Susanne Grylka-Baeschlin1, Mike Clarke2, Cecily Begley3, Deirdre Daly4, Patricia Healy5, Jane Nicoletti6, Declan Devane7, Sandra Morano6, Gérard Krause8, André Karch9, Gerard Savage2, Mechthild M Gross10. 1. Midwifery Research and Education Unit, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover D-30625, Germany; Zurich University of Applied Sciences, Technikumstr. 81, Winterthur CH-8401, Switzerland. Electronic address: Susanne.Grylka@zhaw.ch. 2. Northern Ireland Methodology Hub, Queen's University Belfast, University Road, Belfast, Northern Ireland BT12 6BJ, United Kingdom. 3. School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin DO2 T283, Ireland; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 4. School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin DO2 T283, Ireland. 5. School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland. 6. Medical School and Midwifery School, Genoa University, Genoa, Italy. 7. School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland; HRB-Trials Methodology Research Network, National University of Ireland Galway, Galway, Ireland. 8. Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Inhoffenstr. 7, Braunschweig D-38124, Germany; Hannover Medical School, Carl-Neuberg-Str. 1, Hannover D-30625, Germany; Institute for Infectious Disease Epidemiology, TWINCORE, Hannover D-30625, Germany. 9. Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Inhoffenstr. 7, Braunschweig D-38124, Germany; Institute of Epidemiology and Social Medicine, University of Münster, Albert-Schweitzer-Campus-1, Gebäude D3, Münster D-48149, Germany. 10. Midwifery Research and Education Unit, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover D-30625, Germany.
Abstract
OBJECTIVE: Knowledge about labour characteristics of women achieving successful vaginal birth after caesarean section (VBAC) might be used to improve labour and birth management. This study examined sociodemographic and labour process-related factors regarding a) differences between countries, b) the comparison of successful VBAC with unplanned caesarean section, and c) predictors for the success of planned VBAC in three European countries. DESIGN: We analysed observational data collected within the OptiBIRTH trial, a cluster-randomised controlled trial. SETTING:Fifteen study sites in Ireland, Italy and Germany, five in each country. PARTICIPANTS: 790 participants going into labour for planned VBAC. MEASUREMENTS: Descriptive statistics and random-effects logistic regression models were applied. FINDINGS: The pooled successful VBAC-rate was 74.6%. Italy had the highest proportion of women receiving none of the four intrapartum interventions amniotomy (ARM), oxytocin, epidural or opioids (42.5% vs Ireland: 26.8% and Germany: 25.3%, p < 0.001). Earlier performance of ARM was associated with successful VBAC (3.50 hrs vs 6.08 hrs, p = 0.004). A positive predictor for successful vaginal birth was a previous vaginal birth (OR=3.73, 95% CI [2.17, 6.44], p < 0.001). The effect of ARM increased with longer labour duration (OR for interaction term=1.06, 95% CI [1.004, 1.12], p = 0.035). Higher infant birthweight (OR per kg=0.34, 95% CI [0.23, 0.50], p < 0.001), ARM (reference spontaneous rupture of membranes (SROM), OR=0.20, 95% CI [0.11, 0.37], p < 0.001) and a longer labour duration (OR per hour=0.93, 95% CI [0.90, 0.97], p < 0.001) decreased the odds of a vaginal birth. KEY CONCLUSION:Women with a previous vaginal birth, an infant with a lower birth weight, SROM and a shorter labour duration were most likely to have a successful vaginal birth. If SROM did not occur, an earlier ARM increased the odds of a vaginal birth. IMPLICATION FOR PRACTICE: Labour progress should be accelerated by fostering endogenous uterine contractions. With slow labour progress and intact membranes, ARM might increase the chance of a vaginal birth.
RCT Entities:
OBJECTIVE: Knowledge about labour characteristics of women achieving successful vaginal birth after caesarean section (VBAC) might be used to improve labour and birth management. This study examined sociodemographic and labour process-related factors regarding a) differences between countries, b) the comparison of successful VBAC with unplanned caesarean section, and c) predictors for the success of planned VBAC in three European countries. DESIGN: We analysed observational data collected within the OptiBIRTH trial, a cluster-randomised controlled trial. SETTING: Fifteen study sites in Ireland, Italy and Germany, five in each country. PARTICIPANTS: 790 participants going into labour for planned VBAC. MEASUREMENTS: Descriptive statistics and random-effects logistic regression models were applied. FINDINGS: The pooled successful VBAC-rate was 74.6%. Italy had the highest proportion of women receiving none of the four intrapartum interventions amniotomy (ARM), oxytocin, epidural or opioids (42.5% vs Ireland: 26.8% and Germany: 25.3%, p < 0.001). Earlier performance of ARM was associated with successful VBAC (3.50 hrs vs 6.08 hrs, p = 0.004). A positive predictor for successful vaginal birth was a previous vaginal birth (OR=3.73, 95% CI [2.17, 6.44], p < 0.001). The effect of ARM increased with longer labour duration (OR for interaction term=1.06, 95% CI [1.004, 1.12], p = 0.035). Higher infant birthweight (OR per kg=0.34, 95% CI [0.23, 0.50], p < 0.001), ARM (reference spontaneous rupture of membranes (SROM), OR=0.20, 95% CI [0.11, 0.37], p < 0.001) and a longer labour duration (OR per hour=0.93, 95% CI [0.90, 0.97], p < 0.001) decreased the odds of a vaginal birth. KEY CONCLUSION:Women with a previous vaginal birth, an infant with a lower birth weight, SROM and a shorter labour duration were most likely to have a successful vaginal birth. If SROM did not occur, an earlier ARM increased the odds of a vaginal birth. IMPLICATION FOR PRACTICE: Labour progress should be accelerated by fostering endogenous uterine contractions. With slow labour progress and intact membranes, ARM might increase the chance of a vaginal birth.
Authors: G Gitas; L Proppe; A K Ertan; S Baum; A Rody; M Kocaer; K Dinas; L Allahqoli; A S Laganà; A Sotiriadis; S Sommer; I Alkatout Journal: BMC Pregnancy Childbirth Date: 2021-05-04 Impact factor: 3.007
Authors: George Gitas; Ibrahim Alkatout; Kubilay A Ertan; Achim Rody; Louisa Proppe; Mustafa Kocaer; Antonio Simone Laganà; Leila Allahqoli; Themistoklis Mikos; Soteris Sommer; Sascha Baum Journal: J Turk Ger Gynecol Assoc Date: 2022-07-05