Maternal complications with vaginal birth after cesarean delivery: A multicenter study - 18/08/11
, Jeffrey Peipert, MD, MPH d, Deborah B. Nelson, PhD a, b, Anthony Odibo, MD a, b, Erika J. Stevens, MA a, b, David M. Stamilio, MD, MSCE a, b, Emmanuelle Pare, MD a, b, Michal Elovitz, MD a, Anthony Sciscione, DO e, Mary D. Sammel, ScD b, Sarah J. Ratcliffe, PhD b
Reprint requests: George A. Macones, MD, 2000 Courtyard Building, 3400 Spruce St, Philadelphia. PA 19104.Abstract |
Objective |
This study was undertaken to determine incidence and risk factors for uterine rupture in women attempting vaginal birth after cesarean delivery (VBAC) in a wide range of hospital settings.
Study design |
We performed a case-control study nested within a cohort of women who have had a prior cesarean to determine the incidence and risk factors for uterine rupture in women attempting VBAC.
Results |
The incidence rate of uterine rupture in those who attempt VBAC was 9.8 per 1000. A prior vaginal delivery was associated with a lower risk of uterine rupture (adjusted odds ratio [OR] = 0.40, 95% CI 0.20-0.81). Although prostaglandins alone were not associated with uterine rupture, sequential use of prostaglandin and pitocin was associated with uterine rupture (adjusted OR = 3.07, 95% CI 0.98-9.88).
Conclusion |
Women with a prior cesarean should be offered VBAC, and women with a prior cesarean and prior vaginal delivery should be encouraged to VBAC. Although other studies have suggested that prostaglandins should be avoided, we suggest that inductions requiring sequential agents be avoided.
Le texte complet de cet article est disponible en PDF.Key words : Vaginal birth after cesarean delivery, Uterine rupture, Tertiary care
Plan
| Supported by a grant from NICHD (RO1 HD 35631). Dr Macones is a recipient of a K24 grant from NICHD (K24 HD01289), which partially supports this work and Dr Peipert is a recipient of a K24 grant from NICHD (K24 HD01298) which partially supports this work. |
Vol 193 - N° 5
P. 1656-1662 - novembre 2005 Retour au numéro
Article précédent
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