Vaginal birth after Caesarean section: an Australian multicentre study

Appleton, Bill; Targett, Christopher; Rasmussen, Michael; Readman, Emma; Sale, Fiona; Permezel, Michael

doi:10.1111/j.1479-828x.2000.tb03175.x

Cited by 48 publications

(30 citation statements)

References 14 publications

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“…14 There are variations in the reported incidence of scar rupture across units. Large studies in Scotland (n=35,854) 7 and Australia (n=21,452) 13 reported uterine rupture rates of 0.35% and 0.3%, respectively. A large study 8 (n=20,095) in the United States gave a scar rupture rate of 0.52% among women with spontaneous onset of labour (relative risk compared with elective CS, 3.3; 95% confidence interval, 1.8 to 6.0).The true incidence of scar rupture could be difficult to ascertain: some ruptures will pass undetected, and what some would call a rupture others may classify as a 'dehiscence', and this word is not always taken as synonymous with rupture.…”

Section: Risk Of Scar Rupturementioning

confidence: 97%

“…This is not a risk that materializes often, but when it happens the woman may suffer massive bleeding, blood transfusion, loss of her womb or compromised reproductive future, and the baby may die or suffer hypoxic brain injury. 13 These are serious complications that the woman should be warned of well in advance. 14 There are variations in the reported incidence of scar rupture across units.…”

Section: Risk Of Scar Rupturementioning

confidence: 99%

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Vaginal birth after Caesarean section: what information should women be given?

Edozien¹

2007

Clinical Risk

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at the expense of a vast number of unnecessary Caesarean sections. Also since the absolute risks of rupture and other severe complications of VBAC are low, large trials are needed in order to detect differences in the incidence of these complications. The results of the Australian Collaborative Trial of Birth After Caesarean (ACTOBAC) are awaited but it must be noted that this trial was conducted in the face of concerns by consumer groups about the ethics of randomly assigning healthy women with uncomplicated pregnancies to major surgery (for example, see http://www.canaustralia.net/advocacy.htm).In the absence of evidence from random-allocation trials we must base our practice, and the information we provide to women, on what we know from non-randomized cohort studies. A trial of vaginal delivery will be successful in three of every four women and should be encouraged, but it also carries a risk -scar rupture -that women should know about. Also, women opting for VBAC should have the confidence that their obstetric unit has measures in place to minimise the chance of this risk materialising.Unfortunately, it appears that while most units have protocols or guidelines for CS, few have one for VBAC. Studies 9,10 have shown that women often differ from doctors in their choice, and the reasons behind it, of method of delivery after CS, and it has been emphasized that '[p]atient preference cannot be ignored in the delivery equation'. 11 Nevertheless discussion of VBAC, and documentation of same, at the booking appointment and during pregnancy often appears perfunctory.VBAC is an intervention for which specific and valid consent has to be obtained. This means that the woman should be informed of the benefits and success rate but also of the risk. The alternative, an elective CS, should be discussed. In communicating risk, cognizance should be taken of the woman's reproductive history; generally, the success rate of VBAC is higher and risk of scar rupture lower if the woman has had a previous vaginal delivery.Service users also want to be informed of warning signs in labour during VBAC, the philosophy and policies of hospital and staff, and strategies to improve chances of success. 12 AbstractWith rising Caesarean section (CS) rates, more women are having to consider the choice between an elective CS and a vaginal delivery (VBAC) in their subsequent pregnancy. This paper argues that there is an unmet need for clinicians to provide sufficient information to women in this position, so that the woman's choice can be an informed one. Consent should be evidence-based, but there are currently no published random-allocation studies comparing VBAC with elective repeat CS. However the available evidence could be better used by clinicians to facilitate informed choice.

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Section: Risk Of Scar Rupturementioning

confidence: 97%

Section: Risk Of Scar Rupturementioning

confidence: 99%

Vaginal birth after Caesarean section: what information should women be given?

Edozien¹

2007

Clinical Risk

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“…The incidence of uterine rupture is 0.2-1.5% in women who attempt labor after a transverse lower uterine segment incision [14,16,18,27,45] and 1-1.6% in women who have had a vertical incision in the lower uterine segment [46][47][48][49]. The risk is 4-9% with a classical or bTQ incision; thus TOL after Caesarean is contraindicated in these situations [16,19,30].…”

Section: Uterine Rupturementioning

confidence: 93%

“…Several other smaller studies reported that it appeared to be safe, effective, and not associated with an increased risk of uterine rupture [45,[64][65][66].…”

Section: Inductionmentioning

confidence: 95%

Guidelines for vaginal birth after previous caesarean birth

Lalonde¹

2005

Intl J Gynecology & Obste

121

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“…As recently as 2000, the Australian vaginal birth after caesarean section (VBAC) study group found that only one quarter of women with a previous caesarean scar had a vaginal delivery. 37 This is despite the known low risk of uterine rupture in VBACs. As noted by Robson and de Costa, the issue of offering a trial vaginal delivery after a previous caesarean section '... illustrates beautifully the essential tension between evidence-based practice and patient choice and autonomy'.…”

Section: The Twentieth Century and Beyondmentioning

confidence: 96%

A history of caesarean section: From ancient world to the modern era

Todman¹

2007

Aust NZ J Obst Gynaeco

102

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Caesarean section has been recorded in history since ancient times in both Western and non-Western literature. Although the first use of the term in obstetrics was from the seventeenth century, its early history is obscured by mythology. The origin of the term caesarean is believed to be from the birth of Julius Caesar; however, this is unlikely considering his mother Aurelia Cotta lived for many years afterwards. In ancient times, it was performed only when the woman was dead or dying as an attempt to rescue the fetus. With few exceptions, this was the pattern until the era of anaesthesia in the nineteenth century. Developments in surgical technique from the later nineteenth century and through the twentieth century have refined the procedure, with resulting low morbidity and mortality. As a consequence, the objectives of caesarean section have evolved from rescuing the fetus or for cultural or religious reasons towards concerns for the safety of mother and child as well as considering the mother's preferences.

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Vaginal birth after Caesarean section: an Australian multicentre study

Cited by 48 publications

References 14 publications

Vaginal birth after Caesarean section: what information should women be given?

Vaginal birth after Caesarean section: what information should women be given?

Guidelines for vaginal birth after previous caesarean birth

A history of caesarean section: From ancient world to the modern era

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