Risk factors at caesarean section and failure of subsequent trial, of labour

Autor: Myrthe B. Sluijs, Otto P. Bleker, Wilbert A. Spaans, Jos van Roosmalen
Přispěvatelé: Obstetrics and Gynaecology
Jazyk: angličtina
Rok vydání: 2002
Předmět:
Zdroj: European journal of obstetrics, gynecology, and reproductive biology, 100(2), 163-166. Elsevier Ireland Ltd
ISSN: 0301-2115
DOI: 10.1016/s0301-2115(01)00464-x
Popis: Many recent reports document the relative safety of a trial of labor (TOL) as an alternative to cesarean section (CS), but when a trial fails the patient is at increased risk of infection and other morbidity. Infection also is a problem for infants born by repeat section after a TOL fails. Reportedly a TOL fails in a large majority of subsequent pregnancies after cesarean delivery at full dilatation. This retrospective review was planned to identify risk factors at CS that are associated with failure of a TOL in a later pregnancy. Of 214 women having a previous cesarean section (the "index" pregnancy), 69% underwent a TOL in a later pregnancy. The trial succeeded in 71% of cases. Twin pregnancies were excluded. The major indication for elective operative delivery, noted in one third of index pregnancies, was fetal distress. Emergency sections were done mainly for failure to progress, suspected cephalopelvic disproportion, or fetal distress. In the ensuing pregnancy, a TOL succeeded in more than two thirds of attempts. All but 5% of patients gave birth after 37 weeks' gestation. The woman's request was the major reason for elective repeat section in 52% of cases. Birth weight of the index infant was not a factor, but the decision to offer a TOL in a subsequent pregnancy related significantly to cervical dilation at the time of the index cesarean section. The chance of a successful TOL was significantly reduced by the use of oxytocin, failure to progress, or suspected cephalopelvic disproportion in the index labor. In addition, failure were more frequent with contractions lasting more than 12 hours or cervical dilation less than 1 cm/hour in the index birth. Birth weights after vaginal delivery were significantly less than when a TOL failed. The strongest indicator of a failed TOL was a birth weight exceeding 4000 g; the odds ratio was 6.6. No uterine ruptures occurred in either index or subsequent pregnancies, but there was one scar dehiscence in an elective repeat section for a following pregnancy. One infant died of placental disruption, and one of congenital malformation after emergency section for fetal distress. Women contemplating a trial of labor after cesarean section in a previous pregnancy should know that the chance of success is diminished if, at the index pregnancy, oxytocin was used, contractions lasted longer than 12 hours, or cervical dilation progressed slowly. It appears wise to obtain a partograph from the first labor if a subsequent TOL is a possibility.
Databáze: OpenAIRE
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