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A trial of labor after previous cesarean is safe and can be …
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Biology Articles » Reproductive Biology » Delivery After Previous Cesarean: A Risk Evaluation » Tables
Tables - 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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