Adverse Outcomes Up for Vaginal Birth After Previous C-Section
MONDAY, May 7, 2018 -- The rates of severe maternal and neonatal morbidity and mortality are elevated with attempted vaginal delivery after single prior cesarean delivery, according to a study published in the May 7 issue of CMAJ, the journal of the Canadian Medical Association.
Carmen B. Young, M.D., from the University of Alberta in Edmonton, Canada, and colleagues compared maternal and infant outcomes after attempted vaginal birth after cesarean delivery versus elective repeat cesarean delivery.
The researchers found that there were low absolute rates of severe maternal morbidity and mortality, but the rates were significantly higher after attempted vaginal birth versus after elective repeat cesarean delivery (10.7 versus 5.65 per 1,000 deliveries; adjusted rate ratio, 1.96; 95 percent confidence interval, 1.76 to 2.19). Small adjusted rate differences were seen in severe maternal morbidity and mortality (5.42 per 1,000 deliveries) and serious neonatal morbidity and mortality (7.09 per 1,000 deliveries). A temporal worsening was seen for the correlation between vaginal birth after cesarean delivery and serious neonatal morbidity and mortality (adjusted rate ratio, 0.94; 95 percent confidence interval, 0.77 to 1.15 in 2003 to 2005; adjusted rate ratio, 2.07; 95 percent confidence interval, 1.83 to 2.35 in 2012 to 2014).
"Temporal worsening of infant outcomes after attempted vaginal birth after cesarean delivery highlights the need for greater care in selecting candidates, and more careful monitoring of labor and delivery," the authors write.
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Posted: May 2018