Intrapartum cesarean delivery and the risk of perinatal complications in women with and without a single prior cesarean delivery.

Abstract

OBJECTIVE:

To determine maternal and neonatal complications associated with an intrapartum cesarean delivery (CD) with and without a history of a previous CD.

METHODS:

A retrospective cohort study of all women who underwent an unplanned intrapartum CD following a trial of labor in a university-affiliated tertiary hospital, between 2009 and 2016. Perinatal outcomes of women with and without a history of a previous CD were compared. Composite adverse maternal outcome included one or more of the following: postpartum hemorrhage, need for blood transfusion, or cesarean hysterectomy. Composite adverse neonatal outcome included one or more of the following: 5-min Apgar score <7, neonatal seizure, need for intubation, meconium-aspiration-syndrome, or hypoxic-ischemic encephalopathy.

RESULTS:

During the study period, 42 275 women attempted vaginal delivery. Of them, 2229 (5.3%) women underwent an unplanned intrapartum CD and met inclusion criteria: 337 (15.1%) with (study group) and 1892 (84.9%) without (control group) a previous CD. Women without a previous CD were younger and were characterized by higher rates of nulliparity and induction of labor compared with women with a previous CD. Other demographic and obstetrical characteristics did not differ between the groups. Indications for CD were also comparable between the groups. Uterine rupture complicated 2.3% of trials of labor among women with a previous CD. Adverse maternal (2.7% vs 2.9%, P = 1.0) and neonatal (3.9% vs 4.3%, P = 0.88) outcomes were comparable between the groups. After adjusting for potential confounders, a previous CD was not associated independently with adverse maternal outcomes (adjusted odds ratio [aOR] 0.86, 95% confidence interval [CI] 0.31-2.38; P = 0.78) or neonatal outcomes (aOR 0.79, 95% CI 0.36-1.75; P = 0.56).

CONCLUSION:

Our study provides evidence that perinatal outcomes of intrapartum CD delivery among women with a previous CD do not differ from those in women without a previous CD. These findings might improve the consultation and informed decision-making process for couples considering a trial of labor after CD.

• Authors: Eran Ashwal, Anat Lavie, Yair Blecher, Emmanuel Attali, Amir Aviram, Eran Hadar, Ariel Lasry, Yariv Yogev, Liran Hiersch
• Journal: International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics (Int J Gynaecol Obstet) Vol. 157 Issue 2 Pg. 359-365 (May 2022) ISSN: 1879-3479 [Electronic] United States
• PMID: 34165801 (Publication Type: Journal Article)
• Copyright: © 2021 International Federation of Gynecology and Obstetrics.

Topics

• Cesarean Section (adverse effects)
• Delivery, Obstetric (adverse effects)
• Female
• Humans
• Infant, Newborn
• Parturition
• Pregnancy
• Retrospective Studies
• Uterine Rupture (epidemiology, etiology)