Title: Message
make
sure this woman sees this- perhaps the 'expert' might benefit
too
Increased
success of trial of labor after previous vaginal birth after
caesarean.
Obstet Gynecol. 2004 Oct;104(4):715-9
Gyamfi C, Juhasz G, Gyamfi P, Stone
JL.
OBJECTIVE: To estimate whether a history of a previous successful
vaginal birth after caesarean delivery (VBAC) has an effect on a subsequent VBAC
attempt. METHODS: A chart review of cases identified from the International
Classification of Diseases, 9th Revision (ICD-9) codes and cases identified in
the logbooks on Labor and Delivery yielded 1,216 cases of attempted VBAC from
1996 to 2000. Data gathered from these cases included history of previous
successful VBAC. Variables of interest included previous successful normal
spontaneous vaginal delivery, history of diabetes, labor induction, and
recurrent indication for caesarean delivery. RESULTS: Of the 336 patients with a
history of one or more previous successful VBAC attempts, 94.6% had a subsequent
successful VBAC, whereas 70.5% of the remaining 880 patients were successful (P
.001). For those patients with one or more previous successful normal
spontaneous vaginal deliveries, 87.8% had a successful VBAC, whereas 75.6% were
successful without this history (P =.001). The presence of diabetes and a
recurrent indication for caesarean delivery both decreased VBAC success and were
independently associated with poor outcome (P .001). Patients with a history
of previous VBAC were 7 times more likely to have a subsequent VBAC success
(odds ratio 7.40, 95% confidence interval 4.51-12.16; P .001). Those with a
history of previous normal spontaneous vaginal delivery were not more likely to
have a successful VBAC when the other variables were controlled. Induction did
not affect VBAC outcome. CONCLUSION: A history of a previous successful VBAC
increases the likelihood for success with future attempts. Maternal diabetes and
history of a recurrent indication for caesarean delivery are poor
prognosticators for successful trial of labor. LEVEL OF EVIDENCE:
II-2
Effect of prior vaginal delivery or prior
vaginal birth after caesarean delivery on obstetric outcomes in women undergoing
trial of labor.
Obstet Gynecol. 2004 Aug;104(2):273-7
Hendler I, Bujold E.
OBJECTIVE: We sought to study the effects of prior vaginal
delivery or prior vaginal birth after cesarean delivery (VBAC) on the success of
a trial of labor after a cesarean delivery. METHODS: An observational study of
patients who underwent a trial of labor after a single low-transverse cesarean
delivery. Patients with a previous cesarean delivery and no vaginal birth were
compared with patients with a single vaginal delivery before or after the
previous cesarean delivery. The rates of successful VBAC, uterine rupture, and
scar dehiscence were analyzed. Multivariable regression was performed to adjust
for confounding variables. RESULTS: Of 2,204 patients, 1,685 (76.4%) had a
previous cesarean delivery and no vaginal delivery, 198 (9.0%) had a vaginal
delivery before the cesarean delivery, and 321 (14.6%) had a prior VBAC. The
rate of successful trial of labor was 70.1%, 81.8%, and 93.1%, respectively (P
.001). A prior VBAC was associated with fewer third- and fourth-degree
lacerations (8.5% versus 2.5% versus 3.7%, P .001) and fewer operative
vaginal deliveries (14.7% versus 5.6% versus 1.9%, P .001) but not with
uterine rupture (1.5% versus 0.5% versus 0.3%, P =.12). Patients with a prior
VBAC had, in addition, a higher rate of uterine scar dehiscence (21.8%) compared
with patients with a previous cesarean delivery and no vaginal delivery (5.3%; P
=.001). CONCLUSION: A prior vaginal delivery and, particularly, a prior VBAC are
associated with a higher rate of successful trial of labor compared with
patients with no prior vaginal delivery. In addition, prior VBAC is associated
with an increased rate of uterine scar
dehiscence.
-Original Message-From:
[EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Marie
HeathSent: Saturday, April 08, 2006 6:08 PMTo:
ozmidwifery@acegraphics.com.auSubject: [ozmidwifery] Uterine
Rupture Risk
I would just like to offer my
recent experience of having supported an amazing woman to achieve a beautiful
VBAC birth despite the demons of obstetrics and community
fear.
This particular lady had an
amazing vaginal birth despite the information from a GP and Obstetrician. The
obstetric advice during pregnancy was that because she had had a fever during
her first labour and after lscs was treated with antibiotics, then her uterus
would not have healed so well and therefore she would have a 1 in 70 chance of
uterine rupture should she attempt to have a vaginal birth for her second
pregnancy.
She chose, after much further
research to not see that obstetrician or any obstetrician again, continuing to
see me as a private
