This article examines data from a recent systematic evidence review on term deliveries conducted for the National Institutes of Health Consensus Conference sponsored by the Agency for Healthcare Research and Quality on vaginal birth after caesarean, from a meta-analysis of associated perinatal outcomes, and subsequent publications that meet stringent quality review standards. We present a summary of fetal and neonatal outcomes emphasizing information that clinicians and patients need to make decisions regarding mode of delivery after prior cesarean and look for areas where future studies may provide important insights.
[Show abstract][Hide abstract] ABSTRACT: Objective
To evaluate neonatal outcome after elective repeat cesarean delivery (ERCD) versus trial of labor (TOL) after previous cesarean delivery.
This systematic evidence review is based on Pubmed search, Cochrane library and experts recommendations.
The risks of fetal, perinatal and neonatal mortality are low after previous cesarean delivery but significantly higher for TOL as compared with ERCD. The risk of bag-and-mask ventilation and intubation for meconium-stained amniotic fluid are higher for TOL as compared with ERCD. Infants born after ERCD are more likely presented transient tachypnea. The risk of hypoxic encephalopathy/asphyxia is low after previous cesarean delivery but significantly higher for TOL as compared with ERCD. The risk of neonatal sepsis after previous cesarean delivery is significantly higher for TOL as compared with ERCD. There is no significant difference between TOL or ERCD regarding NICU admission. The strength of evidence is low to conclude about the impact of route of delivery upon birth trauma and Apgar score.
The risk of the main neonatal complications is low whatever the route of delivery after previous caesarean delivery. However, the risk of perinatal mortality, bag-and-mask ventilation, perinatal asphyxia, is higher after TOL compared with ERCD. The risk of transient tachypnea is higher after ERCD compared with TOL.
Journal de Gynécologie Obstétrique et Biologie de la Reproduction 12/2012; 41(8):727–734. DOI:10.1016/j.jgyn.2012.09.034 · 0.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To compare uterine artery volume blood flow (Quta ), vascular resistance (Ruta ), pulsatility index (Uta PI), and the fraction of maternal cardiac output (CO) distributed to the uteroplacental circulation in pregnant women with and without a previous caesarean section.
Cross-sectional observational study.
University hospital in Norway.
Thirty-two pregnant women with previous caesarean section and 32 matched controls.
Ultrasonography was used to measure uterine artery diameter and blood flow velocity between 22(+0) and 23(+6) weeks of gestation. Impedance cardiography was used to assess maternal haemodynamics.
Quta , Ruta , Uta PI, and the fraction of maternal CO distributed to the uteroplacental circulation.
The mean Quta was 356.26 ± 213.72 ml/minute in cases and 456.41 ± 209.70 ml/minute in controls (P = 0.038). Ruta was significantly (P = 0.026) higher among cases compared with controls (0.32 ± 0.20 versus 0.22 ± 0.14 mmHg/ml/minute), but the Uta PI did not differ between the groups (0.93 ± 0.23 versus 0.92 ± 0.47; P = 0.929). The fraction of maternal CO distributed to the uteroplacental circulation was 5.75 ± 3.68% in cases and 8.45 ± 5.02% in controls (P = 0.014).
Uterine artery volume blood flow and the fraction of maternal cardiac output distributed to the uteroplacental circulation are lower, and uterine vascular resistance (but not Uta PI) is higher, in women with previous caesarean section compared with the control group.
BJOG An International Journal of Obstetrics & Gynaecology 10/2013; 121(2). DOI:10.1111/1471-0528.12441 · 3.45 Impact Factor
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