Is vaginal birth after cesarean safe? Experience at a community hospital - 03/09/11
Abstract |
Objective: We sought to evaluate the effectiveness and safety of promoting a trial of labor after prior cesarean birth in a community hospital. Study Design: A 4-year prospective cohort study was conducted of all patients who had prior cesarean births (N = 1481). A comparison of outcomes was performed between those who elected repeat cesarean delivery (n = 727) and those who attempted a trial of labor after previous cesarean(s) (n = 754). Results: We found that the vaginal birth after cesarean attempt rate was 50.9% and declined significantly during the last 2 years of the study. The elective repeat cesarean rate was 49.1% and increased significantly during the last 2 years of the study. In addition, we found that neonatal outcomes were similar, with the exception of 2 neonatal deaths caused by uterine rupture. Twelve uterine ruptures occurred (1.6%), and 11 of the 12 ruptures involved either induction or augmentation of labor, or both. Conclusions: A trial of vaginal birth after cesarean is safe provided that induction of labor is not used. The uterine rupture rate of 1.6% is higher than reported in the literature; this may reflect underreporting by community hospitals. (Am J Obstet Gynecol 2001;184:1478-87.)
Le texte complet de cet article est disponible en PDF.Keywords : Trial of labor, VBAC attempt rate, uterine rupture, induction, previous cesarean
Plan
![]() | Reprint requests: Howard Blanchette, MD, Chairman, Department of Obstetrics and Gynecology, Danbury Hospital, 24 Hospital Avenue, Danbury, CT 06810. |
![]() ![]() | Editors ’ note: This manuscript was revised after these discussions were presented. |
Vol 184 - N° 7
P. 1478-1487 - juin 2001 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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