Planned mode of delivery after previous cesarean section and short-term maternal and perinatal outcomes: A population-based record linkage cohort study in Scotland
Policy consensus in high-income countries supports offering pregnant women with previous cesarean section a choice between planning an elective repeat cesarean section (ERCS) or attempting a vaginal birth, known as a planned vaginal birth after previous cesarean (VBAC), provided they do not have con...
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| creator | Fitzpatrick, Kathryn E Kurinczuk, Jennifer J Bhattacharya, Sohinee Quigley, Maria A |
| description | Policy consensus in high-income countries supports offering pregnant women with previous cesarean section a choice between planning an elective repeat cesarean section (ERCS) or attempting a vaginal birth, known as a planned vaginal birth after previous cesarean (VBAC), provided they do not have contraindications to planned VBAC. However, robust comprehensive information on the associated outcomes to counsel eligible women about this choice is lacking. This study investigated the short-term maternal and perinatal outcomes associated with planned mode of delivery after previous cesarean section among women delivering a term singleton and considered eligible to have a planned VBAC.
A population-based cohort of 74,043 term singleton births in Scotland between 2002 and 2015 to women with one or more previous cesarean sections was conducted using linked Scottish national datasets. Logistic or modified Poisson regression, as appropriate, was used to estimate the effect of planned mode of delivery on maternal and perinatal outcomes adjusted for sociodemographic, maternal medical, and obstetric-related characteristics. A total of 45,579 women gave birth by ERCS, and 28,464 had a planned VBAC, 28.4% of whom went on to have an in-labor nonelective repeat cesarean section. Compared to women delivering by ERCS, those who had a planned VBAC were significantly more likely to have uterine rupture (0.24%, n = 69 versus 0.04%, n = 17, adjusted odds ratio [aOR] 7.3, 95% confidence interval [CI] 3.9-13.9, p < 0.001), a blood transfusion (1.14%, n = 324 versus 0.50%, n = 226, aOR 2.3, 95% CI 1.9-2.8, p < 0.001), puerperal sepsis (0.27%, n = 76 versus 0.17%, n = 78, aOR 1.8, 95% CI 1.3-2.7, p = 0.002), and surgical injury (0.17% versus 0.09%, n = 40, aOR 3.0, 95% CI 1.8-4.8, p < 0.001) and experience adverse perinatal outcomes including perinatal death, admission to a neonatal unit, resuscitation requiring drugs and/or intubation, and an Apgar score < 7 at 5 minutes (7.99%, n = 2,049 versus 6.37%, n = 2,570, aOR 1.6, 95% CI 1.5-1.7, p < 0.001). However, women who had a planned VBAC were more likely than those delivering by ERCS to breastfeed at birth or hospital discharge (63.6%, n = 14,906 versus 54.5%, n = 21,403, adjusted risk ratio [aRR] 1.2, 95% CI 1.1-1.2, p < 0.001) and were more likely to breastfeed at 6-8 weeks postpartum (43.6%, n = 10,496 versus 34.5%, n = 13,556, aRR 1.2, 95% CI 1.2-1.3, p < 0.001). The effect of planned mode of delivery on the mother's risk of hav |
| doi_str_mv | 10.1371/journal.pmed.1002913 |
| format | Article |
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A population-based cohort of 74,043 term singleton births in Scotland between 2002 and 2015 to women with one or more previous cesarean sections was conducted using linked Scottish national datasets. Logistic or modified Poisson regression, as appropriate, was used to estimate the effect of planned mode of delivery on maternal and perinatal outcomes adjusted for sociodemographic, maternal medical, and obstetric-related characteristics. A total of 45,579 women gave birth by ERCS, and 28,464 had a planned VBAC, 28.4% of whom went on to have an in-labor nonelective repeat cesarean section. Compared to women delivering by ERCS, those who had a planned VBAC were significantly more likely to have uterine rupture (0.24%, n = 69 versus 0.04%, n = 17, adjusted odds ratio [aOR] 7.3, 95% confidence interval [CI] 3.9-13.9, p < 0.001), a blood transfusion (1.14%, n = 324 versus 0.50%, n = 226, aOR 2.3, 95% CI 1.9-2.8, p < 0.001), puerperal sepsis (0.27%, n = 76 versus 0.17%, n = 78, aOR 1.8, 95% CI 1.3-2.7, p = 0.002), and surgical injury (0.17% versus 0.09%, n = 40, aOR 3.0, 95% CI 1.8-4.8, p < 0.001) and experience adverse perinatal outcomes including perinatal death, admission to a neonatal unit, resuscitation requiring drugs and/or intubation, and an Apgar score < 7 at 5 minutes (7.99%, n = 2,049 versus 6.37%, n = 2,570, aOR 1.6, 95% CI 1.5-1.7, p < 0.001). However, women who had a planned VBAC were more likely than those delivering by ERCS to breastfeed at birth or hospital discharge (63.6%, n = 14,906 versus 54.5%, n = 21,403, adjusted risk ratio [aRR] 1.2, 95% CI 1.1-1.2, p < 0.001) and were more likely to breastfeed at 6-8 weeks postpartum (43.6%, n = 10,496 versus 34.5%, n = 13,556, aRR 1.2, 95% CI 1.2-1.3, p < 0.001). The effect of planned mode of delivery on the mother's risk of having a postnatal stay greater than 5 days, an overnight readmission to hospital within 42 days of birth, and other puerperal infection varied according to whether she had any prior vaginal deliveries and, in the case of length of postnatal stay, also varied according to the number of prior cesarean sections. The study is mainly limited by the potential for residual confounding and misclassification bias.
Among women considered eligible to have a planned VBAC, planned VBAC compared to ERCS is associated with an increased risk of the mother having serious birth-related maternal and perinatal complications. Conversely, planned VBAC is associated with an increased likelihood of breastfeeding, whereas the effect on other maternal outcomes differs according to whether a woman has any prior vaginal deliveries and the number of prior cesarean sections she has had. However, the absolute risk of adverse outcomes is small for either delivery approach. This information can be used to counsel and manage the increasing number of women with previous cesarean section, but more research is needed on longer-term outcomes.]]></description><identifier>ISSN: 1549-1676</identifier><identifier>ISSN: 1549-1277</identifier><identifier>EISSN: 1549-1676</identifier><identifier>DOI: 10.1371/journal.pmed.1002913</identifier><identifier>PMID: 31550245</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adult ; Apgar score ; Biology and Life Sciences ; Birth ; Births ; Blood transfusion ; Breast Feeding ; Cesarean section ; Cesarean Section, Repeat - adverse effects ; Cesarean Section, Repeat - mortality ; Childbirth & labor ; Cohort analysis ; Complications ; Control ; Delivery (Childbirth) ; Elective Surgical Procedures ; Female ; Health aspects ; Health risk assessment ; Hospital admission and discharge ; Humans ; Infant ; Infant mortality ; Infant, Newborn ; Intubation ; Length of Stay ; Medical Record Linkage ; Medicine and Health Sciences ; Methods ; Neonates ; Newborn infants ; Obstetrics ; Parturition ; Patient Discharge ; Patient Readmission ; People and places ; Perinatal Death ; Perinatal Mortality ; Poisson density functions ; Population-based studies ; Postpartum ; Pregnancy ; Pregnancy Complications - epidemiology ; Pregnancy Complications - mortality ; Pregnancy Complications - therapy ; Pregnant women ; Puerperal infection ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Scotland - epidemiology ; Sepsis ; Systematic review ; Time Factors ; Transfusion ; Uterine perforation ; Uterus ; Vagina ; Vaginal Birth after Cesarean - adverse effects ; Vaginal Birth after Cesarean - mortality ; Women ; Womens health</subject><ispartof>PLoS medicine, 2019-09, Vol.16 (9), p.e1002913-e1002913</ispartof><rights>COPYRIGHT 2019 Public Library of Science</rights><rights>2019 Fitzpatrick et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2019 Fitzpatrick et al 2019 Fitzpatrick et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c764t-c54eb24820913346afe64e8b92e557671a05071241028dfc74f46ef33d0a3e823</citedby><cites>FETCH-LOGICAL-c764t-c54eb24820913346afe64e8b92e557671a05071241028dfc74f46ef33d0a3e823</cites><orcidid>0000-0001-9554-6337 ; 0000-0002-8058-6181 ; 0000-0002-6476-5307 ; 0000-0002-2358-5860</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6759152/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6759152/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31550245$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Smith, Gordon C.</contributor><creatorcontrib>Fitzpatrick, Kathryn E</creatorcontrib><creatorcontrib>Kurinczuk, Jennifer J</creatorcontrib><creatorcontrib>Bhattacharya, Sohinee</creatorcontrib><creatorcontrib>Quigley, Maria A</creatorcontrib><title>Planned mode of delivery after previous cesarean section and short-term maternal and perinatal outcomes: A population-based record linkage cohort study in Scotland</title><title>PLoS medicine</title><addtitle>PLoS Med</addtitle><description><![CDATA[Policy consensus in high-income countries supports offering pregnant women with previous cesarean section a choice between planning an elective repeat cesarean section (ERCS) or attempting a vaginal birth, known as a planned vaginal birth after previous cesarean (VBAC), provided they do not have contraindications to planned VBAC. However, robust comprehensive information on the associated outcomes to counsel eligible women about this choice is lacking. This study investigated the short-term maternal and perinatal outcomes associated with planned mode of delivery after previous cesarean section among women delivering a term singleton and considered eligible to have a planned VBAC.
A population-based cohort of 74,043 term singleton births in Scotland between 2002 and 2015 to women with one or more previous cesarean sections was conducted using linked Scottish national datasets. Logistic or modified Poisson regression, as appropriate, was used to estimate the effect of planned mode of delivery on maternal and perinatal outcomes adjusted for sociodemographic, maternal medical, and obstetric-related characteristics. A total of 45,579 women gave birth by ERCS, and 28,464 had a planned VBAC, 28.4% of whom went on to have an in-labor nonelective repeat cesarean section. Compared to women delivering by ERCS, those who had a planned VBAC were significantly more likely to have uterine rupture (0.24%, n = 69 versus 0.04%, n = 17, adjusted odds ratio [aOR] 7.3, 95% confidence interval [CI] 3.9-13.9, p < 0.001), a blood transfusion (1.14%, n = 324 versus 0.50%, n = 226, aOR 2.3, 95% CI 1.9-2.8, p < 0.001), puerperal sepsis (0.27%, n = 76 versus 0.17%, n = 78, aOR 1.8, 95% CI 1.3-2.7, p = 0.002), and surgical injury (0.17% versus 0.09%, n = 40, aOR 3.0, 95% CI 1.8-4.8, p < 0.001) and experience adverse perinatal outcomes including perinatal death, admission to a neonatal unit, resuscitation requiring drugs and/or intubation, and an Apgar score < 7 at 5 minutes (7.99%, n = 2,049 versus 6.37%, n = 2,570, aOR 1.6, 95% CI 1.5-1.7, p < 0.001). However, women who had a planned VBAC were more likely than those delivering by ERCS to breastfeed at birth or hospital discharge (63.6%, n = 14,906 versus 54.5%, n = 21,403, adjusted risk ratio [aRR] 1.2, 95% CI 1.1-1.2, p < 0.001) and were more likely to breastfeed at 6-8 weeks postpartum (43.6%, n = 10,496 versus 34.5%, n = 13,556, aRR 1.2, 95% CI 1.2-1.3, p < 0.001). The effect of planned mode of delivery on the mother's risk of having a postnatal stay greater than 5 days, an overnight readmission to hospital within 42 days of birth, and other puerperal infection varied according to whether she had any prior vaginal deliveries and, in the case of length of postnatal stay, also varied according to the number of prior cesarean sections. The study is mainly limited by the potential for residual confounding and misclassification bias.
Among women considered eligible to have a planned VBAC, planned VBAC compared to ERCS is associated with an increased risk of the mother having serious birth-related maternal and perinatal complications. Conversely, planned VBAC is associated with an increased likelihood of breastfeeding, whereas the effect on other maternal outcomes differs according to whether a woman has any prior vaginal deliveries and the number of prior cesarean sections she has had. However, the absolute risk of adverse outcomes is small for either delivery approach. This information can be used to counsel and manage the increasing number of women with previous cesarean section, but more research is needed on longer-term outcomes.]]></description><subject>Adult</subject><subject>Apgar score</subject><subject>Biology and Life Sciences</subject><subject>Birth</subject><subject>Births</subject><subject>Blood transfusion</subject><subject>Breast Feeding</subject><subject>Cesarean section</subject><subject>Cesarean Section, Repeat - adverse effects</subject><subject>Cesarean Section, Repeat - mortality</subject><subject>Childbirth & labor</subject><subject>Cohort analysis</subject><subject>Complications</subject><subject>Control</subject><subject>Delivery (Childbirth)</subject><subject>Elective Surgical Procedures</subject><subject>Female</subject><subject>Health aspects</subject><subject>Health risk assessment</subject><subject>Hospital admission and discharge</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant mortality</subject><subject>Infant, Newborn</subject><subject>Intubation</subject><subject>Length of Stay</subject><subject>Medical Record Linkage</subject><subject>Medicine and Health Sciences</subject><subject>Methods</subject><subject>Neonates</subject><subject>Newborn infants</subject><subject>Obstetrics</subject><subject>Parturition</subject><subject>Patient Discharge</subject><subject>Patient Readmission</subject><subject>People and places</subject><subject>Perinatal Death</subject><subject>Perinatal Mortality</subject><subject>Poisson density functions</subject><subject>Population-based studies</subject><subject>Postpartum</subject><subject>Pregnancy</subject><subject>Pregnancy Complications - epidemiology</subject><subject>Pregnancy Complications - mortality</subject><subject>Pregnancy Complications - therapy</subject><subject>Pregnant women</subject><subject>Puerperal infection</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Scotland - epidemiology</subject><subject>Sepsis</subject><subject>Systematic review</subject><subject>Time Factors</subject><subject>Transfusion</subject><subject>Uterine perforation</subject><subject>Uterus</subject><subject>Vagina</subject><subject>Vaginal Birth after Cesarean - adverse effects</subject><subject>Vaginal Birth after Cesarean - mortality</subject><subject>Women</subject><subject>Womens health</subject><issn>1549-1676</issn><issn>1549-1277</issn><issn>1549-1676</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>DOA</sourceid><recordid>eNqVk9tu1DAQhiMEoqXwBggsISG4yGI7dg69QKoqDpUqiihwaznOeNclsYPtVOzz8KI47bbqor0A5cLx5Jt_Tpkse0rwghQVeXPhJm9lvxgH6BYEY9qQ4l62TzhrclJW5f0773vZoxAuZgY3-GG2VxDOMWV8P_v9uZfWQocG1wFyGnXQm0vwayR1BI9GD5fGTQEpCNKDtCiAisZZJG2Hwsr5mCduQINMR8rnyj6CN1bGdHNTVG6AcIiO0OjGqZezc97KkGJ6UM53qDf2h1wCUm6WQyFO3RoZi86Viym77nH2QMs-wJPNeZB9e__u6_HH_PTsw8nx0WmuqpLFXHEGLWU1xakTBSulhpJB3TYUOK_KikjMcUUoI5jWnVYV06wEXRQdlgXUtDjInl_rjr0LYtPfIGiBS8qLum4ScXJNdE5eiNGbQfq1cNKIK4PzSyF9NKoH0VCpCa50y4qGNVy2dVO2WnecVryuyaz1dhNtatMIFdjoZb8luv3FmpVYuktRVrwhfE731UbAu58ThCgGExT0qWWQJiYobVK1ZVPxhL74C91d3YZaylSAsdqluGoWFUclpphVpK4Sle-glmAhJeksaJPMW_xiB5-eDgajdjq83nJITIRfcSmnEMTJ-Zf_YD_9O3v2fZt9eYddgezjKrh-mn_esA2ya1B5F4IHfTtAgsW8pzedFvOeis2eJrdnd4d_63SzmMUfKlo4Sg</recordid><startdate>20190924</startdate><enddate>20190924</enddate><creator>Fitzpatrick, Kathryn E</creator><creator>Kurinczuk, Jennifer J</creator><creator>Bhattacharya, Sohinee</creator><creator>Quigley, Maria A</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISN</scope><scope>ISR</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><scope>CZK</scope><orcidid>https://orcid.org/0000-0001-9554-6337</orcidid><orcidid>https://orcid.org/0000-0002-8058-6181</orcidid><orcidid>https://orcid.org/0000-0002-6476-5307</orcidid><orcidid>https://orcid.org/0000-0002-2358-5860</orcidid></search><sort><creationdate>20190924</creationdate><title>Planned mode of delivery after previous cesarean section and short-term maternal and perinatal outcomes: A population-based record linkage cohort study in Scotland</title><author>Fitzpatrick, Kathryn E ; Kurinczuk, Jennifer J ; Bhattacharya, Sohinee ; Quigley, Maria A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c764t-c54eb24820913346afe64e8b92e557671a05071241028dfc74f46ef33d0a3e823</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Apgar score</topic><topic>Biology and Life Sciences</topic><topic>Birth</topic><topic>Births</topic><topic>Blood transfusion</topic><topic>Breast Feeding</topic><topic>Cesarean section</topic><topic>Cesarean Section, Repeat - adverse effects</topic><topic>Cesarean Section, Repeat - mortality</topic><topic>Childbirth & labor</topic><topic>Cohort analysis</topic><topic>Complications</topic><topic>Control</topic><topic>Delivery (Childbirth)</topic><topic>Elective Surgical Procedures</topic><topic>Female</topic><topic>Health aspects</topic><topic>Health risk assessment</topic><topic>Hospital admission and discharge</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant mortality</topic><topic>Infant, Newborn</topic><topic>Intubation</topic><topic>Length of Stay</topic><topic>Medical Record Linkage</topic><topic>Medicine and Health Sciences</topic><topic>Methods</topic><topic>Neonates</topic><topic>Newborn infants</topic><topic>Obstetrics</topic><topic>Parturition</topic><topic>Patient Discharge</topic><topic>Patient Readmission</topic><topic>People and places</topic><topic>Perinatal Death</topic><topic>Perinatal Mortality</topic><topic>Poisson density functions</topic><topic>Population-based studies</topic><topic>Postpartum</topic><topic>Pregnancy</topic><topic>Pregnancy Complications - epidemiology</topic><topic>Pregnancy Complications - mortality</topic><topic>Pregnancy Complications - therapy</topic><topic>Pregnant women</topic><topic>Puerperal infection</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Scotland - epidemiology</topic><topic>Sepsis</topic><topic>Systematic review</topic><topic>Time Factors</topic><topic>Transfusion</topic><topic>Uterine perforation</topic><topic>Uterus</topic><topic>Vagina</topic><topic>Vaginal Birth after Cesarean - adverse effects</topic><topic>Vaginal Birth after Cesarean - mortality</topic><topic>Women</topic><topic>Womens health</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fitzpatrick, Kathryn E</creatorcontrib><creatorcontrib>Kurinczuk, Jennifer J</creatorcontrib><creatorcontrib>Bhattacharya, Sohinee</creatorcontrib><creatorcontrib>Quigley, Maria A</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Canada</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><collection>PLoS Medicine</collection><jtitle>PLoS medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fitzpatrick, Kathryn E</au><au>Kurinczuk, Jennifer J</au><au>Bhattacharya, Sohinee</au><au>Quigley, Maria A</au><au>Smith, Gordon C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Planned mode of delivery after previous cesarean section and short-term maternal and perinatal outcomes: A population-based record linkage cohort study in Scotland</atitle><jtitle>PLoS medicine</jtitle><addtitle>PLoS Med</addtitle><date>2019-09-24</date><risdate>2019</risdate><volume>16</volume><issue>9</issue><spage>e1002913</spage><epage>e1002913</epage><pages>e1002913-e1002913</pages><issn>1549-1676</issn><issn>1549-1277</issn><eissn>1549-1676</eissn><abstract><![CDATA[Policy consensus in high-income countries supports offering pregnant women with previous cesarean section a choice between planning an elective repeat cesarean section (ERCS) or attempting a vaginal birth, known as a planned vaginal birth after previous cesarean (VBAC), provided they do not have contraindications to planned VBAC. However, robust comprehensive information on the associated outcomes to counsel eligible women about this choice is lacking. This study investigated the short-term maternal and perinatal outcomes associated with planned mode of delivery after previous cesarean section among women delivering a term singleton and considered eligible to have a planned VBAC.
A population-based cohort of 74,043 term singleton births in Scotland between 2002 and 2015 to women with one or more previous cesarean sections was conducted using linked Scottish national datasets. Logistic or modified Poisson regression, as appropriate, was used to estimate the effect of planned mode of delivery on maternal and perinatal outcomes adjusted for sociodemographic, maternal medical, and obstetric-related characteristics. A total of 45,579 women gave birth by ERCS, and 28,464 had a planned VBAC, 28.4% of whom went on to have an in-labor nonelective repeat cesarean section. Compared to women delivering by ERCS, those who had a planned VBAC were significantly more likely to have uterine rupture (0.24%, n = 69 versus 0.04%, n = 17, adjusted odds ratio [aOR] 7.3, 95% confidence interval [CI] 3.9-13.9, p < 0.001), a blood transfusion (1.14%, n = 324 versus 0.50%, n = 226, aOR 2.3, 95% CI 1.9-2.8, p < 0.001), puerperal sepsis (0.27%, n = 76 versus 0.17%, n = 78, aOR 1.8, 95% CI 1.3-2.7, p = 0.002), and surgical injury (0.17% versus 0.09%, n = 40, aOR 3.0, 95% CI 1.8-4.8, p < 0.001) and experience adverse perinatal outcomes including perinatal death, admission to a neonatal unit, resuscitation requiring drugs and/or intubation, and an Apgar score < 7 at 5 minutes (7.99%, n = 2,049 versus 6.37%, n = 2,570, aOR 1.6, 95% CI 1.5-1.7, p < 0.001). However, women who had a planned VBAC were more likely than those delivering by ERCS to breastfeed at birth or hospital discharge (63.6%, n = 14,906 versus 54.5%, n = 21,403, adjusted risk ratio [aRR] 1.2, 95% CI 1.1-1.2, p < 0.001) and were more likely to breastfeed at 6-8 weeks postpartum (43.6%, n = 10,496 versus 34.5%, n = 13,556, aRR 1.2, 95% CI 1.2-1.3, p < 0.001). The effect of planned mode of delivery on the mother's risk of having a postnatal stay greater than 5 days, an overnight readmission to hospital within 42 days of birth, and other puerperal infection varied according to whether she had any prior vaginal deliveries and, in the case of length of postnatal stay, also varied according to the number of prior cesarean sections. The study is mainly limited by the potential for residual confounding and misclassification bias.
Among women considered eligible to have a planned VBAC, planned VBAC compared to ERCS is associated with an increased risk of the mother having serious birth-related maternal and perinatal complications. Conversely, planned VBAC is associated with an increased likelihood of breastfeeding, whereas the effect on other maternal outcomes differs according to whether a woman has any prior vaginal deliveries and the number of prior cesarean sections she has had. However, the absolute risk of adverse outcomes is small for either delivery approach. This information can be used to counsel and manage the increasing number of women with previous cesarean section, but more research is needed on longer-term outcomes.]]></abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>31550245</pmid><doi>10.1371/journal.pmed.1002913</doi><orcidid>https://orcid.org/0000-0001-9554-6337</orcidid><orcidid>https://orcid.org/0000-0002-8058-6181</orcidid><orcidid>https://orcid.org/0000-0002-6476-5307</orcidid><orcidid>https://orcid.org/0000-0002-2358-5860</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1549-1676 |
| ispartof | PLoS medicine, 2019-09, Vol.16 (9), p.e1002913-e1002913 |
| issn | 1549-1676 1549-1277 1549-1676 |
| language | eng |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Adult Apgar score Biology and Life Sciences Birth Births Blood transfusion Breast Feeding Cesarean section Cesarean Section, Repeat - adverse effects Cesarean Section, Repeat - mortality Childbirth & labor Cohort analysis Complications Control Delivery (Childbirth) Elective Surgical Procedures Female Health aspects Health risk assessment Hospital admission and discharge Humans Infant Infant mortality Infant, Newborn Intubation Length of Stay Medical Record Linkage Medicine and Health Sciences Methods Neonates Newborn infants Obstetrics Parturition Patient Discharge Patient Readmission People and places Perinatal Death Perinatal Mortality Poisson density functions Population-based studies Postpartum Pregnancy Pregnancy Complications - epidemiology Pregnancy Complications - mortality Pregnancy Complications - therapy Pregnant women Puerperal infection Retrospective Studies Risk Assessment Risk Factors Scotland - epidemiology Sepsis Systematic review Time Factors Transfusion Uterine perforation Uterus Vagina Vaginal Birth after Cesarean - adverse effects Vaginal Birth after Cesarean - mortality Women Womens health |
| title | Planned mode of delivery after previous cesarean section and short-term maternal and perinatal outcomes: A population-based record linkage cohort study in Scotland |
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