Delivery After Prior Cesarean: Maternal Morbidity and Mortality (original) (raw)
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Trends in cesarean birth and vaginal birth after previous cesarean, 1991-99
National Vital Statistics Reports from the Centers For Disease Control and Prevention National Center For Health Statistics National Vital Statistics System, 2001
OBJECTIVES: This report presents trends in rates of cesarean delivery and rates of vaginal birth after previous cesarean (VBAC) delivery for 1991-99. Data for the United States showing trends by maternal age, race/ethnicity, and State are presented. Also trends in cesarean rates by selected maternal characteristics, medical risk factors, and complications of labor and/or delivery are shown. A brief explanation of the Healthy People 2010 objective regarding cesarean and VBAC rates for low-risk women is also included. Summary statistics for 2000 based on preliminary data are also included, but most tabular and text information is based on detailed final statistics for 1999.METHODS: Cesarean and VBAC rates were computed based on the information reported on birth certificates.RESULTS: The U.S. cesarean rate dropped 8 percent between 1991 and 1996 (from 22.6 to 20.7 per 100 births) but then increased 6 percent between 1996 and 1999 (to 22.0); preliminary data show that the rate increased again by 4 percent between 1999 and 2000 (to 22.9). The decline between 1991 and 1996 was present for women of all ages but was most pronounced for those under 30 years of age. The decline was greatest for non-Hispanic white women, 10 percent, compared with a 7-percent decline for Hispanic women and only a 1-percent decline for non-Hispanic black women. All groups experienced increases in cesarean rates of about 6 to 7 percent between 1996 and 1999. The increase in cesarean rates between 1996 and 1999 was greatest for women 30 years of age and over. The VBAC rate increased 33 percent between 1991 and 1996 (from 21.3 to 28.3 per 100 births to women with a previous cesarean) but then fell 17 percent between 1996 and 1999 (to 23.4). The dramatic increase in VBAC rates between 1991 and 1996, followed by the subsequent decline, was experienced by women of all ages and for each major race/ethnicity group. Similar trends in cesarean rates were present for nearly all States and for most medical risk factors and complications of labor and/or delivery.
Clinics in Perinatology, 2011
In 2008, approximately 1.4 million women in the United States had a cesarean delivery, representing 32.3% of all births. 1 Cesarean delivery continues to be the most common major surgical procedure for women in the United States. 2 In addition, because of increases in primary cesarean delivery, an increasing number of US women approach birth having already had at least 1 previous cesarean delivery. This article examines the trends and patterns in total, primary, and repeat cesarean deliveries, in vaginal birth after cesarean (VBAC), and in the percentage of women who have had a prior cesarean.
Birth After Previous Cesarean Delivery: Short-Term Maternal Outcomes
Seminars in Perinatology, 2010
An estimated 40% of the 1.3 million cesarean deliveries performed each year in the United States are repeat procedures. The appropriate clinical management approach for women with previous cesarean delivery remains challenging because options are limited. The risks and benefits of clinical management choices in the woman's health need to be quantified. Thus, we discuss the available published scientific data on (1) the short-term maternal outcomes of trial of labor after cesarean and elective repeat cesarean delivery, (2) the differences between outcomes for both, (3) the important factors that influence these outcomes, and (4) successful vs. unsuccessful vaginal birth after cesarean. For women with a previous cesarean delivery, a successful trial of labor offers several distinct, consistently reproducible advantages compared with elective repeat cesarean delivery, including fewer hysterectomies, fewer thromboembolic events, lower blood transfusion rates, and shorter hospital stay. However, when trial of labor after cesarean fails, emergency cesarean is associated with increased uterine rupture, hysterectomy, operative injury, blood transfusion, endometritis, and longer hospital stay. Care of women with a history of previous cesarean delivery involves a confluence of interactions between medical and nonmedical factors; however, the most important determinants of the short-term outcomes among these women are likely individualized counseling, accurate clinical diagnoses, and careful management during a trial of labor. We recommend a randomized controlled trial among women undergoing a TOLAC and a longitudinal cohort study among women with previous cesarean to evaluate adverse outcomes, with focused attention on both mother and the infant.
Labor Outcomes With Increasing Number of Prior Vaginal Births After Cesarean Delivery
Obstetrics & Gynecology, 2008
OBJECTIVE: To estimate the success rates and risks of an attempted vaginal birth after cesarean delivery (VBAC) according to the number of prior successful VBACs. METHODS: From a prospective multicenter registry collected at 19 clinical centers from 1999 to 2002, we selected women with one or more prior low transverse cesarean deliveries who attempted a VBAC in the current pregnancy. Outcomes were compared according to the number of prior VBAC attempts subsequent to the last cesarean delivery. RESULTS: Among 13,532 women meeting eligibility criteria, VBAC success increased with increasing number of prior VBACs: 63.3%, 87.6%, 90.9%, 90.6%, and 91.6% for those with 0, 1, 2, 3, and 4 or more prior VBACs, respectively (P<.001). The rate of uterine rupture decreased after the first successful VBAC and did not increase thereafter: 0.87%, 0.45%, 0.38%, 0.54%, 0.52% (P.)30.؍ The risk of uterine dehiscence and other peripartum complications also declined statistically after the first successful VBAC. No increase in neonatal morbidities was seen with increasing VBAC number thereafter. CONCLUSION: Women with prior successful VBAC attempts are at low risk for maternal and neonatal complications during subsequent VBAC attempts. An increasing number of prior VBACs is associated with a greater probability of VBAC success, as well as a lower risk of uterine rupture and perinatal complications in the current pregnancy.
Delivery after previous cesarean: a risk evaluation
Obstetrics & Gynecology, 1999
Objective: To examine the risks of vaginal delivery after previous cesarean and to find criteria to help decide whether a trial of labor or an elective repeat cesarean should be preferred. Methods: We evaluated 29,046 deliveries after previous cesarean registered in a pooled database of 457,825 deliveries used to assess quality control in gynecology and obstetrics departments in Switzerland. Results: Among the 17,613 trial-of-labor cases logged (attempt rate 60.64%), the success rate was 73.73% (65.56% after inducing labor and 75.06% after the spontaneous onset of labor). The following complications were significantly more frequent in the previous-cesarean group: maternal febrile episodes (relative risk [RR] 2.77; 95% confidence interval [CI] 2.52, 3.05), thromboembolic events (RR 2.81; CI 2.23, 3.55), bleeding due to placenta previa during pregnancy (RR 2.06; CI 1.70, 2.49), uterine rupture (92 cases; RR 42.18; CI 31.09, 57.24), and perinatal mortality (118 cases, including six associated with uterine rupture; RR 1.33; CI 1.10, 1.62). The postcesarean group also showed a 0.28% rate of peripartum hysterectomy (81 cases; RR 6.07; CI 4.71, 7.83). There was one maternal death in the group, compared with 14 maternal deaths in the group without previous cesarean (no statistical significance). The risk of uterine rupture for patients with previous cesareans was elevated in the trial-of-labor group compared with the group without trial of labor (RR 2.07; CI 1.29, 3.30), but all other maternal risks, including peripartum hysterectomy (RR 0.36; CI 0.23, 0.56), were lower. When comparing the women having a trial of labor, the 70 with uterine rupture more often had induced labor (24.29% compared with 13.92% in the nonrupture group; P ؍ ؍ ؍ .013), had epidural anesthesia (24.29% compared with 8.44%; P < < < .001), had an abnormal fetal heart rate tracing (32.86% compared with 8.53%; P < < < .001), and had failure to progress (21.43% compared with 7.98%; P ؍ ؍ ؍ .001). Conclusion: A history of cesarean delivery significantly elevates the risks for mother and child in future deliveries. Nonetheless, a trial of labor after previous cesarean is safe. Induction of labor, epidural anesthesia, failure to progress, and abnormal fetal heart rate pattern are all associated with failure of a trial of labor and uterine rupture.
Obstetric outcomes in women with two prior cesarean deliveries undergoing a trial of labor
American Journal of Obstetrics and Gynecology, 2003
Objective: This study was undertaken to compare clinical outcomes in women with 1 versus 2 prior cesarean deliveries who attempt vaginal birth after cesarean delivery (VBAC) and also to compare clinical outcomes of women with 2 prior cesarean deliveries who attempt VBAC or opt for a repeat cesarean delivery. Study design: We performed a secondary analysis of a retrospective cohort study, in which the medical records of more than 25,000 women with a prior cesarean delivery from 16 community and tertiary care hospitals were reviewed by trained nurse abstractors. Information on demographics, obstetric history, medical and social history, and the outcomes of the index pregnancy was obtained. Comparisons of obstetric outcomes were made between women with 1 versus 2 prior cesarean deliveries, and also between women with 2 prior cesarean deliveries who opt for VBAC attempt versus elective repeat cesarean delivery. Both bivariate and multivariate techniques were used for these comparisons. Results: The records of 20,175 women with one previous cesarean section and 3,970 with 2 prior cesarean sections were reviewed. The rate of VBAC success was similar in women with a single prior cesarean delivery (75.5%) compared with those with 2 prior cesarean deliveries (74.6%), though the odds of major morbidity were higher in those with 2 prior cesarean deliveries (adjusted odd ratio[OR] = 1.61 95% CI 1.11-2.33). Among women with 2 prior cesarean deliveries, those who opt for a VBAC attempt had higher odds of major complications compared with those who opt for elective repeat cesarean delivery (adjusted OR = 2.26, 95% CI 1.17-4.37). Conclusion: The likelihood of major complications is higher with a VBAC attempt in women with 2 prior cesarean deliveries compared with those with a single prior cesarean delivery. In women with 2 prior cesarean deliveries, while major complications are increased in those who
Vaginal delivery following one previous cesarean birth: nation wide survey
Asia-Oceania journal of obstetrics and gynaecology / AOFOG, 1990
The present state of vaginal delivery following a previous cesarean section (CS) was evaluated through a nation wide survey, including 22,815 deliveries. The overall cesarean rate was 9.6%. Of all the parturients with one previous cesarean section 55.1% delivered vaginally. A previous CS and labor arrest were the major indications for a repeated CS in 28.7% and 26.4%, respectively. Rupture of the uterus following vaginal delivery was found more often in the group with a previous CS than in those with no uterine scar (1.2% and 0.03%, respectively), (P less than 0.0001). None of the uterine ruptures was fatal neither to the mother nor to the fetus. Post partum fever appeared more often among vaginal deliveries following a CS than among those with no uterine scar. However, CS is followed by fever 10.8 times more than vaginal delivery. Intrapartum and neonatal death rates following vaginal delivery were similar for those with or without a previous CS (3.42% and 3.38%, respectively). An ...
Cesarean Delivery: Background, Trends, and Epidemiology
Seminars in Perinatology, 2006
OBJECTIVE To examine trends in cesarean delivery for the overall population and for women with "no indicated risk" for cesarean section, and to summarize the available literature on "maternal request" cesarean deliveries. FINDINGS Nearly 3 in 10 births were delivered by cesarean section in 2004 (29.1%), the highest rate ever reported in the United States. The overall rate has increased by over 40% since 1996, reflecting two concurrent trends: an increase in the primary rate (14.6% to 20.6%), and a steep decline in the rate of vaginal birth after cesarean (28.3% to 9.2%). There has been a clear increase in primary cesarean delivery without a medical or obstetrical indication, and studies using hospital discharge data or birth certificate data estimate the rate of primary cesarean deliveries with no reported medical or obstetrical indication to be between 3% and 7% of all deliveries to women who had not had a previous cesarean delivery. However, these studies contain no direct information on whether these cesareans were the result of maternal request or because of physician recommendation. There was little data to support the contention that the rise in the cesarean rate was the result of maternal request. CONCLUSION There are no systematic data available on cesarean delivery by "maternal request." However, the rate of primary cesarean delivery is increasing rapidly for women of all ages, races, and medical conditions, as well as for births at all gestational ages. Since a first cesarean section virtually guarantees that subsequent pregnancies will be cesarean deliveries (the repeat cesarean delivery rate is now almost 91%), research is needed on physician practice patterns, maternal attitudes, clinical outcomes for mother and infant (harms, benefits), and clinical and nonclinical factors (institutional, legal, economic) that affect the decision to have a cesarean delivery. Semin Perinatol 30:235-241.
Data Revues 00029378 V192i4 S000293780500058x, 2011
Objective: This study was undertaken to compare clinical outcomes in women with 1 versus 2 prior cesarean deliveries who attempt vaginal birth after cesarean delivery (VBAC) and also to compare clinical outcomes of women with 2 prior cesarean deliveries who attempt VBAC or opt for a repeat cesarean delivery. Study design: We performed a secondary analysis of a retrospective cohort study, in which the medical records of more than 25,000 women with a prior cesarean delivery from 16 community and tertiary care hospitals were reviewed by trained nurse abstractors. Information on demographics, obstetric history, medical and social history, and the outcomes of the index pregnancy was obtained. Comparisons of obstetric outcomes were made between women with 1 versus 2 prior cesarean deliveries, and also between women with 2 prior cesarean deliveries who opt for VBAC attempt versus elective repeat cesarean delivery. Both bivariate and multivariate techniques were used for these comparisons. Results: The records of 20,175 women with one previous cesarean section and 3,970 with 2 prior cesarean sections were reviewed. The rate of VBAC success was similar in women with a single prior cesarean delivery (75.5%) compared with those with 2 prior cesarean deliveries (74.6%), though the odds of major morbidity were higher in those with 2 prior cesarean deliveries (adjusted odd ratio[OR] = 1.61 95% CI 1.11-2.33). Among women with 2 prior cesarean deliveries, those who opt for a VBAC attempt had higher odds of major complications compared with those who opt for elective repeat cesarean delivery (adjusted OR = 2.26, 95% CI 1.17-4.37). Conclusion: The likelihood of major complications is higher with a VBAC attempt in women with 2 prior cesarean deliveries compared with those with a single prior cesarean delivery. In women with 2 prior cesarean deliveries, while major complications are increased in those who