Celeste D Bickford1, Patricia A Janssen2. 1. School of Population and Public Health, The University of British Columbia, Vancouver, BC. 2. School of Population and Public Health, The University of British Columbia, Vancouver, BC ; Child and Family Research Institute, Vancouver, BC.
Abstract
BACKGROUND: As rates for cesarean births continue to rise, more women are faced with the choice to plan a vaginal or a repeat cesarean birth after a previous cesarean. The objective of this population-based retrospective cohort study was to compare the safety of planned vaginal birth with cesarean birth after 1-2 previous cesarean sections. METHODS: We identified singleton term births in British Columbia from 2000 to 2008 using data from the British Columbia Perinatal Data Registry. Women carrying a singleton fetus in cephalic presentation at term (37-41 weeks of gestation completed) with 1-2 prior cesarean births were included. Those with gestational hypertension, pre-existing diabetes and cardiac disease were excluded. Maternal and neonatal outcomes were classified as either life-threatening or non-life threatening. We compared outcomes among women with none versus at least 1 previous vaginal birth, by planned method of delivery. We estimated relative risks (RR) and 95% confidence intervals (CI) for composite outcomes using Poisson regression. RESULTS: Of the 33 812 women in the sample, 5406 had a history of vaginal delivery and 28 406 did not. The composite risk for life-threatening maternal outcomes was elevated among women planning vaginal compared with cesarean birth both with and without a prior vaginal birth (RR 2.06, 95% CI 1.20-3.52) and (2.52, 95% CI 2.04-3.11). Absolute differences (attributable risk [AR]) were 1.01% and 1.31% respectively. Non-life threatening maternal outcomes were decreased among women planning a vaginal birth if they had had at least 1 prior vaginal delivery (RR 0.51, 95% CI 0.33-0.77; AR 1.17%). The composite risk of intrapartum stillbirth, neonatal death or life-threatening neonatal outcomes did not differ among women planning vaginal or cesarean birth with a prior vaginal delivery and non-life threatening neonatal outcomes were decreased, (RR 0.67, 95% CI 0.52-0.86); AR 1.92%). INTERPRETATION: After 1 or 2 previous cesarean births, risks for adverse outcomes between planned vaginal and cesarean birth are reduced among women with a prior vaginal birth. Our data offer women and their health care providers the opportunity to consider risk profiles separately for women who have and have not had a prior vaginal delivery.
BACKGROUND: As rates for cesarean births continue to rise, more women are faced with the choice to plan a vaginal or a repeat cesarean birth after a previous cesarean. The objective of this population-based retrospective cohort study was to compare the safety of planned vaginal birth with cesarean birth after 1-2 previous cesarean sections. METHODS: We identified singleton term births in British Columbia from 2000 to 2008 using data from the British Columbia Perinatal Data Registry. Women carrying a singleton fetus in cephalic presentation at term (37-41 weeks of gestation completed) with 1-2 prior cesarean births were included. Those with gestational hypertension, pre-existing diabetes and cardiac disease were excluded. Maternal and neonatal outcomes were classified as either life-threatening or non-life threatening. We compared outcomes among women with none versus at least 1 previous vaginal birth, by planned method of delivery. We estimated relative risks (RR) and 95% confidence intervals (CI) for composite outcomes using Poisson regression. RESULTS: Of the 33 812 women in the sample, 5406 had a history of vaginal delivery and 28 406 did not. The composite risk for life-threatening maternal outcomes was elevated among women planning vaginal compared with cesarean birth both with and without a prior vaginal birth (RR 2.06, 95% CI 1.20-3.52) and (2.52, 95% CI 2.04-3.11). Absolute differences (attributable risk [AR]) were 1.01% and 1.31% respectively. Non-life threatening maternal outcomes were decreased among women planning a vaginal birth if they had had at least 1 prior vaginal delivery (RR 0.51, 95% CI 0.33-0.77; AR 1.17%). The composite risk of intrapartum stillbirth, neonatal death or life-threatening neonatal outcomes did not differ among women planning vaginal or cesarean birth with a prior vaginal delivery and non-life threatening neonatal outcomes were decreased, (RR 0.67, 95% CI 0.52-0.86); AR 1.92%). INTERPRETATION: After 1 or 2 previous cesarean births, risks for adverse outcomes between planned vaginal and cesarean birth are reduced among women with a prior vaginal birth. Our data offer women and their health care providers the opportunity to consider risk profiles separately for women who have and have not had a prior vaginal delivery.
Authors: Mark B Landon; John C Hauth; Kenneth J Leveno; Catherine Y Spong; Sharon Leindecker; Michael W Varner; Atef H Moawad; Steve N Caritis; Margaret Harper; Ronald J Wapner; Yoram Sorokin; Menachem Miodovnik; Marshall Carpenter; Alan M Peaceman; Mary Jo O'Sullivan; Baha Sibai; Oded Langer; John M Thorp; Susan M Ramin; Brian M Mercer; Steven G Gabbe Journal: N Engl J Med Date: 2004-12-14 Impact factor: 91.245
Authors: Alison G Cahill; David M Stamilio; Anthony O Odibo; Jeffrey F Peipert; Sarah J Ratcliffe; Erika J Stevens; Mary D Sammel; George A Macones Journal: Am J Obstet Gynecol Date: 2006-07-17 Impact factor: 8.661
Authors: Brian M Mercer; Sharon Gilbert; Mark B Landon; Catherine Y Spong; Kenneth J Leveno; Dwight J Rouse; Michael W Varner; Atef H Moawad; Hyagriv N Simhan; Margaret Harper; Ronald J Wapner; Yoram Sorokin; Menachem Miodovnik; Marshall Carpenter; Alan Peaceman; Mary J O'Sullivan; Baha M Sibai; Oded Langer; John M Thorp; Susan M Ramin Journal: Obstet Gynecol Date: 2008-02 Impact factor: 7.661