to 2003-2014: The association between non-TOLAC and maternal age > 39 years became weaker, the association between short education and TOLAC failure became stronger, and the association between TOLAC failure and small size of delivery unit became stronger. ConclusionLow maternal age, high education, and western country of origin were associated with high TOLAC rates, and low TOLAC failure rates. Maternity unit characteristics (size and region) contributed with effects on the same level as individual determinants studied. Temporal changes were observed in determinant effects.public-health/opening-hours-employeesaddresses/.

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“…This finding suggests that the reduction in women undergoing TOLAC does not reflect improved selection of patients for VBAC [3,13]. Success rates for TOLAC range from 28 to 85% [3,[14][15][16] and are higher for women with a previous CS for nonrecurring indications, such as breech presentation, and for women with a previous vaginal birth [17][18][19][20]. Furthermore, TOLAC is supported by obstetrical best practice guidelines in numerous countries [7,9,11,21].…”

Section: Introductionmentioning

confidence: 99%

Factors obstetricians, family physicians and midwives consider when counselling women about a trial of labour after caesarean and planned repeat caesarean: a qualitative descriptive study

Landy

Sword

Kathnelson

et al. 2020

BMC Pregnancy Childbirth

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Background: Repeat caesarean sections (CSs) are major contributors to the high rate of CS in Canada and globally. Women's decisions to have a planned repeat CS (PRCS) or a trial of labour after CS (TOLAC) are influenced by their maternity care providers. This study explored factors maternity care providers consider when counselling pregnant women with a previous CS, eligible for a TOLAC, about delivery method. Methods: A qualitative descriptive design was implemented. Semi-structured, one-to-one in-depth telephone interviews were conducted with 39 maternity care providers in Ontario, Canada. Participants were recruited at 2 maternity care conferences and with the use of snowball sampling. Interviews were audio recorded and transcribed verbatim. Data were uploaded into the data management software, NVIVO 10.0 and analyzed using qualitative content analysis. Results: Participants consisted of 12 obstetricians, 13 family physicians and 14 midwives. Emergent themes, reflecting the factors maternity care providers considered when counselling on mode of delivery, were organized under the categories clinical/patient factors, health system factors and provider preferences. Maternity care providers considered clinical/patient factors, including women's choice … with conditions, their assessment of women's chances of a successful TOLAC, their perception of women's risk tolerance, women's preferred delivery method, and their perception of women's beliefs and attitudes about childbirth. Additionally, providers considered health system factors which included colleague support for TOLAC and time needed to mount an emergency CS. Finally, provider factors emerged as considerations when counselling. They included provider preference for PRCS or TOLAC, provider scope of practice, financial incentives and convenience related to PRCS, past experiences with TOLAC and PRCS and providers' perspectives on risk of TOLAC. Conclusion: The findings highlight the multiplicity of factors maternity care providers consider when counselling women. Effectively addressing clinical, health care system and personal factors that influence counselling may help decrease nonmedically indicated PRCS.

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Trial of labor after cesarean in the low-risk obstetric population: a retrospective nationwide cohort study

Abstract: Although these outcomes remain rare, low-risk women undergoing a TOL remain at increased risk of adverse maternal events as compared with those who chose elective repeat cesarean delivery.

Cited by 12 publications

References 28 publications

Planned mode of delivery after previous cesarean section and short-term maternal and perinatal outcomes: A population-based record linkage cohort study in Scotland

Planned mode of delivery after previous cesarean section and short-term maternal and perinatal outcomes: A population-based record linkage cohort study in Scotland

Low risk pregnancies after a cesarean section: Determinants of trial of labor and its failure

Factors obstetricians, family physicians and midwives consider when counselling women about a trial of labour after caesarean and planned repeat caesarean: a qualitative descriptive study

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