JanetF
14-02-2006, 13:06
(C) 2006 The American College of Obstetricians and Gynecologists
Volume 107(2, Part 1), February 2006, pp 240-245
Results of a Well-Defined Protocol for a Trial of Labor After Prior Cesarean
Delivery
[Original Research]
Gonen, Ron MD1; Nisenblat, Victoria MD1; Barak, Shlomi MD1; Tamir, Ada DSc2;
Ohel, Gonen MD1
>From the Departments of 1Obstetrics and Gynecology, Bnai Zion Medical
Center;
and 2Community Medicine and Epidemiology, Faculty of Medicine, Technion,
Haifa,
Israel.
Corresponding author: Ron Gonen, MD, Deputy Chief, Department of Obstetrics
and
Gynecology, Director of Maternal-Fetal Medicine, Bnai Zion Medical Center,
47
Golomb Street, Haifa 31048, Israel; e-mail: rongon@bezeqint.net.
----------------------------------------------
Outline
Abstract
PATIENTS AND METHODS
RESULTS
DISCUSSION
REFERENCES
Graphics
Table 1
Table 2
Table 3
Abstract
OBJECTIVE: It has been claimed that a trial of labor after cesarean carries
higher maternal and fetal risks than planned cesarean delivery. Because the
management of such patients in our department differs from that described in
some studies, and is perhaps more cautious, we hypothesized that the outcome
may
be better.
METHODS: We identified women with 1 previous low uterine segment cesarean
who
had delivered a cephalic singleton infant at gestational age 34 weeks or
more
from January 2000 through May 2005. Our policy is to encourage such women to
undergo a trial of labor unless cesarean delivery is indicated. Unless
otherwise
indicated, our policy is to wait for spontaneous labor. We do not use
prostaglandins,
and recommend cesarean delivery if the cervix is unripe.(Bishop score
RESULTS: A trial of labor was attempted by 841 women (80% successful), and
467
underwent planned cesarean delivery. Uterine rupture was observed in 1 woman
18
hours after vaginal delivery. There was no difference in major or minor
maternal
morbidity. There was no serious neonatal morbidity. Among the planned
cesarean
patients, hospital stay was longer, and there were more admissions to the
neonatal intensive care unit.
CONCLUSION: With our well-defined protocol, a trial of labor after cesarean
seems to be as safe for the mother and infant as planned cesarean delivery,
and
the hospital stay is shorter.
REFERENCES
1. Hamilton BE, Martin JA, Sutton PD, U.S. Department of Health and Human
Services Centers for Disease Control and Prevention. Births: preliminary
data
for 2002. Natl Vital Stat Rep 2003;51:1-20. Document Delivery
2. McMahon MJ, Luther ER, Bowes WA, Olshan AF. Comparison of a trial of
labor
with an elective second cesarean section. N Engl J Med 1996;335:689-95. Full
Text Available From:
3. Lydon-Rochelle M, Holt VL, Easterling TR, Martin DP. Risk of uterine
rupture
during labor among women with one prior cesarean delivery. N Engl J Med
2001;345:3-8. Full Text Available From:
4. Landon MB, Hauth JC, Leveno KJ, Spong CY, Leindecker S, Varner MW, et al.
Maternal and perinatal outcomes associated with a trial of labor after prior
cesarean delivery. N Engl J Med 2004;351:2581-9. Full Text Available From:
5. Gonen R, Tamir A, Degani S, Ohel G. Variables associated with successful
vaginal birth after one cesarean section: a proposed vaginal birth after
cesarean section score. Am J Perinatol 2004;21:447-53. Document Delivery
Library
Holdings
6. Sachs BP, Kobelin C, Castro MA, Frigoletto F. The risks of lowering the
cesarean-delivery rate. N Engl J Med 1999;340:54-7. Full Text Available
From:
7. Asakura H, Myers SA. More than one previous cesarean delivery: a 5-year
experience with 435 patients. Obstet Gynecol 1995;85:924-9. Ovid Full Text
Full
Text Available From:
8. Caughey AB, Shipp TD, Repke JT, Zelop CM, Cohen A, Lieberman E. Rate of
uterine rupture during a trial of labor in women with one or two prior
cesarean
deliveries. Am J Obstet Gynecol 1999;181:872-6. Document Delivery Library
Holdings
9. Vaginal birth after previous cesarean delivery. ACOG Practice Bulletin
No.54.
American College of Obstetricians and Gynecologists. Obstet Gynecol
2004;104:203-11.
10. Ananth CV, Smulian JC, Vintzileos AM. The association of placenta previa
with history of cesarean delivery and abortion: a metaanalysis. Am J Obstet
Gynecol 1997;177:1071-8. Document Delivery Library Holdings
11. Mankuta DD, Leshno MM, Menasche MM, Brezis MM. Vaginal birth after
cesarean
section: trial of labor or repeat cesarean section? A decision analysis. Am
J
Obstet Gynecol 2003;189:714-9. Full Text Available From:
----------------------------------------------
Accession Number: 00006250-200602000-00007
Volume 107(2, Part 1), February 2006, pp 240-245
Results of a Well-Defined Protocol for a Trial of Labor After Prior Cesarean
Delivery
[Original Research]
Gonen, Ron MD1; Nisenblat, Victoria MD1; Barak, Shlomi MD1; Tamir, Ada DSc2;
Ohel, Gonen MD1
>From the Departments of 1Obstetrics and Gynecology, Bnai Zion Medical
Center;
and 2Community Medicine and Epidemiology, Faculty of Medicine, Technion,
Haifa,
Israel.
Corresponding author: Ron Gonen, MD, Deputy Chief, Department of Obstetrics
and
Gynecology, Director of Maternal-Fetal Medicine, Bnai Zion Medical Center,
47
Golomb Street, Haifa 31048, Israel; e-mail: rongon@bezeqint.net.
----------------------------------------------
Outline
Abstract
PATIENTS AND METHODS
RESULTS
DISCUSSION
REFERENCES
Graphics
Table 1
Table 2
Table 3
Abstract
OBJECTIVE: It has been claimed that a trial of labor after cesarean carries
higher maternal and fetal risks than planned cesarean delivery. Because the
management of such patients in our department differs from that described in
some studies, and is perhaps more cautious, we hypothesized that the outcome
may
be better.
METHODS: We identified women with 1 previous low uterine segment cesarean
who
had delivered a cephalic singleton infant at gestational age 34 weeks or
more
from January 2000 through May 2005. Our policy is to encourage such women to
undergo a trial of labor unless cesarean delivery is indicated. Unless
otherwise
indicated, our policy is to wait for spontaneous labor. We do not use
prostaglandins,
and recommend cesarean delivery if the cervix is unripe.(Bishop score
RESULTS: A trial of labor was attempted by 841 women (80% successful), and
467
underwent planned cesarean delivery. Uterine rupture was observed in 1 woman
18
hours after vaginal delivery. There was no difference in major or minor
maternal
morbidity. There was no serious neonatal morbidity. Among the planned
cesarean
patients, hospital stay was longer, and there were more admissions to the
neonatal intensive care unit.
CONCLUSION: With our well-defined protocol, a trial of labor after cesarean
seems to be as safe for the mother and infant as planned cesarean delivery,
and
the hospital stay is shorter.
REFERENCES
1. Hamilton BE, Martin JA, Sutton PD, U.S. Department of Health and Human
Services Centers for Disease Control and Prevention. Births: preliminary
data
for 2002. Natl Vital Stat Rep 2003;51:1-20. Document Delivery
2. McMahon MJ, Luther ER, Bowes WA, Olshan AF. Comparison of a trial of
labor
with an elective second cesarean section. N Engl J Med 1996;335:689-95. Full
Text Available From:
3. Lydon-Rochelle M, Holt VL, Easterling TR, Martin DP. Risk of uterine
rupture
during labor among women with one prior cesarean delivery. N Engl J Med
2001;345:3-8. Full Text Available From:
4. Landon MB, Hauth JC, Leveno KJ, Spong CY, Leindecker S, Varner MW, et al.
Maternal and perinatal outcomes associated with a trial of labor after prior
cesarean delivery. N Engl J Med 2004;351:2581-9. Full Text Available From:
5. Gonen R, Tamir A, Degani S, Ohel G. Variables associated with successful
vaginal birth after one cesarean section: a proposed vaginal birth after
cesarean section score. Am J Perinatol 2004;21:447-53. Document Delivery
Library
Holdings
6. Sachs BP, Kobelin C, Castro MA, Frigoletto F. The risks of lowering the
cesarean-delivery rate. N Engl J Med 1999;340:54-7. Full Text Available
From:
7. Asakura H, Myers SA. More than one previous cesarean delivery: a 5-year
experience with 435 patients. Obstet Gynecol 1995;85:924-9. Ovid Full Text
Full
Text Available From:
8. Caughey AB, Shipp TD, Repke JT, Zelop CM, Cohen A, Lieberman E. Rate of
uterine rupture during a trial of labor in women with one or two prior
cesarean
deliveries. Am J Obstet Gynecol 1999;181:872-6. Document Delivery Library
Holdings
9. Vaginal birth after previous cesarean delivery. ACOG Practice Bulletin
No.54.
American College of Obstetricians and Gynecologists. Obstet Gynecol
2004;104:203-11.
10. Ananth CV, Smulian JC, Vintzileos AM. The association of placenta previa
with history of cesarean delivery and abortion: a metaanalysis. Am J Obstet
Gynecol 1997;177:1071-8. Document Delivery Library Holdings
11. Mankuta DD, Leshno MM, Menasche MM, Brezis MM. Vaginal birth after
cesarean
section: trial of labor or repeat cesarean section? A decision analysis. Am
J
Obstet Gynecol 2003;189:714-9. Full Text Available From:
----------------------------------------------
Accession Number: 00006250-200602000-00007