Low risk pregnancies after a cesarean section: Determinants of trial of labor and its failure
In pregnancies after a previous cesarean section (CS), a planned repeat CS delivery has been associated with excess risk of adverse outcome. However, also the alternative, a trial of labor after CS (TOLAC), has been associated with excess risks. A TOLAC failure, involving a non-planned CS, carries t...
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| description | In pregnancies after a previous cesarean section (CS), a planned repeat CS delivery has been associated with excess risk of adverse outcome. However, also the alternative, a trial of labor after CS (TOLAC), has been associated with excess risks. A TOLAC failure, involving a non-planned CS, carries the highest risk of adverse outcome and a vaginal delivery the lowest. Thus, the decision regarding delivery mode is pivotal in clinical handling of these pregnancies. However, even with a high TOLAC rate, as seen in Norway, repeat CSs are regularly performed for no apparent medical reason. The objective of the present study was to assess to which extent demographic, socioeconomic, and health system factors are determinants of TOLAC and TOLAC failure in low risk pregnancies, and whether any effects observed changed with time.
The study group comprised 24 645 second deliveries (1989-2014) after a first delivery CS. Thus, none of the women had prior vaginal deliveries or more than one CS. Included pregnancies were low risk, cephalic, single, and had gestational age ≥ 37 weeks. Data were obtained from the Medical Birth Registry of Norway (MBRN). The exposure variables were (second delivery) maternal age, length of maternal education, maternal country of origin, size of the delivery unit, health region (South-East, West, Mid, North), and maternal county of residence. The outcomes were TOLAC and TOLAC failure, as rates (%), relative risk (RR) and relative risk adjusted (ARR). Changes in determinant effects over time were assessed by comparing rates in two periods, 1989-2002 vs 2003-2014, and including these periods in an interaction model.
The TOLAC rate was 74.9%, with a TOLAC failure rate of 16.2%, resulting in a vaginal birth rate of 62.8%. Low TOLAC rates were observed at high maternal age and in women from East Asia or Latin America. High TOLAC failure rates were observed at high maternal age, in women with less than 11 years of education, and in women of non-western origin. The effects of health system factors, i.e. delivery unit size and administrative region were considerable, on both TOLAC and TOLAC failure. The effects of several determinants changed significantly (P < 0.05) from 1989-2002 to 2003-2014: The association between non-TOLAC and maternal age > 39 years became weaker, the association between short education and TOLAC failure became stronger, and the association between TOLAC failure and small size of delivery unit became stronger.
Low maternal age |
| doi_str_mv | 10.1371/journal.pone.0226894 |
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The study group comprised 24 645 second deliveries (1989-2014) after a first delivery CS. Thus, none of the women had prior vaginal deliveries or more than one CS. Included pregnancies were low risk, cephalic, single, and had gestational age ≥ 37 weeks. Data were obtained from the Medical Birth Registry of Norway (MBRN). The exposure variables were (second delivery) maternal age, length of maternal education, maternal country of origin, size of the delivery unit, health region (South-East, West, Mid, North), and maternal county of residence. The outcomes were TOLAC and TOLAC failure, as rates (%), relative risk (RR) and relative risk adjusted (ARR). Changes in determinant effects over time were assessed by comparing rates in two periods, 1989-2002 vs 2003-2014, and including these periods in an interaction model.
The TOLAC rate was 74.9%, with a TOLAC failure rate of 16.2%, resulting in a vaginal birth rate of 62.8%. Low TOLAC rates were observed at high maternal age and in women from East Asia or Latin America. High TOLAC failure rates were observed at high maternal age, in women with less than 11 years of education, and in women of non-western origin. The effects of health system factors, i.e. delivery unit size and administrative region were considerable, on both TOLAC and TOLAC failure. The effects of several determinants changed significantly (P < 0.05) from 1989-2002 to 2003-2014: The association between non-TOLAC and maternal age > 39 years became weaker, the association between short education and TOLAC failure became stronger, and the association between TOLAC failure and small size of delivery unit became stronger.
Low maternal age, high education, and western country of origin were associated with high TOLAC rates, and low TOLAC failure rates. Maternity unit characteristics (size and region) contributed with effects on the same level as individual determinants studied. Temporal changes were observed in determinant effects.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0226894</identifier><identifier>PMID: 31929542</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adult ; Age ; Birth ; Cesarean section ; Cesarean Section - adverse effects ; Cesarean Section, Repeat - statistics & numerical data ; Clinical Decision-Making ; Conditioned stimulus ; Demographics ; Determinants ; Diabetes ; Education ; Educational Status ; Failure rates ; Female ; Gestational age ; Gynecology ; Health ; Health risk assessment ; Hospitals ; Humans ; Hypertension ; Interaction models ; Labor ; Maternal Age ; Medicine and Health Sciences ; Methods ; Norway - epidemiology ; Obstetrics ; Parent educational background ; Pediatrics ; People and Places ; Pregnancy ; Pregnancy complications ; Public health ; Retrospective Studies ; Risk ; Socio-economic aspects ; Socioeconomic Factors ; Trial of Labor ; Vagina ; Womens health</subject><ispartof>PloS one, 2020-01, Vol.15 (1), p.e0226894-e0226894</ispartof><rights>2020 Lehmann 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>2020 Lehmann et al 2020 Lehmann et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c526t-4c8391707da1cc3e5093a7348ea752818bfe1a33341d12e9dd8a2ff9bc1135803</citedby><cites>FETCH-LOGICAL-c526t-4c8391707da1cc3e5093a7348ea752818bfe1a33341d12e9dd8a2ff9bc1135803</cites><orcidid>0000-0002-0681-9928</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/PMC6957160/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6957160/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,724,777,781,861,882,2096,2915,23847,27905,27906,53772,53774,79349,79350</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31929542$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Laine, Katariina</contributor><creatorcontrib>Lehmann, Sjur</creatorcontrib><creatorcontrib>Baghestan, Elham</creatorcontrib><creatorcontrib>Børdahl, Per E</creatorcontrib><creatorcontrib>Irgens, Lorentz M</creatorcontrib><creatorcontrib>Rasmussen, Svein</creatorcontrib><title>Low risk pregnancies after a cesarean section: Determinants of trial of labor and its failure</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>In pregnancies after a previous cesarean section (CS), a planned repeat CS delivery has been associated with excess risk of adverse outcome. However, also the alternative, a trial of labor after CS (TOLAC), has been associated with excess risks. A TOLAC failure, involving a non-planned CS, carries the highest risk of adverse outcome and a vaginal delivery the lowest. Thus, the decision regarding delivery mode is pivotal in clinical handling of these pregnancies. However, even with a high TOLAC rate, as seen in Norway, repeat CSs are regularly performed for no apparent medical reason. The objective of the present study was to assess to which extent demographic, socioeconomic, and health system factors are determinants of TOLAC and TOLAC failure in low risk pregnancies, and whether any effects observed changed with time.
The study group comprised 24 645 second deliveries (1989-2014) after a first delivery CS. Thus, none of the women had prior vaginal deliveries or more than one CS. Included pregnancies were low risk, cephalic, single, and had gestational age ≥ 37 weeks. Data were obtained from the Medical Birth Registry of Norway (MBRN). The exposure variables were (second delivery) maternal age, length of maternal education, maternal country of origin, size of the delivery unit, health region (South-East, West, Mid, North), and maternal county of residence. The outcomes were TOLAC and TOLAC failure, as rates (%), relative risk (RR) and relative risk adjusted (ARR). Changes in determinant effects over time were assessed by comparing rates in two periods, 1989-2002 vs 2003-2014, and including these periods in an interaction model.
The TOLAC rate was 74.9%, with a TOLAC failure rate of 16.2%, resulting in a vaginal birth rate of 62.8%. Low TOLAC rates were observed at high maternal age and in women from East Asia or Latin America. High TOLAC failure rates were observed at high maternal age, in women with less than 11 years of education, and in women of non-western origin. The effects of health system factors, i.e. delivery unit size and administrative region were considerable, on both TOLAC and TOLAC failure. The effects of several determinants changed significantly (P < 0.05) from 1989-2002 to 2003-2014: The association between non-TOLAC and maternal age > 39 years became weaker, the association between short education and TOLAC failure became stronger, and the association between TOLAC failure and small size of delivery unit became stronger.
Low maternal age, high education, and western country of origin were associated with high TOLAC rates, and low TOLAC failure rates. Maternity unit characteristics (size and region) contributed with effects on the same level as individual determinants studied. Temporal changes were observed in determinant effects.</description><subject>Adult</subject><subject>Age</subject><subject>Birth</subject><subject>Cesarean section</subject><subject>Cesarean Section - adverse effects</subject><subject>Cesarean Section, Repeat - statistics & numerical data</subject><subject>Clinical Decision-Making</subject><subject>Conditioned stimulus</subject><subject>Demographics</subject><subject>Determinants</subject><subject>Diabetes</subject><subject>Education</subject><subject>Educational Status</subject><subject>Failure rates</subject><subject>Female</subject><subject>Gestational age</subject><subject>Gynecology</subject><subject>Health</subject><subject>Health risk assessment</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Interaction models</subject><subject>Labor</subject><subject>Maternal Age</subject><subject>Medicine and Health Sciences</subject><subject>Methods</subject><subject>Norway - epidemiology</subject><subject>Obstetrics</subject><subject>Parent educational background</subject><subject>Pediatrics</subject><subject>People and Places</subject><subject>Pregnancy</subject><subject>Pregnancy complications</subject><subject>Public health</subject><subject>Retrospective Studies</subject><subject>Risk</subject><subject>Socio-economic aspects</subject><subject>Socioeconomic Factors</subject><subject>Trial of Labor</subject><subject>Vagina</subject><subject>Womens health</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</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>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNptUktvEzEQXiEQLYV_gMASFy4JfqzXNgckVKCtFIkLHJE16x0HB2cd7F0Q_x6nSasWcfLI32Nm7K9pnjO6ZEKxN5s05xHicpdGXFLOO23aB80pM4IvOk7Fwzv1SfOklA2lUuiue9ycCGa4kS0_bb6t0m-SQ_lBdhnXI4wuYCHgJ8wEiMMCGWEkBd0U0viWfMCKbEMlToUkT6YcIO6LCH2qknEgoSIeQpwzPm0eeYgFnx3Ps-brp49fzi8Xq88XV-fvVwsneTctWqeFYYqqAZhzAiU1ApRoNYKSXDPde2QghGjZwDiaYdDAvTe9Y0xITcVZ8_Lgu4up2OPLFMuFUFRKbnRlXB0YQ4KN3eWwhfzHJgj2-iLltYU8BRfRSqrBOCUQ0bfOdFC7-F65vnWMu4FVr3fHbnO_xcHhOGWI90zvI2P4btfpl-2MVKzbj_v6aJDTzxnLZLehOIwRRkzz9dyaqvqfbaW--of6_-3aA8vlVEpGfzsMo3aflhuV3afFHtNSZS_uLnIruomH-AvAUL42</recordid><startdate>20200101</startdate><enddate>20200101</enddate><creator>Lehmann, Sjur</creator><creator>Baghestan, Elham</creator><creator>Børdahl, Per E</creator><creator>Irgens, Lorentz M</creator><creator>Rasmussen, Svein</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>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-0681-9928</orcidid></search><sort><creationdate>20200101</creationdate><title>Low risk pregnancies after a cesarean section: Determinants of trial of labor and its failure</title><author>Lehmann, Sjur ; Baghestan, Elham ; Børdahl, Per E ; Irgens, Lorentz M ; Rasmussen, Svein</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c526t-4c8391707da1cc3e5093a7348ea752818bfe1a33341d12e9dd8a2ff9bc1135803</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Age</topic><topic>Birth</topic><topic>Cesarean section</topic><topic>Cesarean Section - adverse effects</topic><topic>Cesarean Section, Repeat - statistics & numerical data</topic><topic>Clinical Decision-Making</topic><topic>Conditioned stimulus</topic><topic>Demographics</topic><topic>Determinants</topic><topic>Diabetes</topic><topic>Education</topic><topic>Educational Status</topic><topic>Failure rates</topic><topic>Female</topic><topic>Gestational age</topic><topic>Gynecology</topic><topic>Health</topic><topic>Health risk assessment</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Interaction models</topic><topic>Labor</topic><topic>Maternal Age</topic><topic>Medicine and Health Sciences</topic><topic>Methods</topic><topic>Norway - epidemiology</topic><topic>Obstetrics</topic><topic>Parent educational background</topic><topic>Pediatrics</topic><topic>People and Places</topic><topic>Pregnancy</topic><topic>Pregnancy complications</topic><topic>Public health</topic><topic>Retrospective Studies</topic><topic>Risk</topic><topic>Socio-economic aspects</topic><topic>Socioeconomic Factors</topic><topic>Trial of Labor</topic><topic>Vagina</topic><topic>Womens health</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lehmann, Sjur</creatorcontrib><creatorcontrib>Baghestan, Elham</creatorcontrib><creatorcontrib>Børdahl, Per E</creatorcontrib><creatorcontrib>Irgens, Lorentz M</creatorcontrib><creatorcontrib>Rasmussen, Svein</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Ecology Abstracts</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Meteorological & Geoastrophysical Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Materials Science Collection</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Materials Science Database</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Meteorological & Geoastrophysical Abstracts - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lehmann, Sjur</au><au>Baghestan, Elham</au><au>Børdahl, Per E</au><au>Irgens, Lorentz M</au><au>Rasmussen, Svein</au><au>Laine, Katariina</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Low risk pregnancies after a cesarean section: Determinants of trial of labor and its failure</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2020-01-01</date><risdate>2020</risdate><volume>15</volume><issue>1</issue><spage>e0226894</spage><epage>e0226894</epage><pages>e0226894-e0226894</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>In pregnancies after a previous cesarean section (CS), a planned repeat CS delivery has been associated with excess risk of adverse outcome. However, also the alternative, a trial of labor after CS (TOLAC), has been associated with excess risks. A TOLAC failure, involving a non-planned CS, carries the highest risk of adverse outcome and a vaginal delivery the lowest. Thus, the decision regarding delivery mode is pivotal in clinical handling of these pregnancies. However, even with a high TOLAC rate, as seen in Norway, repeat CSs are regularly performed for no apparent medical reason. The objective of the present study was to assess to which extent demographic, socioeconomic, and health system factors are determinants of TOLAC and TOLAC failure in low risk pregnancies, and whether any effects observed changed with time.
The study group comprised 24 645 second deliveries (1989-2014) after a first delivery CS. Thus, none of the women had prior vaginal deliveries or more than one CS. Included pregnancies were low risk, cephalic, single, and had gestational age ≥ 37 weeks. Data were obtained from the Medical Birth Registry of Norway (MBRN). The exposure variables were (second delivery) maternal age, length of maternal education, maternal country of origin, size of the delivery unit, health region (South-East, West, Mid, North), and maternal county of residence. The outcomes were TOLAC and TOLAC failure, as rates (%), relative risk (RR) and relative risk adjusted (ARR). Changes in determinant effects over time were assessed by comparing rates in two periods, 1989-2002 vs 2003-2014, and including these periods in an interaction model.
The TOLAC rate was 74.9%, with a TOLAC failure rate of 16.2%, resulting in a vaginal birth rate of 62.8%. Low TOLAC rates were observed at high maternal age and in women from East Asia or Latin America. High TOLAC failure rates were observed at high maternal age, in women with less than 11 years of education, and in women of non-western origin. The effects of health system factors, i.e. delivery unit size and administrative region were considerable, on both TOLAC and TOLAC failure. The effects of several determinants changed significantly (P < 0.05) from 1989-2002 to 2003-2014: The association between non-TOLAC and maternal age > 39 years became weaker, the association between short education and TOLAC failure became stronger, and the association between TOLAC failure and small size of delivery unit became stronger.
Low maternal age, high education, and western country of origin were associated with high TOLAC rates, and low TOLAC failure rates. Maternity unit characteristics (size and region) contributed with effects on the same level as individual determinants studied. Temporal changes were observed in determinant effects.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>31929542</pmid><doi>10.1371/journal.pone.0226894</doi><orcidid>https://orcid.org/0000-0002-0681-9928</orcidid><oa>free_for_read</oa></addata></record> |
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| recordid | cdi_plos_journals_2337055298 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS); EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Adult Age Birth Cesarean section Cesarean Section - adverse effects Cesarean Section, Repeat - statistics & numerical data Clinical Decision-Making Conditioned stimulus Demographics Determinants Diabetes Education Educational Status Failure rates Female Gestational age Gynecology Health Health risk assessment Hospitals Humans Hypertension Interaction models Labor Maternal Age Medicine and Health Sciences Methods Norway - epidemiology Obstetrics Parent educational background Pediatrics People and Places Pregnancy Pregnancy complications Public health Retrospective Studies Risk Socio-economic aspects Socioeconomic Factors Trial of Labor Vagina Womens health |
| title | Low risk pregnancies after a cesarean section: Determinants of trial of labor and its failure |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-20T09%3A51%3A20IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Low%20risk%20pregnancies%20after%20a%20cesarean%20section:%20Determinants%20of%20trial%20of%20labor%20and%20its%20failure&rft.jtitle=PloS%20one&rft.au=Lehmann,%20Sjur&rft.date=2020-01-01&rft.volume=15&rft.issue=1&rft.spage=e0226894&rft.epage=e0226894&rft.pages=e0226894-e0226894&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0226894&rft_dat=%3Cproquest_plos_%3E2337055298%3C/proquest_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2337055298&rft_id=info:pmid/31929542&rft_doaj_id=oai_doaj_org_article_508a9c73eeef4c96ac11fb7cb4c12cd1&rfr_iscdi=true |