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Re: VBAC revisited From: Dean Huffman (dean@thehuffpeople.net) Tue Jul 8 19:25:25 2003 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: art fougner, md: "Re: CNMs" Previous message: Joe Cutchin: "Re: CNMs" Maybe in reply to: Dr. Ainsworth: "VBAC revisited" Next in thread: Braun, R. Daniel: "Re: VBAC revisited" .. Risk of Uterine Rupture during Labor among Women with a Prior Cesarean Delivery Mona Lydon-Rochelle, Ph.D., Victoria L. Holt, Ph.D., Thomas R. Easterling, M.D., and Diane P. Martin, Ph.D. Article - Table of Contents - Abstract of this article - PDF of this article - Editors' Summaries Related editorials in the Journal: - Greene, M. F. - Find Similar Articles in the Journal - Notify a friend about this article - Journal Watch (General) Summary - Journal Watch Women's Health Summary - Articles citing this article Services - Add to Personal Archive - Download to Citation Manager - Alert me when this article is cited ISI Web of Science - Related Articles - Citing Articles (44) Medline - Related Articles in Medline Articles in Medline by Author: - Lydon-Rochelle, M. - Martin, D. P. - Medline Citation Collections - Pregnancy - Related Chapters at Harrison's Online ABSTRACT Background Each year in the United States, approximately 60 percent of women with a prior cesarean delivery who become pregnant again attempt labor. Concern persists that a trial of labor may increase the risk of uterine rupture, an uncommon but serious obstetrical complication. Methods We conducted a population-based, retrospective cohort analysis using data from all primiparous women who gave birth to live singleton infants by cesarean section in civilian hospitals in Washington State from 1987 through 1996 and who delivered a second singleton child during the same period (a total of 20,095 women). We assessed the risk of uterine rupture for deliveries with spontaneous onset of labor, those with labor induced by prostaglandins, and those in which labor was induced by other means; these three groups of deliveries were compared with repeated cesarean delivery without labor. Results Uterine rupture occurred at a rate of 1.6 per 1000 among women with repeated cesarean delivery without labor (11 women), 5.2 per 1000 among women with spontaneous onset of labor (56 women), 7.7 per 1000 among women whose labor was induced without prostaglandins (15 women), and 24.5 per 1000 among women with prostaglandin-induced labor (9 women). As compared with the risk in women with repeated cesarean delivery without labor, uterine rupture was more likely among women with spontaneous onset of labor (relative risk, 3.3; 95 percent confidence interval, 1.8 to 6.0), induction of labor without prostaglandins (relative risk, 4.9; 95 percent confidence interval, 2.4 to 9.7), and induction with prostaglandins (relative risk, 15.6; 95 percent confidence interval, 8.1 to 30.0). Conclusions For women with one prior cesarean delivery, the risk of uterine rupture is higher among those whose labor is induced than among those with repeated cesarean delivery without labor. Labor induced with a prostaglandin confers the highest risk. - - - - Re: VBAC revisited From: Braun, R. Daniel (rbraun@iupui.edu) Tue Jul 8 08:28:55 2003 They didn't read the study showing an 11 fold increase in Perinatal mortality with VBAC over re[eat C/S 0.9/1000 with VBAC and 1/10,000 with repeat C/S Dan -----Original Message----- From: DoctorJoe@aol.com [mailto:DoctorJoe@aol.com] Sent: Tuesday, July 08, 2003 7:26 AM To: Multiple recipients of list OB-GYN-L Subject: Re: VBAC revisited In a message dated 7/8/03 06:42:40, rbraun@iupui.edu writes: Hence the need to teach our residents how to use forceps correctly. Dan <snip> Hence the view of many that preventing that primary CS is key. Lynne Loeffler, CNM, JD Well, just add THIS news story to the mix. Joe P. -- CIMS Alarmed By Highest US Cesarean Rate Ever PONTE VEDRA, Fla., July 8 /PRNewswire/ -- The Coalition for Improving Maternity Services (CIMS) views with alarm the Centers for Disease Control's report that the 2002 cesarean rate reached 26.1%, the highest rate ever for the U.S. The World Health Organization states that a cesarean rate greater than 10-15% cannot be justified. "One in four women giving birth by major abdominal surgery is difficult to defend," said Deborah Woolley, CNM, Ph.D., CIMS' Chairperson. "For example, there has been no decline in cerebral palsy or shoulder dystocia associated with the rise in this operation. Furthermore, studies show that healthy women, who should rarely need operative delivery, undergo a large percentage of the cesarean sections performed in the U.S." According to The Coalition for Improving Maternity Services, the overuse of cesarean section poses considerable danger to the health and well-being of mothers and babies. Compared with vaginal birth, maternal risks include increased risk of death, surgical injury, infection, hemorrhage, deep venous clots, and pulmonary embolism. Women are more likely to experience pain and poor health after birth, and to require readmission to the hospital. Women having unplanned cesareans are more likely to suffer post-partum depression or post-traumatic stress syndrome. Otherwise healthy babies born by cesarean are more likely to need assistance with breathing, be admitted to intensive care for breathing problems, and to develop persistent pulmonary hypertension, a life threatening complication. Mothers are more likely to have difficulty forming an attachment to their infant and to breastfeed. Long-term and reproductive hazards of cesarean section include chronic pelvic pain or bowel problems, infertility, ectopic pregnancy, miscarriage, premature birth, placenta previa (the placenta overlays the cervix), placental abruption (the placenta detaches before the birth), and uterine rupture. The risk of uterine rupture is 1 in 500 even with planned repeat cesarean versus 1 in 10,000 with an unscarred uterus. Besides improving maternal-infant health, reducing the cesarean rate to an appropriate level would save the national health care system over $2 billion annually. The rise in cesarean rate is attributable both to the rise in first cesareans, now at 18%, also a new high, and the precipitous fall in the percentage of vaginal births after cesarean (VBACs). CIMS is especially concerned about the ongoing increase in first cesareans because most women having a first cesarean will go on to have more despite the fact that elective repeat cesarean section is more hazardous for the mother and not any safer for the baby. Each subsequent cesarean incrementally increases the likelihood of most cesarean-related complications, including placenta accreta, (the placenta invades the uterus resulting in massive hemorrhage at the delivery). The American College of Obstetricians and Gynecologists attributes the 10-fold increase in this deadly complication over the last decades to the rise in cesareans. While uterine rupture is slightly more likely with planned vaginal birth (5 per 1,000 versus 2 per 1,000 for a repeat cesarean), newborn outcomes do not differ. With appropriate care, 7 out of 10 women or more laboring after a cesarean will birth vaginally. The decline in the VBAC rate has come about through obstetricians discouraging and outright refusing VBAC, a reversal of policy deplored by CIMS. Denial of VBAC forces thousands of women into having major operations they neither want nor need. A free copy of The Risks of Cesarean Delivery to Mother and Baby, a CIMS Fact Sheet, is available from http://www.motherfriendly.org. SOURCE Coalition for Improving Maternity Services CO: Coalition for Improving Maternity Services ST: Florida SU: WOM Web site: http://www.motherfriendly.org http://www.prnewswire.com 07/08/2003 00:01 EDT Next message: art fougner, md: "Re: CNMs" Previous message: Joe Cutchin: "Re: CNMs" Maybe in reply to: Dr. Ainsworth: "VBAC revisited" Next in thread: Braun, R. Daniel: "Re: VBAC revisited"

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