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Vaginal birth risks after previous caesareans

Wednesday September 25th, 2019

Women who have had one or more caesarean sections and go on to attempt a vaginal birth could risk the health of themselves and their child, according to a new analysis.

Research published in today’s PLOS Medicine revealed that although the absolute risk of complications was small, there was an increased risk of uterine rupture, a blood transfusion or surgical injury. There was also a heightened risk for the infant of stillbirth, admission to neonatal unit, resuscitation requiring drugs or intubation, or an Apgar score less than seven at five minutes.

The research, led by Nuffield Department of Population Health, University of Oxford, and colleagues, found that 1.8% of those attempting a vaginal birth and 0.8% of those having a planned caesarean experienced serious maternal complications.

Kathryn Fitzpatrick, who led the study, said 8.0% of those attempting a vaginal birth and 6.4% of those having a planned caesarean experienced one or more of the adverse infant outcomes examined.

"Our findings can be used to counsel and manage women with previous caesarean section and should be considered alongside existing evidence on the increased risk of serious maternal morbidity in subsequent pregnancies associated with elective repeat caesarean section,” she added.

The research involved data from 74,043 full term births of single babies in Scotland between 2002 and 2015.

For women who have had previous caesarean section, the researchers estimated the short term maternal and perinatal health outcomes associated with attempting a vaginal birth compared to planning another caesarean section. They found that 45,579 women had a planned caesarean, while 28,464 attempted vaginal birth, 28.4% of whom went on to have an emergency caesarean section.

Fitzpatrick said further studies are needed to confirm their findings and investigate the longer-term outcomes associated with multiple caesareans or attempting vaginal birth following previous caesarean.

Fitzpatrick KE, Kurinczuk JJ, Bhattacharya S et al. Planned mode of delivery after previous caesarean section and short-term maternal and perinatal outcomes: A population-based record linkage cohort study in Scotland. PLoS Med 24 September 2019

https://doi.org/10.1371/journal.pmed.1002913

Tags: Childbirth and Pregnancy | Nursing & Midwifery | UK News | Women's Health & Gynaecology

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