Trial of labor compared to repeat cesarean section in women with no other risk factors than a prior cesarean delivery

Anne Studsgaard; Malene Skorstengaard; Julie Glavind; Lone Hvidman; Niels Uldbjerg

doi:10.1111/aogs.12240

Trial of labor compared to repeat cesarean section in women with no other risk factors than a prior cesarean delivery

Anne Studsgaard, Malene Skorstengaard, Julie Glavind, Lone Hvidman, Niels Uldbjerg

Center for Epidemiologi og Screening

20 Citationer (Scopus)

Abstract

Objective To compare outcomes with trial of labor after cesarean (TOLAC) or elective repeat cesarean delivery on maternal request (ERCD-MR). Design Prospective cohort study. Setting Danish university hospital. Population Women with TOLAC (n = 1161) and women with ERCD-MR (n = 622) between 2003 and 2010. Exclusion criteria were diabetes, two prior cesarean sections, index cesarean at a different hospital, a delivery after the index cesarean, twin gestation, gestational age <37⁺⁰ weeks and stillbirth. Methods Data were obtained from the Aarhus Birth Cohort database, which comprised prospective registration of the deliveries. Main outcome measures Adverse neonatal outcomes, risk factors for emergency cesarean, and uterine rupture in case of TOLAC. Results TOLAC was associated with an increased risk of neonatal depression [odds ratio (OR) 3.6, 95% confidence interval (CI) 1.1-19.1] and neonatal intensive care unit admission (adjusted OR 1.9, 95% CI 1.3-2.8). Within the TOLAC group 67% delivered vaginally. In the TOLAC group 1.3% (n = 15) of the women had a complete uterine rupture. None of these infants had sequelae after 12 months. Significant risk factors for emergency cesarean were no prior vaginal delivery (adjusted OR 1.8, 95% CI 1.1-3.0), index emergency cesarean during labor (adjusted OR 3.0, 95% CI 2.3-4.1), maternal age ≥35 years (adjusted OR 1.9, 95% CI 1.3-2.8), pre-pregnancy body mass index ≥30 (adjusted OR 2.1, 95% CI 1.3-3.3), and birthweight 4000-4499 g (adjusted OR 1.5, 95% CI 1.1-2.1). Uterine rupture was associated with the use of epidural analgesia (OR 2.2, 95% CI 1.1-4.9) and no prior vaginal delivery (p = 0.03). Conclusion TOLAC is an acceptable individualized option for women without major risk factors.

Originalsprog	Engelsk
Tidsskrift	Acta Obstetrica et Gynecologica
Vol/bind	92
Udgave nummer	11
Sider (fra-til)	1256-63
Antal sider	8
ISSN	0001-6349
DOI	https://doi.org/10.1111/aogs.12240
Status	Udgivet - nov. 2013

FN’s Verdensmål

Dette resultat bidrager til følgende verdensmål

Adgang til dokumentet

10.1111/aogs.12240

Citationsformater

@article{af92cdf18b184a53b85876a4af28bd2d,

title = "Trial of labor compared to repeat cesarean section in women with no other risk factors than a prior cesarean delivery",

abstract = "Objective To compare outcomes with trial of labor after cesarean (TOLAC) or elective repeat cesarean delivery on maternal request (ERCD-MR). Design Prospective cohort study. Setting Danish university hospital. Population Women with TOLAC (n = 1161) and women with ERCD-MR (n = 622) between 2003 and 2010. Exclusion criteria were diabetes, two prior cesarean sections, index cesarean at a different hospital, a delivery after the index cesarean, twin gestation, gestational age <37+0 weeks and stillbirth. Methods Data were obtained from the Aarhus Birth Cohort database, which comprised prospective registration of the deliveries. Main outcome measures Adverse neonatal outcomes, risk factors for emergency cesarean, and uterine rupture in case of TOLAC. Results TOLAC was associated with an increased risk of neonatal depression [odds ratio (OR) 3.6, 95% confidence interval (CI) 1.1-19.1] and neonatal intensive care unit admission (adjusted OR 1.9, 95% CI 1.3-2.8). Within the TOLAC group 67% delivered vaginally. In the TOLAC group 1.3% (n = 15) of the women had a complete uterine rupture. None of these infants had sequelae after 12 months. Significant risk factors for emergency cesarean were no prior vaginal delivery (adjusted OR 1.8, 95% CI 1.1-3.0), index emergency cesarean during labor (adjusted OR 3.0, 95% CI 2.3-4.1), maternal age ≥35 years (adjusted OR 1.9, 95% CI 1.3-2.8), pre-pregnancy body mass index ≥30 (adjusted OR 2.1, 95% CI 1.3-3.3), and birthweight 4000-4499 g (adjusted OR 1.5, 95% CI 1.1-2.1). Uterine rupture was associated with the use of epidural analgesia (OR 2.2, 95% CI 1.1-4.9) and no prior vaginal delivery (p = 0.03). Conclusion TOLAC is an acceptable individualized option for women without major risk factors.",

keywords = "Adult, Cesarean Section, Repeat, Cohort Studies, Female, Humans, Infant, Newborn, Logistic Models, Pregnancy, Risk Factors, Trial of Labor, Uterine Rupture, Vaginal Birth after Cesarean",

author = "Anne Studsgaard and Malene Skorstengaard and Julie Glavind and Lone Hvidman and Niels Uldbjerg",

note = "{\textcopyright} 2013 Nordic Federation of Societies of Obstetrics and Gynecology.",

year = "2013",

month = nov,

doi = "10.1111/aogs.12240",

language = "English",

volume = "92",

pages = "1256--63",

journal = "Acta Obstetricia et Gynecologica Scandinavica",

issn = "0001-6349",

publisher = "GrupoSaned",

number = "11",

}

TY - JOUR

T1 - Trial of labor compared to repeat cesarean section in women with no other risk factors than a prior cesarean delivery

AU - Studsgaard, Anne

AU - Skorstengaard, Malene

AU - Glavind, Julie

AU - Hvidman, Lone

AU - Uldbjerg, Niels

PY - 2013/11

Y1 - 2013/11

N2 - Objective To compare outcomes with trial of labor after cesarean (TOLAC) or elective repeat cesarean delivery on maternal request (ERCD-MR). Design Prospective cohort study. Setting Danish university hospital. Population Women with TOLAC (n = 1161) and women with ERCD-MR (n = 622) between 2003 and 2010. Exclusion criteria were diabetes, two prior cesarean sections, index cesarean at a different hospital, a delivery after the index cesarean, twin gestation, gestational age <37+0 weeks and stillbirth. Methods Data were obtained from the Aarhus Birth Cohort database, which comprised prospective registration of the deliveries. Main outcome measures Adverse neonatal outcomes, risk factors for emergency cesarean, and uterine rupture in case of TOLAC. Results TOLAC was associated with an increased risk of neonatal depression [odds ratio (OR) 3.6, 95% confidence interval (CI) 1.1-19.1] and neonatal intensive care unit admission (adjusted OR 1.9, 95% CI 1.3-2.8). Within the TOLAC group 67% delivered vaginally. In the TOLAC group 1.3% (n = 15) of the women had a complete uterine rupture. None of these infants had sequelae after 12 months. Significant risk factors for emergency cesarean were no prior vaginal delivery (adjusted OR 1.8, 95% CI 1.1-3.0), index emergency cesarean during labor (adjusted OR 3.0, 95% CI 2.3-4.1), maternal age ≥35 years (adjusted OR 1.9, 95% CI 1.3-2.8), pre-pregnancy body mass index ≥30 (adjusted OR 2.1, 95% CI 1.3-3.3), and birthweight 4000-4499 g (adjusted OR 1.5, 95% CI 1.1-2.1). Uterine rupture was associated with the use of epidural analgesia (OR 2.2, 95% CI 1.1-4.9) and no prior vaginal delivery (p = 0.03). Conclusion TOLAC is an acceptable individualized option for women without major risk factors.

AB - Objective To compare outcomes with trial of labor after cesarean (TOLAC) or elective repeat cesarean delivery on maternal request (ERCD-MR). Design Prospective cohort study. Setting Danish university hospital. Population Women with TOLAC (n = 1161) and women with ERCD-MR (n = 622) between 2003 and 2010. Exclusion criteria were diabetes, two prior cesarean sections, index cesarean at a different hospital, a delivery after the index cesarean, twin gestation, gestational age <37+0 weeks and stillbirth. Methods Data were obtained from the Aarhus Birth Cohort database, which comprised prospective registration of the deliveries. Main outcome measures Adverse neonatal outcomes, risk factors for emergency cesarean, and uterine rupture in case of TOLAC. Results TOLAC was associated with an increased risk of neonatal depression [odds ratio (OR) 3.6, 95% confidence interval (CI) 1.1-19.1] and neonatal intensive care unit admission (adjusted OR 1.9, 95% CI 1.3-2.8). Within the TOLAC group 67% delivered vaginally. In the TOLAC group 1.3% (n = 15) of the women had a complete uterine rupture. None of these infants had sequelae after 12 months. Significant risk factors for emergency cesarean were no prior vaginal delivery (adjusted OR 1.8, 95% CI 1.1-3.0), index emergency cesarean during labor (adjusted OR 3.0, 95% CI 2.3-4.1), maternal age ≥35 years (adjusted OR 1.9, 95% CI 1.3-2.8), pre-pregnancy body mass index ≥30 (adjusted OR 2.1, 95% CI 1.3-3.3), and birthweight 4000-4499 g (adjusted OR 1.5, 95% CI 1.1-2.1). Uterine rupture was associated with the use of epidural analgesia (OR 2.2, 95% CI 1.1-4.9) and no prior vaginal delivery (p = 0.03). Conclusion TOLAC is an acceptable individualized option for women without major risk factors.

KW - Adult

KW - Cesarean Section, Repeat

KW - Cohort Studies

KW - Female

KW - Humans

KW - Infant, Newborn

KW - Logistic Models

KW - Pregnancy

KW - Risk Factors

KW - Trial of Labor

KW - Uterine Rupture

KW - Vaginal Birth after Cesarean

U2 - 10.1111/aogs.12240

DO - 10.1111/aogs.12240

M3 - Journal article

C2 - 23962339

SN - 0001-6349

VL - 92

SP - 1256

EP - 1263

JO - Acta Obstetricia et Gynecologica Scandinavica

JF - Acta Obstetricia et Gynecologica Scandinavica

IS - 11

ER -

Trial of labor compared to repeat cesarean section in women with no other risk factors than a prior cesarean delivery

Abstract

FN’s Verdensmål

Adgang til dokumentet

Fingeraftryk

Citationsformater