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Adverse Outcomes Up for Vaginal Birth After Previous C-Section

MONDAY, Sept. 30, 2019 -- Women undergoing vaginal birth after cesarean (VBAC) are more likely to have adverse maternal birth-related complications and perinatal outcomes, according to a study published online Sept. 24 in PLOS Medicine.

Kathryn E. Fitzpatrick, from the University of Oxford in the United Kingdom, and colleagues examined short-term maternal and perinatal outcomes associated with planned mode of delivery after previous cesarean section using data from 74,043 term singleton births in Scotland between 2002 and 2015 among women eligible for VBAC. Overall, 45,579 women gave birth by elective repeat cesarean section (ERCS) and 28,464 had a planned VBAC, 28.4 percent of whom had an in-labor nonelective repeat cesarean section.

The researchers found that women with a planned VBAC were significantly more likely to have uterine rupture compared with those delivering by ERCS (adjusted odds ratio [aOR], 7.3). They were also more likely to have a blood transfusion (aOR, 2.3), puerperal sepsis (aOR, 1.8), and surgical injury (aOR, 3.0). For perinatal outcomes, there was a higher likelihood for perinatal death, neonatal unit admission, resuscitation requiring drugs and/or intubation, and an Apgar score <7 at 5 minutes (aOR, 1.6). Women with a planned VBAC were more likely to breastfeed at birth or hospital discharge and at six to eight weeks postpartum (adjusted risk ratios, 1.2 and 1.2, respectively).

"However, the absolute risk of adverse outcomes is small for either delivery approach," the authors write. "This information can be used to counsel and manage the increasing number of women with previous cesarean section, but more research is needed on longer-term outcomes."

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Posted: September 2019