The effect of obesity on the delivery mode in labor after previous cesarean delivery.

Objective This study was aimed to evaluate success rates of (1) external cephalic version (ECV) among women with one prior cesarean delivery (CD) and (2) maternal and neonatal outcomes after ECV among women with prior CD. Study Design Two linked studies using U.S. Natality Database were performed. First we performed a retrospective cohort comparing ECV success rates of women with prior CD and women without prior CD. Then we compared the outcomes of TOLACs (trial of labor after cesarean delivery) that occurred after ECV with those that occurred without ECV. Multivariable logistic regression analysis was used to estimate adverse outcomes. Results A total of 715 women had ECV after 36 weeks with prior CD and 9,976 had ECV without prior scar. ECV success rate with scar was 80.6% and without scar was 86.4% (p < 0.001). Seven hundred and sixteen women underwent TOLAC after ECV attempt and 234,617 underwent TOLAC without a preceding attempt. Women with preceding version had increased risks of maternal transfusion (1 vs. 0.4%, adjusted OR [odds ratio]: 2.48 [95% CI (confidence interval): 1.17–5.23]), unplanned hysterectomy (0.4 vs. 0.06%, adjusted OR: 6.90 [95% CI: 2.19–21.78]), and low 5-minute Apgar's score (2.5 vs. 1.5%, adjusted OR: 1.76 [95% CI: 1.10–2.82]). Conclusion Women with prior CD may have a decrease in the rate of successful ECV. While the absolute risks are low, ECV appears to increase risks of adverse maternal and neonatal outcomes among women undergoing a trial of labor.

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Uterine dehiscence in term pregnant patients with one previous cesarean delivery: Growth factor immunoexpression and collagen content in the scarred lower uterine segment

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2005.07.048 ◽

2006 ◽

Vol 194 (2) ◽

pp. 527-534 ◽

Cited By ~ 26

Author(s):

Fabrizio Pollio ◽

Stefania Staibano ◽

Massimo Mascolo ◽

Gaetano Salvatore ◽

Francesco Persico ◽

...

Keyword(s):

Growth Factor ◽

Cesarean Delivery ◽

Lower Uterine Segment ◽

Collagen Content ◽

Previous Cesarean ◽

Uterine Dehiscence

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The association of interpregnancy interval and mode of delivery with outcomes among a cohort of Guatemalan women with a history of prior cesarean

10.21203/rs.3.rs-52175/v1 ◽

2020 ◽

Author(s):

Margo Harrison ◽

Ana Garces ◽

Lester Figueroa ◽

Jamie Westcott ◽

Michael Hambidge ◽

...

Keyword(s):

Cesarean Delivery ◽

Mode Of Delivery ◽

Vaginal Birth ◽

Delivery Mode ◽

Interpregnancy Interval ◽

Vaginal Birth After Cesarean ◽

Cesarean Birth ◽

Dilation And Curettage ◽

History Of ◽

Repeat Cesarean Delivery

Abstract Design: Our objectives were to analyze how interpregnancy interval (IPI) was associated with delivery mode and how outcomes varied by these characteristics.Methods: This secondary analysis used data from a prospective study conducted in Chimaltenango, Guatemala from January 2017 through April 2020.Results: Of 26,465 Guatemalan women, 3,170 (12.0%) had a history of prior cesarean. 560 (20.1%) women delivered by vaginal birth after cesarean with the remaining 2,233 (79.9%) delivered by repeat cesarean delivery. Repeat cesarean reduced the risk of needing a dilation and curettage compared to vaginal birth after cesarean, but this association did not vary by IPI (AOR 0.01 – 0.03, p < 0.001). Repeat cesarean delivery, as compared to vaginal birth after cesarean, significantly reduced the likelihood a woman breastfeeding within one hour of birth (AOR 0.009 – 0.10, p < 0.001), but IPI was not associated with the outcome. Regarding stillbirth, repeat cesarean birth reduced the likelihood of stillbirth as compared to vaginal birth (AOR 0.2, p = 0.001 – 0.002), but again IPI was not associated with the outcome.Conclusion: Outcomes by mode of delivery among a Guatemalan cohort of women with a history of prior cesarean birth do not vary by IPI.

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