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A trial of labor after previous cesarean is safe and can be …


Biology Articles » Reproductive Biology » Delivery After Previous Cesarean: A Risk Evaluation » Tables

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- Delivery After Previous Cesarean: A Risk Evaluation


Table 1. Overview 1983–1996: All Deliveries (n = 457,825) Registered in the Database of the Swiss Working Group of Obstetric and Gynecologic Institutions

Characteristic n %

Total number of admissions with birth 457,825  
Parity >1 255,453  
Previous cesarean 29,046 11.37
No previous cesarean 226,407 88.63
Repeat cesarean
    With trial of labor 17,613 60.64
    Without trial of labor 11,433 39.36
Trial of labor
    Successful 12,986 73.73
    Unsuccessful (emergency repeat cesarean) 4627 26.27
Trial of labor with induction 2459 13.96
    Successful 1612 65.56
    Unsuccessful 847 34.44
Trial of labor without induction 15,154 86.04
    Successful 11,374 75.06
    Unsuccessful 3780 24.94

 


Table 2. Comparison of Patients With or Without Previous Cesarean Among All Patients With a Singleton Pregnancy and a Parity of More Than One

  Previous cesarean (n = 29,046)
   
Characteristic n (%) RR (95% CI) P No previous cesarean (n = 226,407) All para >1 (n = 255,453)

Vaginal bleeding due to placenta previa in pregnancy 128 (0.44) 2.06 (1.70, 2.49) 484 (0.21) 612 (0.24)
Vaginal bleeding due to low placental implantation 110 (0.38) 1.31 (1.07, 1.61) .008 653 (0.29) 763 (0.30)
Bleeding due to placental abruption in pregnancy 100 (0.34) 1.87 (1.51, 2.32)   416 (0.18) 516 (0.20)
Placental abruption during labor 170 (0.59) 1.49 (1.27, 1.76) 887 (0.39) 1057 (0.41)
Uterine rupture 92 (0.32) 42.18 (31.09, 57.24) 17 (0.01) 109 (0.04)
Hysterectomy 81 (0.28) 6.07 (4.71, 7.83) 104 (0.05) 15 (0.01)
Ileus 37 (0.13) 10.68 (7.18, 15.88) 27 (0.01) 64 (0.03)
Thromboembolic complications 88 (0.30) 2.81 (2.23, 3.55) 244 (0.11) 332 (0.13)
Febrile complications 526 (1.81) 2.77 (2.52, 3.05) 1478 (0.65) 2004 (0.78)
Transfer of the mother to another hospital, department, or ICU 105 (0.36) 3.02 (2.44, 3.74) 271 (0.12) 376 (0.15)
Maternal death 1 (0.003) 0.56 (0.08, 4.11) .566 14 (0.01) 15 (0.01)
Apgar score 229 (0.79) 1.56 (1.36, 1.80) 1142 (0.50) 1371 (0.54)
Arterial pH 131 (0.45) 2.49 (2.06, 3.01) 410 (0.18) 541 (0.21)
Perinatal death 118 (0.41) 1.33 (1.10, 1.62) .004 691 (0.31) 809 (0.32)
Neonatal transfer after birth 2024 (6.97) 1.50 (1.43, 1.57) 10,517 (4.65) 12,541 (4.91)

RR = relative risk or relative frequency compared with the corresponding subgroup; CI = confidence interval; ICU = intensive care unit. Data are presented as n (%), except as noted.


Table 3. Comparison of the Group of Patients With Elective Repeat Cesarean and the Group With a Trial of Labor

  Trial of labor (n = 17,613)
   
Characteristic n (%) RR (95% CI) P Elective repeat cesarean (n = 11,433) Total (n = 29,046)

Younger than 30 y 8640 (49.05) 1.17 (1.14, 1.20) 4805 (42.03) 13,445 (46.29)
Unmarried 311 (1.77) 1.35 (1.12, 1.64) 149 (1.30) 460 (1.58)
Private insurance 6293 (35.73) 0.84 (0.82, 0.87) 4862 (42.53) 11,155 (38.40)
Request for tubal sterilization 2033 (11.54) 0.37 (0.35, 0.38) 3605 (31.53) 5638 (19.41)
Preeclampsia 623 (3.54) 0.70 (0.62, 0.78) 580 (5.07) 1203 (4.14)
Uterine rupture 70 (0.40) 2.07 (1.29, 3.30) .002 22 (0.19) 92 (0.32)
Hysterectomy 29 (0.16) 0.36 (0.23, 0.56) 52 (0.45) 92 (0.32)
Febrile morbidity 264 (1.50) 0.65 (0.55, 0.77) 262 (2.29) 526 (1.81)
Thromboembolic complications 39 (0.22) 0.52 (0.34, 0.78) .002 49 (0.43) 88 (0.30)
Fetal weight >=4000 g 1990 (11.30) 1.42 (1.32, 1.53) 910 (7.96) 2900 (9.98)
Fetal malpresentation 1919 (10.90) 0.62 (0.59, 0.66) 2000 (17.49) 3919 (13.49)
Perinatal death 86 (0.49) 1.74 (1.17, 2.60) .006 32 (0.28) 118 (0.41)
Perinatal death in infants >28 wk with no malformations 33 (0.19) 2.14 (1.07, 4.27) .031 10 (0.09) 43 (0.15)
Neonatal transfer 1075 (6.10) 0.74 (0.68, 0.80) 949 (8.30) 2024 (6.97)

Abbreviations as in Table 1.
Data are presented as n (%), except as noted.

 


Table 4. Comparison of the Group of Patients With Successful Trial of Labor and the Group With Emergency Repeat Cesarean After Unsuccessful Trial of Labor

  Emergency repeat cesarean (n = 4627)
   
Characteristic n (%) RR (95% CI) P Successful trial of labor (n = 12,986) Trial of labor (n = 17,613)

Induction of labor 847 (18.31) 1.47 (1.37, 1.59) 1612 (12.41) 2459 (13.96)
Augmentation of labor 1212 (26.19) 0.67 (0.63, 0.70) 5098 (39.26) 6310 (35.83)
Fetal malpresentation 1107 (23.92) 3.83 (3.53, 4.14) 812 (6.25) 1919 (10.90)
Fetal weight >=4000 g 678 (14.65) 1.45 (1.33, 1.58) 1312 (10.10) 1990 (11.30)
Fetal weight >=4000 g and induction of labor 150 (3.24) 2.12 (1.72, 2.60) 199 (1.53) 349 (1.98)
Uterine rupture 52 (1.12) 8.11 (5.18, 12.70) 18 (0.14) 70 (0.40)
Hysterectomy 20 (0.43) 6.24 (3.14, 12.39) 9 (0.07) 29 (0.16)
Abnormal fetal heart rate tracing 727 (15.71) 2.58 (2.35, 2.83) 792 (6.10) 1519 (8.62)
Perinatal death 27 (0.58) 1.28 (0.82, 2.02) .28 (NS) 59 (0.45) 86 (0.49)
Neonatal transfer after birth 415 (8.97) 1.76 (1.57, 1.98) 660 (5.08) 1075 (6.10)

NS = not significant; other abbreviations as in Table 1.
Data are presented as n (%), except as noted.

 

Table 5. Analysis of the Trial-of-Labor Patients Having Uterine Rupture

  Trial of labor with uterine rupture (n = 70)
   
Characteristic n (%) RR (95% CI) P Trial of labor without uterine rupture (n = 17,543) All trials of labor (n = 17,613)

Induction of labor 17 (24.29) 1.74 (1.13, 2.70) .013 2442 (13.92) 2459 (13.96)
Labor augmentation with oxytocin 29 (41.43) 1.16 (0.86, 1.55) .327 (NS) 6281 (35.80) 6310 (35.83)
Epidural anesthesia during labor 17 (24.29) 2.88 (1.86, 4.46) 1480 (8.44) 1497 (8.50)
Failure to progress 15 (21.43) 2.69 (1.68, 4.29) 1400 (7.98) 1415 (8.03)
Abnormal fetal heart rate tracing 23 (32.86) 3.85 (2.67, 5.55) 1496 (8.53) 1519 (8.62)

NS = not significant; other abbreviations as in Table 1.
Data are presented as n (%), except as noted.



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