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Is vaginal birth after cesarean safe? Experience at a community hospital

Is vaginal birth after cesarean safe? Experience at a community hospital Objective: We sought to evaluate the effectiveness and safety of promoting a trial of labor after prior cesarean birth in a community hospital. Study Design: A 4-year prospective cohort study was conducted of all patients who had prior cesarean births (N = 1481). A comparison of outcomes was performed between those who elected repeat cesarean delivery (n = 727) and those who attempted a trial of labor after previous cesarean(s) (n = 754). Results: We found that the vaginal birth after cesarean attempt rate was 50.9% and declined significantly during the last 2 years of the study. The elective repeat cesarean rate was 49.1% and increased significantly during the last 2 years of the study. In addition, we found that neonatal outcomes were similar, with the exception of 2 neonatal deaths caused by uterine rupture. Twelve uterine ruptures occurred (1.6%), and 11 of the 12 ruptures involved either induction or augmentation of labor, or both. Conclusions: A trial of vaginal birth after cesarean is safe provided that induction of labor is not used. The uterine rupture rate of 1.6% is higher than reported in the literature; this may reflect underreporting by community hospitals. (Am J Obstet Gynecol 2001;184:1478-87.) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Obstetrics and Gynecology Wolters Kluwer Health

Is vaginal birth after cesarean safe? Experience at a community hospital

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References (32)

Publisher
Wolters Kluwer Health
Copyright
Copyright © 2001 Mosby, Inc.
ISSN
0002-9378
DOI
10.1067/mob.2001.114852
Publisher site
See Article on Publisher Site

Abstract

Objective: We sought to evaluate the effectiveness and safety of promoting a trial of labor after prior cesarean birth in a community hospital. Study Design: A 4-year prospective cohort study was conducted of all patients who had prior cesarean births (N = 1481). A comparison of outcomes was performed between those who elected repeat cesarean delivery (n = 727) and those who attempted a trial of labor after previous cesarean(s) (n = 754). Results: We found that the vaginal birth after cesarean attempt rate was 50.9% and declined significantly during the last 2 years of the study. The elective repeat cesarean rate was 49.1% and increased significantly during the last 2 years of the study. In addition, we found that neonatal outcomes were similar, with the exception of 2 neonatal deaths caused by uterine rupture. Twelve uterine ruptures occurred (1.6%), and 11 of the 12 ruptures involved either induction or augmentation of labor, or both. Conclusions: A trial of vaginal birth after cesarean is safe provided that induction of labor is not used. The uterine rupture rate of 1.6% is higher than reported in the literature; this may reflect underreporting by community hospitals. (Am J Obstet Gynecol 2001;184:1478-87.)

Journal

American Journal of Obstetrics and Gynecology – Wolters Kluwer Health

Published: Jun 1, 2001

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