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Vol 90, No 8 (2019)
Research paper
Published online: 2019-08-30
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Safety and success rate of vaginal birth after two cesarean sections: retrospective cohort study

Jan Modzelewski12, Monika Jakubiak-Proc12, Anna Materny2, Maria Sotniczuk2, Anna Kajdy12, Michal Rabijewski1
DOI: 10.5603/GP.2019.0076
·
Pubmed: 31482547
·
Ginekol Pol 2019;90(8):444-451.
Affiliations
  1. Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland
  2. Żelazna Medical Centre, St. Sophia Specialist Hospital, Warsaw, Poland

open access

Vol 90, No 8 (2019)
ORIGINAL PAPERS Obstetrics
Published online: 2019-08-30

Abstract

Objectives: Cesarean section is a lifesaving procedure with short and long-term consequences. Growing rates of cesarean sections worldwide arise problems for subsequent birth. The aim of this study was to compare safety of vaginal birth after two cesarean sections with repeat third cesarean section to help healthcare providers and patients make well informed decisions about mode of subsequent delivery. 

Material and methods: This was a retrospective cohort study conducted in a tertiary reference hospital. Database of all deliveries (2010–2017) after two previous cesarean sections was created from electronic and paper medical records. Preterm deliveries, abnormal karyotype and neonates with congenital anomalies were excluded from the study. The final analysis included 412 cases for maternal outcome analysis and 406 cases for neonatal outcome analysis. 

Results: Trial of labor after two cesareans in comparison to repeat cesarean section increases the risk of hemorrhage (OR: 10.84) and unfavorable composite maternal outcome (OR: 2.58). Failed trial of labor increases this risk of hemorrhage (OR: 15.27) and unfavorable composite maternal outcome (OR: 4.59) even further. There were no significant differences in neonatal outcomes. 22 out of 35 trials of labor ended in successful delivery giving a success rate of 62.85%. 5 of 7 labor inductions ended in repeat cesarean section giving 28.6% success rate. There were no maternal deaths and emergency hysterectomies.

Conclusions: Trial of labor, especially failed trial of labor, is associated with an increased risk of perinatal complications.

Abstract

Objectives: Cesarean section is a lifesaving procedure with short and long-term consequences. Growing rates of cesarean sections worldwide arise problems for subsequent birth. The aim of this study was to compare safety of vaginal birth after two cesarean sections with repeat third cesarean section to help healthcare providers and patients make well informed decisions about mode of subsequent delivery. 

Material and methods: This was a retrospective cohort study conducted in a tertiary reference hospital. Database of all deliveries (2010–2017) after two previous cesarean sections was created from electronic and paper medical records. Preterm deliveries, abnormal karyotype and neonates with congenital anomalies were excluded from the study. The final analysis included 412 cases for maternal outcome analysis and 406 cases for neonatal outcome analysis. 

Results: Trial of labor after two cesareans in comparison to repeat cesarean section increases the risk of hemorrhage (OR: 10.84) and unfavorable composite maternal outcome (OR: 2.58). Failed trial of labor increases this risk of hemorrhage (OR: 15.27) and unfavorable composite maternal outcome (OR: 4.59) even further. There were no significant differences in neonatal outcomes. 22 out of 35 trials of labor ended in successful delivery giving a success rate of 62.85%. 5 of 7 labor inductions ended in repeat cesarean section giving 28.6% success rate. There were no maternal deaths and emergency hysterectomies.

Conclusions: Trial of labor, especially failed trial of labor, is associated with an increased risk of perinatal complications.

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Keywords

vaginal birth after two cesareans; cesarean section; trial of labor; uterine rupture; obstetric labor complications

About this article
Title

Safety and success rate of vaginal birth after two cesarean sections: retrospective cohort study

Journal

Ginekologia Polska

Issue

Vol 90, No 8 (2019)

Article type

Research paper

Pages

444-451

Published online

2019-08-30

Page views

2688

Article views/downloads

2594

DOI

10.5603/GP.2019.0076

Pubmed

31482547

Bibliographic record

Ginekol Pol 2019;90(8):444-451.

Keywords

vaginal birth after two cesareans
cesarean section
trial of labor
uterine rupture
obstetric labor complications

Authors

Jan Modzelewski
Monika Jakubiak-Proc
Anna Materny
Maria Sotniczuk
Anna Kajdy
Michal Rabijewski

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