Trial of labor after caesarean section in low risk pregnancies

• Verfasst von: Kehl, Sven [VerfasserIn]
• Verfasst von: Düster, Hanna [VerfasserIn]
• Verfasst von: Weiß, Christel [VerfasserIn]
• Verfasst von: Bader, Simon [VerfasserIn]
• Verfasst von: Schneider, Michael [VerfasserIn]
• Verfasst von: Beckmann, Matthias W. [VerfasserIn]
• Verfasst von: Dammer, Ulf [VerfasserIn]
• Verfasst von: Pretscher, Jutta [VerfasserIn]
• Titel: Trial of labor after caesarean section in low risk pregnancies
• Titelzusatz: is it risky?
• Verf.angabe: Sven Kehl, Hanna Düster, Christel Weiss, Simon Bader, Michael Schneider, Matthias W. Beckmann, Ulf Dammer, Jutta Pretscher
• E-Jahr: 2024
• Jahr: 29 August 2024
• Umfang: 7 S.
• Fussnoten: Gesehen am 20.09.2024
• Titel Quelle: Enthalten in: Archives of gynecology and obstetrics
• Ort Quelle: Berlin : Springer, 1870
• Jahr Quelle: 2024
• Band/Heft Quelle: (2024), Seite 1-7
• ISSN Quelle: 1432-0711
• DOI: doi:10.1007/s00404-024-07700-1
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Caesarean section rate
• Sach-SW: Composite adverse outcome
• Sach-SW: Medical Ethics
• Sach-SW: Prior caesarean section
• Sach-SW: TOLAC
• Sach-SW: Uterine rupture
• Sach-SW: VBAC
• K10plus-PPN: 1903059879

Abstract

Purpose: To evaluate the influence of a previous caesarean section on adverse composite maternal and perinatal outcome in women who attempted a trial of labor. Methods: This historical cohort study analyzed maternal and perinatal outcome in women with otherwise low risk pregnancies at term who underwent a trial of labor after a caesarean section (TOLAC). The primary outcome measure was the adverse composite outcome. Secondary outcome measures were amongst others the caesarean section rate and the mode of vaginal delivery. Results: The adverse composite outcome was more frequently in the previous caesarean section group compared to women with no previous caesarean Sect. (22.3% vs. 15.6%, p < 0.0001). The percentage of caesarean Sect. (15.4% vs. 8.2%, p < 0,0001), uterine rupture (1.0% vs. 0.02%, p < 0.0001), placental abruption (1.1% vs. 0.3%, p = 0.0014), vaginal operative delivery (16.0% vs. 8.6%, p < 0.0001), pH < 7.10 (3.7% vs. 2.5%, p = 0.0151), base excess < -12 (3.2% vs. 2.2%, p = 0.0297), abnormal cardiotocography (22.5% vs. 13.9%, p < 0,0001) and fetal blood analysis (6.2% vs. 2.6%, p < 0.0001) was significantly higher in women with a previous caesarean section. Taking the parity into account, these differences could only been seen in women without a previous vaginal delivery. In parous women with a previous vaginal delivery and a caesarean section in history, the adverse composite did not differ between the groups. Only the rate of pH < 7.1 was higher in women after a caesarean Sect. (4.5% vs. 1.8%, p = 0.0436). Conclusion: Trial of labor after caesarean in otherwise low risk pregnancies is associated with a higher rate of complications especially if there is no history of vaginal delivery.