- Outcomes of birth options after a previous Cesarean section
• Around the world there have been increases in cesarean section deliveries, leading to a larger proportion of pregnant women with a history of cesarean section.
• For women who have had previous cesarean section, the researchers estimated the short term maternal and perinatal health outcomes associated with attempting a vaginal birth compared to planning another cesarean section. 45,579 women gave birth by planned cesarean and 28,464 attempted vaginal birth, 28.4% of whom went on to have an emergency cesarean section.
• Attempting vaginal birth was associated with an increased risk of the mother having serious birth and post-birth related problems compared to electing for another cesarean section. Attempting vaginal birth was more likely to result in uterine rupture (69 vs 17 women, adjusted odds ratio [aOR] 7.3, 95% confidence interval [CI] 3.9-13.9), a blood transfusion (324 vs 226 women, aOR 2.3, 95% CI 1.9-2.8), sepsis (76 vs 78 women, aOR 1.8, 95% CI 1.3-2.7 ), surgical injury (aOR 3.0, 95% CI 1.8-4.8), and more serious infant outcomes such as stillbirth, admission to neonatal unit, resuscitation requiring drugs or intubation, or an Apgar score less than seven at five minutes (2,049 vs 2,570).
• It should be noted that the absolute risk of complications were small for either type of delivery. Overall, just 1.8% of those attempting a vaginal birth and 0.8% of those having a planned cesarean experienced serious maternal complications. 8.0% of those attempting a vaginal birth and 6.4% of those having a planned cesarean had one or more of the adverse infant outcomes examined.
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