Planned mode of delivery after previous cesarean section and short-term maternal and perinatal outcomes: A population-based record linkage cohort study in Scotland

Policy consensus in high-income countries supports offering pregnant women with previous cesarean section a choice between planning an elective repeat cesarean section (ERCS) or attempting a vaginal birth, known as a planned vaginal birth after previous cesarean (VBAC), provided they do not have con...

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Bibliographic Details
Published in:PLoS medicine 2019-09, Vol.16 (9), p.e1002913-e1002913
Main Authors: Fitzpatrick, Kathryn E, Kurinczuk, Jennifer J, Bhattacharya, Sohinee, Quigley, Maria A
Format: Article
Language:English
Subjects:
Adult
Apgar score
Biology and Life Sciences
Birth
Births
Blood transfusion
Breast Feeding
Cesarean section
Cesarean Section, Repeat - adverse effects
Cesarean Section, Repeat - mortality
Childbirth & labor
Cohort analysis
Complications
Control
Delivery (Childbirth)
Elective Surgical Procedures
Female
Health aspects
Health risk assessment
Hospital admission and discharge
Humans
Infant
Infant mortality
Infant, Newborn
Intubation
Length of Stay
Medical Record Linkage
Medicine and Health Sciences
Methods
Neonates
Newborn infants
Obstetrics
Parturition
Patient Discharge
Patient Readmission
People and places
Perinatal Death
Perinatal Mortality
Poisson density functions
Population-based studies
Postpartum
Pregnancy
Pregnancy Complications - epidemiology
Pregnancy Complications - mortality
Pregnancy Complications - therapy
Pregnant women
Puerperal infection
Retrospective Studies
Risk Assessment
Risk Factors
Scotland - epidemiology
Sepsis
Systematic review
Time Factors
Transfusion
Uterine perforation
Uterus
Vagina
Vaginal Birth after Cesarean - adverse effects
Vaginal Birth after Cesarean - mortality
Women
Womens health
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Summary:Policy consensus in high-income countries supports offering pregnant women with previous cesarean section a choice between planning an elective repeat cesarean section (ERCS) or attempting a vaginal birth, known as a planned vaginal birth after previous cesarean (VBAC), provided they do not have contraindications to planned VBAC. However, robust comprehensive information on the associated outcomes to counsel eligible women about this choice is lacking. This study investigated the short-term maternal and perinatal outcomes associated with planned mode of delivery after previous cesarean section among women delivering a term singleton and considered eligible to have a planned VBAC. A population-based cohort of 74,043 term singleton births in Scotland between 2002 and 2015 to women with one or more previous cesarean sections was conducted using linked Scottish national datasets. Logistic or modified Poisson regression, as appropriate, was used to estimate the effect of planned mode of delivery on maternal and perinatal outcomes adjusted for sociodemographic, maternal medical, and obstetric-related characteristics. A total of 45,579 women gave birth by ERCS, and 28,464 had a planned VBAC, 28.4% of whom went on to have an in-labor nonelective repeat cesarean section. Compared to women delivering by ERCS, those who had a planned VBAC were significantly more likely to have uterine rupture (0.24%, n = 69 versus 0.04%, n = 17, adjusted odds ratio [aOR] 7.3, 95% confidence interval [CI] 3.9-13.9, p < 0.001), a blood transfusion (1.14%, n = 324 versus 0.50%, n = 226, aOR 2.3, 95% CI 1.9-2.8, p < 0.001), puerperal sepsis (0.27%, n = 76 versus 0.17%, n = 78, aOR 1.8, 95% CI 1.3-2.7, p = 0.002), and surgical injury (0.17% versus 0.09%, n = 40, aOR 3.0, 95% CI 1.8-4.8, p < 0.001) and experience adverse perinatal outcomes including perinatal death, admission to a neonatal unit, resuscitation requiring drugs and/or intubation, and an Apgar score < 7 at 5 minutes (7.99%, n = 2,049 versus 6.37%, n = 2,570, aOR 1.6, 95% CI 1.5-1.7, p < 0.001). However, women who had a planned VBAC were more likely than those delivering by ERCS to breastfeed at birth or hospital discharge (63.6%, n = 14,906 versus 54.5%, n = 21,403, adjusted risk ratio [aRR] 1.2, 95% CI 1.1-1.2, p < 0.001) and were more likely to breastfeed at 6-8 weeks postpartum (43.6%, n = 10,496 versus 34.5%, n = 13,556, aRR 1.2, 95% CI 1.2-1.3, p < 0.001). The effect of planned mode of delivery on the mother's risk of hav
ISSN:1549-1676
1549-1277
1549-1676
DOI:10.1371/journal.pmed.1002913