Trial of labor compared to repeat cesarean section in women with no other risk factors than a prior cesarean delivery
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Trial of labor compared to repeat cesarean section in women with no other risk factors than a prior cesarean delivery. / Studsgaard, Anne; Skorstengaard, Malene; Glavind, Julie; Hvidman, Lone; Uldbjerg, Niels.
In: Acta Obstetrica et Gynecologica, Vol. 92, No. 11, 11.2013, p. 1256-63.Research output: Contribution to journal › Journal article › Research › peer-review
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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
N1 - © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.
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
VL - 92
SP - 1256
EP - 1263
JO - Acta Obstetricia et Gynecologica Scandinavica
JF - Acta Obstetricia et Gynecologica Scandinavica
SN - 0001-6349
IS - 11
ER -
ID: 153101632