Elective repeat cesarean delivery compared with spontaneous trial of labor after a prior cesarean delivery: a propensity score analysis.

Abstract

OBJECTIVE:

The purpose of this study was to determine outcomes, after the use of propensity score techniques, to create balanced groups according to whether a woman undergoes elective repeat cesarean delivery (ERCD) or trial of labor (TOL).

STUDY DESIGN:

Women who were eligible for a TOL with 1 previous low transverse incision were categorized according to whether they underwent an ERCD or TOL. A propensity score technique was used to develop ERCD and TOL groups with comparable baseline characteristics. Outcomes were assessed with conditional logistic regression.

RESULTS:

The rates of endometritis, operative injury, respiratory distress syndrome, and newborn infant infection were lower and the rates of hysterectomy and wound complication were higher in the ERCD group.

CONCLUSION:

Propensity score techniques can be used to generate comparable ERCD and TOL groups. Some types of maternal morbidity (such as hysterectomy) are higher; other types (such as operative injury) are lower in the ERCD group. Although the absolute risk is low, neonatal morbidity appears to be lower in the ERCD group.

• Authors: Sharon A Gilbert, William A Grobman, Mark B Landon, Catherine Y Spong, Dwight J Rouse, Kenneth J Leveno, Michael W Varner, Steve N Caritis, Paul J Meis, Yoram Sorokin, Marshall Carpenter, Mary J O'Sullivan, Baha M Sibai, John M Thorp, Susan M Ramin, Brian M Mercer, Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network
• Journal: American journal of obstetrics and gynecology (Am J Obstet Gynecol) Vol. 206 Issue 4 Pg. 311.e1-9 (Apr 2012) ISSN: 1097-6868 [Electronic] United States
• PMID: 22464069 (Publication Type: Comparative Study, Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2012 Mosby, Inc. All rights reserved.

Topics

• Adult
• Cesarean Section, Repeat (adverse effects, statistics & numerical data)
• Elective Surgical Procedures (statistics & numerical data)
• Endometriosis (epidemiology)
• Female
• Humans
• Infant, Newborn
• Infant, Newborn, Diseases (epidemiology)
• Pregnancy
• Pregnancy Complications, Infectious (epidemiology)
• Pregnancy Outcome (epidemiology)
• Propensity Score
• Respiratory Distress Syndrome, Newborn (epidemiology)
• Trial of Labor
• Uterine Rupture (epidemiology)
• Vaginal Birth after Cesarean (statistics & numerical data)