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Strategies to increase the rate of vaginal deliveries after cesarean without negative impact on outcomes

Vikhareva, Olga LU ; Nedopekina, Ekaterina LU ; Kristensen, Karl LU ; Dahlbäck, Charlotte LU ; Pihlsgård, Mats LU ; Rickle, Gisela Skott LU and Herbst, Andreas LU (2022) In Midwifery 106.
Abstract

Objective: To compare the rate of vaginal birth after cesarean section (VBAC), including the maternal and perinatal outcomes, in two historical cohorts before and after the implementation of specific changes in the clinical practice. Design: A retrospective cohort study. Setting: Skåne University Hospital in Malmö, Sweden. Participants: including all women with one previous cesarean section (CS), who delivered during two 4-year periods: 2005–2008 (Group I) and 2013–2016 (Group II). Methods: Medical records were retrieved from the hospital's computerized medical system. The surgical reports of all women delivered by repeat CS were reviewed and the appearance of the lower uterine segment at CS was assessed. The primary outcome was VBAC.... (More)

Objective: To compare the rate of vaginal birth after cesarean section (VBAC), including the maternal and perinatal outcomes, in two historical cohorts before and after the implementation of specific changes in the clinical practice. Design: A retrospective cohort study. Setting: Skåne University Hospital in Malmö, Sweden. Participants: including all women with one previous cesarean section (CS), who delivered during two 4-year periods: 2005–2008 (Group I) and 2013–2016 (Group II). Methods: Medical records were retrieved from the hospital's computerized medical system. The surgical reports of all women delivered by repeat CS were reviewed and the appearance of the lower uterine segment at CS was assessed. The primary outcome was VBAC. Secondary maternal outcomes were uterine rupture/dehiscence, hysterectomy and blood loss. The secondary perinatal outcomes were cord blood pH < 7.05 and perinatal mortality rate. Differences for categorical data were studied using the chi-square test and Fisher's exact test. To assess differences for continuous data t-tests were used. To determine which factors predicted VBAC both univariate and multivariate logistic regression analysis with the likelihood ratio test were performed. A two-tailed P-value < 0.05 was considered statistically significant Findings: 2017 patients were included to the study: 792 patients in Group I and 1225 in Group II. The rate of trial of labor after cesarean (TOLAC) was 65.0% and 76.9% and the VBAC rate was 49.8% and 62.0% in Group I and II respectively (p < 0.0001). Maternal and perinatal adverse outcomes were not statistically different between the two groups. Key conclusions and implications for practice: Appropriate management of women with one previous CS might increase the VBAC rate without a negative impact on maternal or perinatal outcomes. The antenatal teamwork has the greatest contribution to VBAC rate by increasing the number of women undergoing TOLAC.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cesarean section, Trial of labor after cesarean, Uterine rupture, Vaginal birth after cesarean
in
Midwifery
volume
106
article number
103247
publisher
Elsevier
external identifiers
  • scopus:85123080355
  • pmid:35066427
ISSN
0266-6138
DOI
10.1016/j.midw.2021.103247
language
English
LU publication?
yes
id
f483a311-3004-4448-a124-e099df42a85c
date added to LUP
2022-03-17 14:38:08
date last changed
2024-06-13 11:32:28
@article{f483a311-3004-4448-a124-e099df42a85c,
  abstract     = {{<p>Objective: To compare the rate of vaginal birth after cesarean section (VBAC), including the maternal and perinatal outcomes, in two historical cohorts before and after the implementation of specific changes in the clinical practice. Design: A retrospective cohort study. Setting: Skåne University Hospital in Malmö, Sweden. Participants: including all women with one previous cesarean section (CS), who delivered during two 4-year periods: 2005–2008 (Group I) and 2013–2016 (Group II). Methods: Medical records were retrieved from the hospital's computerized medical system. The surgical reports of all women delivered by repeat CS were reviewed and the appearance of the lower uterine segment at CS was assessed. The primary outcome was VBAC. Secondary maternal outcomes were uterine rupture/dehiscence, hysterectomy and blood loss. The secondary perinatal outcomes were cord blood pH &lt; 7.05 and perinatal mortality rate. Differences for categorical data were studied using the chi-square test and Fisher's exact test. To assess differences for continuous data t-tests were used. To determine which factors predicted VBAC both univariate and multivariate logistic regression analysis with the likelihood ratio test were performed. A two-tailed P-value &lt; 0.05 was considered statistically significant Findings: 2017 patients were included to the study: 792 patients in Group I and 1225 in Group II. The rate of trial of labor after cesarean (TOLAC) was 65.0% and 76.9% and the VBAC rate was 49.8% and 62.0% in Group I and II respectively (p &lt; 0.0001). Maternal and perinatal adverse outcomes were not statistically different between the two groups. Key conclusions and implications for practice: Appropriate management of women with one previous CS might increase the VBAC rate without a negative impact on maternal or perinatal outcomes. The antenatal teamwork has the greatest contribution to VBAC rate by increasing the number of women undergoing TOLAC.</p>}},
  author       = {{Vikhareva, Olga and Nedopekina, Ekaterina and Kristensen, Karl and Dahlbäck, Charlotte and Pihlsgård, Mats and Rickle, Gisela Skott and Herbst, Andreas}},
  issn         = {{0266-6138}},
  keywords     = {{Cesarean section; Trial of labor after cesarean; Uterine rupture; Vaginal birth after cesarean}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Midwifery}},
  title        = {{Strategies to increase the rate of vaginal deliveries after cesarean without negative impact on outcomes}},
  url          = {{http://dx.doi.org/10.1016/j.midw.2021.103247}},
  doi          = {{10.1016/j.midw.2021.103247}},
  volume       = {{106}},
  year         = {{2022}},
}