Vaginal Delivery Can Be Safe After Multiple Cesareans
By David Douglas
NEW YORK (Reuters Health) Jul 11 - In women attempting vaginal birth after
multiple previous cesarean deliveries, the risk of uterine rupture is no
greater than in women who have had only one previous cesarean delivery,
researchers report in the July issue of Obstetrics and Gynecology.
The author of an accompanying editorial, Dr. Vern L. Katz, from the Center
for Genetics and Maternal-Fetal Medicine in Eugene, Oregon, told Reuters
Health that this "is exactly the type of evaluation we need to help advise
women on the relative safety and relative risks of both repeat cesarean
delivery and trials of labor after cesarean. Each woman's situation is
specific and advice should be individualized for those specifics."
In the study, Dr. Mark B. Landon of Ohio State University College of
Medicine and Public Health, Columbus, and colleagues prospectively examined
data for women attempting vaginal birth after a single or multiple
cesareans.
Uterine rupture occurred in 9 of 975 women who had had multiple prior
cesareans (0.9%) and in 115 of 16,915 women with a single previous cesarean
(0.7%), a nonsignificant difference.
However, the rates of hysterectomy were significantly increased in the
multiple cesarean group (0.6% versus 0.2%), as were transfusion rates (3.2%
versus 1.6%).
Similarly, a composite of maternal morbidity, including endometritis and
operative injury, was significantly increased in women who had had multiple
cesareans.
Despite this increased risk of complications, the absolute risk is small,
the researchers conclude, and "vaginal birth after multiple cesarean
deliveries should remain an option."
Dr. Katz added that there is a "shifting paradigm of cesarean, not as an
adverse outcome -- a complication -- but as one tool towards achieving the
goal of a healthy mother and baby."
"Thus," he concluded, "the studies that we need, like Mark Landon's, help
provide guidelines in the best use of the tool."
Obstet Gynecol 2006;108:2-3,12-20.
Leanne Wynne
Midwife in charge of "Women's Business"
Mildura Aboriginal Health Service Mob 0418 371862
--
This mailing list is sponsored by ACE Graphics.
Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
