Childbirth in women with multiple previous cesareans - Pregnancy Health
Childbirth in women with multiple previous cesareans - Pregnancy Health
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Childbirth in women with multiple previous cesareans
A study published in February 2010 in BJOG: An International Journal of Gynaecology and Obstetrics, one of the most prestigious medical journal, shows that women with three or more previous cesareans attempting vaginal delivery success rate and have similar risks Maternal morbidity (of possible complications for the mother) than women with a single previous caesarean birth, and a similar morbidity (combined vaginal deliveries and emergency caesarean sections) to those who deliver by repeat cesarean.
The planned vaginal birth after cesarean (VBAC) refers to any woman whom he has performed a Caesarean section previously and try to deliver vaginally, rather than repeat cesarean. Although the rates of complications among women with two previous cesareans, low transverse incision (Pfannenstiel), who attempt a vaginal delivery are relatively low, including the possibility of serious complications such as uterine rupture, the data on outcomes in women with more than two previous cesareans were very limited.
The American College of Obstetricians and Gynaecologists (ACOG) and the Royal College of Obstetricians and Gynaecologists (RCOG), the societies of obstetricians and gynecologists U.S. and Britain, respectively, did not recommend VBAC after 3 previous C-sections. (1) case of the Spanish Society of Gynecology and Obstetrics, only encourages the PVDC when there has been only one previous cesarean delivery.
In this study, researchers wanted to estimate the rate of success and risks of maternal complications in women with three or more previous cesareans that proved a VBAC. The study reviewed data from different centers in 17 maternity hospitals in the northeastern United States between 1996 and 2000. in total, included data from 25 005 women who had had at least one previous cesarean delivery.
The results indicate that women who had three or more previous cesareans showed no differences in morbidity when tried a VBAC and when they opted for a new caesarean section. The 89 women included in the study who had three or more previous cesareans and who opted for a VBAC had the same chances of success that women with one or two previous cesarean: 79.8%, compared with 75% and 74 % respectively. Furthermore, none of them experienced a significant maternal complications such as uterine rupture, uterine artery laceration, or damage to the urinary bladder. These success rates are extremely positive, they indicate that women with more than three previous caesarean sections would have about a 25% chance of completing a new pregnancy with a new C-section. 25%, approximately the percentage of caesarean sections being made to women as “low risk”, with normal pregnancies, with no previous cesarean delivery.
They suggest that, given the results, discard VBAC for women with three or more previous cesareans may not be based on scientific proof. Women with a history of three or more previous cesareans, if another pregnancy, experience no major complications in case of opting for vaginal birth or repeat cesarean. The risks associated with multiple C-sections include, complications related to surgery and abnormal insertion of the placenta in subsequent pregnancies.
The lead researcher Dr. Alison Cahill, Department of Obstetrics and Gynecology, Washington University (St. Louis School of Medicine) stated that “These data suggest that women with three or more previous cesareans who try VBAC have rates of success and risks similar to those with 1 or 2 previous cesareans, and along with other publications, suggests that it may be time to review the current recommendations for testing vaginal delivery in women with more than one previous cesarean delivery. “
“Many had proposed a conservative approach PVDC tests, and we agree that this is prudent. But our evidence does not suggest that a conservative approach, which we interpret as an approach that seeks to reduce morbidity, and specifically the risk of uterine rupture ¬ – necessarily pass PVDC allow only women with one previous cesarean delivery. With proper selection of patients, the VBAC after 2 or 3 previous cesareans, in some cases it may be reasonably safe. “
Philip Steer, BJOG editor in chief, said: “While confidence in the results of the study is limited by small sample relativametne women who had had three previous caesarean section, these results provide additional information for women and contribute to the evidence available on success and safety of VBAC in mujers with more than one previous cesarean delivery. “
“As labor does not always conform to the plans, the results can serve as a reference for doctors when a woman with three or more previous cesareans goes into labor spontaneously.”
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