Rate of spontaneous onset of labour before planned repeat caesarean section at term (original) (raw)
Related papers
Background: There is evidence that induction of labour (IOL) around term reduces perinatal mortality and caesarean delivery rates when compared to expectant management of pregnancy (allowing the pregnancy to continue to await spontaneous labour or definitive indication for delivery). However, it is not clear whether IOL in women with a previous caesarean section confers the same benefits. The aim of this study was to describe outcomes of IOL at 39-41 weeks in women with one previous caesarean delivery and to compare outcomes of IOL or planned caesarean delivery to those of expectant management.
Public Health Research & Practice, 2016
Objective: To explore variation in public hospital rates of early (37−38 weeks gestation) prelabour repeat caesarean section among low-risk women at and beyond term in New South Wales (NSW) between 2008 and 2011. Importance of the study: A NSW Ministry of Health policy directive for public hospitals (PD2007_024), 'Maternity − timing of elective or pre-labour caesarean section', requires that low-risk elective or prelabour caesarean section does not occur before 39 completed weeks gestation. However, compliance with this policy has not been evaluated. Study type: Population-based record linkage study Methods: Linked birth and hospital data for low-risk, prelabour repeat caesarean sections in NSW in 2008−2011 were analysed using multilevel regression modelling. Rates were adjusted for casemix and hospital factors. Low-risk pregnancies were defined as singleton live births at 37−42 weeks gestation among women without medical or obstetric complications and where the indication for caesarean section was 'elective repeat caesarean section'. Results: In 2008−2011, there were 15 163 prelabour repeat caesarean sections among low-risk women in NSW. Overall, 34.7% of low-risk prelabour repeat caesarean sections occurred before 39 weeks gestation. Adjusted NSW public hospital rates of early (37−38 weeks gestation) low-risk prelabour repeat caesarean section varied widely (16.3−67.5%). Adjusting for casemix factors actually increased the between-hospital variation by 4.3%; adjusting for hospital factors reduced variation by 20.0%. Smoking, private healthcare, assisted reproductive technology use, higher parity, a noncaesarean uterine scar and delivering in a hospital with CPAP (continuous positive airway pressure) facilities were associated with higher odds of early delivery, although infants that were small for gestational age were associated with lower odds. Hospitals with higher rates of low-risk deliveries and higher propensity for vaginal birth after caesarean section had lower odds of early delivery.
International journal of epidemiology, 2005
Background There has been an escalation in Caesarean section rates globally. Numerous prenatal factors have been associated with elective and emergency Caesarean section, some of which may be amenable to change. Methods A population-based cohort of 12 944 singleton, liveborn, term pregnancies were used to investigate risk factors for Caesarean section using multivariable logistic regression modelling. Numerous prenatal factors were investigated for their associations with the following outcomes: first, with Caesarean section (both elective and emergency) compared with vaginal delivery (spontaneous and assisted); second, for their associations with elective Caesarean section compared with attempted vaginal delivery; and finally emergency Caesarean section compared with spontaneous vaginal delivery. Results 11 791 women had vaginal delivery and 1153 had Caesarean section (685 emergency, 468 elective). Non-cephalic (breech) presentation (all Caesareans odds ratio (OR) 36.6, 95% confidence interval (CI) 26.8-50.0; elective Caesarean OR 86.4, 95% CI 58.5-127.8; emergency Caesarean OR 9.58, 95% CI 6.06-15.1) and previous Caesarean section (all Caesareans OR 27.8, 95% CI 20.9-37.0, elective Caesarean OR 54.4, 95% CI 38.4-77.5; emergency Caesarean OR 13.0, 95% CI 7.76-21.7) were associated in all analyses with an increased risk of Caesarean section. Extremes of neonatal birthweight were associated with an increased risk of Caesarean section (all Caesareans and emergency section) compared with vaginal delivery as was increasing neonatal head circumferences. In all analyses increasing maternal age (OR 1.07 per year, 95 % CI 1.04-1.09; OR 1.04 per year, 95 % CI 1.01-1.08; OR 1.11 per year, 95% CI 1.08-1.15) was independently associated with increased odds of Caesarean section. Increasing parity was associated with a decrease in risk for all Caesareans and emergency section (OR 0.63, 95% CI 0.53-0.75 and OR 0.46, 95% CI 0.33-0.63, respectively), as was the outcome of the last pregnancy being a live child. Increasing gestation was independently associated with a decreased risk of both all Caesareans and elective Caesarean (OR 0.86, 95% CI 0.80-0.93 and OR 0.52, 95% CI 0.46-0.58 respectively), whereas diabetes mellitus was associated with increased risk. These variables were not associated with emergency section. However, epidural use was associated with an increased risk of emergency Caesarean (OR 6.49, 95% CI 4.78-8.82) while being in a preferred labour position decreased the risk (OR 0.59, 95% CI 0.49-0.73).
Study of Caesarean Section Rates in Induced Versus Spontaneous Labour at Term
2018
DOI: 10.21276/sjams.2018.6.10.89 Abstract: Over recent decades, more and more pregnant women around the world have undergone induction of labour (artificially initiated labour) to deliver their babies. A major concern of labour induction is that elective labour induction may increase the risk of caesarean section (CS). The purpose of this study was to evaluate the risk of Caesarean section with labour induction versus spontaneous labour in nulliparous and multiparous women at term in Indian population. To compare whether the caesarean section (CS) rate is significantly higher among whose labour was induced compared to those who had spontaneous labour at term pregnancy. A cross sectional descriptive study based on convenience sample in which available data from hospital is used. Data of women whose labour was either induced (induction group, n=713) or spontaneous (spontaneous group, n=1325) at 37 +0 to 41 +6 weeks of gestation from January 2017 to December 2017 at Mahatma Gandhi Medi...
Risk of caesarean section after induced labour: do hospitals make a difference
Background: There is a well-known relationship between induced labour and caesarean rates. However, it remains unknown whether this relationship reflects the impact of more complex obstetric conditions or the variability in obstetric practices. We sought to quantify the independent role of the hospital as a variable that can influence the occurrence of caesarean section after induced labour. Methods: As part of the Portuguese Generation XXI birth cohort, we evaluated 2041 consecutive women who underwent singleton pregnancies with labour induction, at five public level III obstetric units (April 2005-August 2006). The indications for induction were classified according to the guidelines of the American and the Royal Colleges of Obstetricians and Gynaecologists. Poisson regression models were adjusted to estimate the association between the hospital and surgical delivery after induction. Crude and adjusted prevalence ratios (PR) and a 95% confidence interval (95% CI) were computed. Results: The proportion of women who were induced without formal clinical indications varied among hospitals from 20.3% to 45.5% (p < 0.001). After adjusting for confounders, the risk of undergoing a caesarean section after induced labour remained significantly different between the hospitals, for the cases in which there was no evident indication for induction [the highest PR reaching 1.86 (95% CI, 1.23–2.82)] and also when at least one such indication was present [1.53 (95% CI, 1.12–2.10)]. This pattern was also observed among the primiparous cephalic term induced women [the highest PR reaching 2.06 (95% CI, 1.23–2.82) when there was no evident indication for induction and 1.61 (95% CI, 1.11–2.34) when at least one such indication was present].
BMC Pregnancy and Childbirth, 2007
Background: British women are increasingly delaying childbirth. The proportion giving birth over the age of 35 rose from 12% in 1996 to 20% in 2006. Women over this age are at a higher risk of perinatal death, and antepartum stillbirth accounts for 61% of all such deaths. Women over 40 years old have a similar stillbirth risk at 39 weeks as women who are between 25 and 29 years old have at 41 weeks. Many obstetricians respond to this by suggesting labour induction at term to forestall some of the risk. In a national survey of obstetricians 37% already induce women aged 40-44 years. A substantial minority of parents support such a policy, but others do not on the grounds that it might increase the risk of Caesarean section. However trials of induction in other high-risk scenarios have not shown any increase in Caesarean sections, rather the reverse. If induction for women over 35 did not increase Caesareans, or even reduced them, it would plausibly improve perinatal outcome and be an acceptable intervention. We therefore plan to perform a trial to test the effect of such an induction policy on Caesarean section rates. This trial is funded by the NHS Research for Patient Benefit (RfPB) Programme.
Trial of labor after cesarean section in risk pregnancies: A population‐based cohort study
Acta Obstetricia et Gynecologica Scandinavica, 2019
Introduction: In most pregnancies after a cesarean section, a trial of labor is an option. The objective of the study was to explore trial of labor and its failure in pregnancies with medical risk conditions, in a population with a high trial of labor rate. Material and methods: In a cohort study (n = 57 109), using data from the Medical Birth Registry of Norway 1989-2014, women with a second delivery after a first pregnancy cesarean section were included. Preterm, multiple, and non-cephalic deliveries were excluded. The outcomes were trial of labor and failed trial of labor, assessed as rates and relative risk, using deliveries without risk conditions as reference. Temporal trends were assessed by 3-year periods. The exposures were selected medical risk conditions, ie previous offspring death, labor dystocia, diabetes, heart conditions, chronic hypertension, chronic kidney disease, rheumatoid arthritis, thyroid disease, asthma, prepregnancy psychiatric conditions, epilepsy, obesity, gestational diabetes, eclampsia and preeclampsia, gestational hypertension, major malformations, second-pregnancy psychiatric conditions, assisted reproduction, macrosomia, and small-for-gestational-age neonates. Induced onset of labor was compared with spontaneous onset of labor for each condition studied. Results: In risk pregnancies (n = 31 994) the trial of labor rate was 64.9% and failure rate was 27.6%, compared with 74.6% and 16.4% in pregnancies without any of the risk conditions studied (n = 25 115). The lowest trial of labor rates were observed in diabetes type 1 (49.5%), diabetes type 2 (46.7%), maternal heart conditions (54.5%), and pregnancy-related psychiatric conditions (19.7%). The highest failure rates were observed in diabetes type 1 (43.1%), diabetes type 2 (40.3%), maternal obesity (36.9%), gestational diabetes (36.0%), and offspring macrosomia (43.0%). Induced labor was associated with failed trial of labor (P < .05), whereas after spontaneous labor, failure rates were less than 40% in all conditions studied. Conclusions: In conditions with high rates of failed trial of labor, eg diabetes, macrosomia, and obesity, a planned cesarean section might be a better option than a trial of labor, particularly if induction of delivery might be needed.
Risk factors at caesarean section and failure of subsequent trial of labour
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2002
Objective: To identify risk factors at caesarean section (CS), related to failure of a trial of labour (TOL) in subsequent pregnancy. Study design: Hospital records (1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999) of the index pregnancy were reviewed at caesarean delivery for oxytocine use, indication for caesarean, dilatation of cervix, speed of dilatation, duration of contractions and birth weight. The records of the subsequent pregnancy were reviewed for successful vaginal birth after caesarean (VBAC), maternal and neonatal outcome. Data were tested for statistical significance with a Mantel-Haenszel equation for odds ratios (OR, with 95% confidence interval (CI)), a Fisher exact test or a Student's 't'-test. Results: From 214 women with a previous caesarean section, 68.7% underwent a TOL, which was successful in 71.4%. A labour pattern during the index pregnancy characterised by oxytocine use (OR ¼ 3:1; 95% CI ¼ 1:4À7:1), contractions for more than 12 h (OR ¼ 3:0; 95% CI ¼ 1:3À7:0) and cervical dilatation less than 1 cm/h (OR ¼ 5:6; 95% CI ¼ 1:1À39:4) increased the risk of a failed TOL at subsequent labour significantly. Conclusion: Women who attempt VBAC may be informed that a labour pattern of their index pregnancy characterised by oxytocine use, contractions for more than 12 h and slow dilatation is associated with a reduced chance of success. A partograph obtained during first labour can be a managerial tool for subsequent labour. #
Archives of Gynecology and Obstetrics, 2013
Purpose To determine the success rate of vaginal birth after cesarean birth (VBAC) and its outcome when labour was induced compared to spontaneous labour. Methods Prospective cohort study of all women who had lower segment caesarian section (LSCS) in any previous delivery and were admitted for a trial of labour after cesarean between April 2010 and March 2011 at a University Hospital. We compared the success rates of VBAC in women who had induction of labour (IOL) to those who came with spontaneous labour. Results During the study period, 320 women who elected to have trial of labour after cesarean and were included in the study, 268 (83.8 %) had spontaneous labour and 52 (16.3 %) had IOL. The most common indications for IOL were post term pregnancy 30 %, diabetes during pregnancy 19 % and prelabour spontaneous rupture of membranes 17 %. There was no difference between both groups in age, previous vaginal delivery and gestational age. In terms of the method of induction, the most commonly used method was transcervical Foley catheter in 21 cases (40.4 %) and then Oxytocin in 19 cases (36.5 %), nine women had combined methods of induction (17.3 %). Prostaglandin E2 was used in three women (5.8 %). The incidence of successful VBAC in spontaneous labour was 72 %, however, when induced, the incidence of successful VBAC was 63.5 %. Compared to the spontaneous labour group, induced women had significantly higher rate of CS (36.5 vs. 28 %; P = 0.026).