Attempted vaginal birth after cesarean: assessment of morbidity and predictors of success

• Main Authors: Rocio Garcia-Jimenez (Author), Irene Valero (Author), Ana M. Weber-Fernandez (Author), Natalia Florez (Author), Irene Martinez-Aguado (Author), Carlota Borrero (Author)
• Format: Book
• Published: Permanyer, 2022-01-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 10.24875/RECHOG.22000080; 0717-7526
• Keywords: Vaginal births after cesarean. Repeat cesarean section. Maternal mortality. Neonatal mortality. Obstetric delivery.; Gynecology and obstetrics; RG1-991
• Source: Revista Chilena de Obstetricia y Ginecología, Vol 87, Iss 6 (2022)

Objective: Determining the appropriate approach for delivery after previous cesarean is a very controversial issue. Our objective was to establish whether pregnant women with a previous cesarean have an increased maternal and fetal morbidity and mortality after attempting vaginal delivery as well as to determine which factors may influence the achievement of a vaginal birth after cesarean. Materials and methods: A retrospective observational cohort study including 390 patients (196 cesarean group and 194 nulliparous group) was carried out. We compared neonatal and maternal outcomes between groups. Afterward, a multivariate logistic regression was applied for our second objective. Results: There were higher rates of uterine rupture (2% vs. 0%, p: 0.045) and puerperal hemorrhage (9.7% vs. 3.1%, p: 0.008) in the cesarean group and lower vaginal delivery rate (58.2% vs. 77.8%, p < 0.0005). We found that the induced onset of labor (OR = 2.9) and new born weight (OR = 1.0001) were associated with an increased risk of cesarean section. Conclusions: Our findings stress the need for further investigations in this field, which might provide a basis for a better management of patients with a previous cesarean.