Abstract
BackgroundThe delivery mode for pregnant women with uteruses scarred by prior caesarean section (CS) is a controversial issue, even though the CS rate has risen in the past 20 years. We performed this retrospective study to identify the factors associated with preference for CS or vaginal birth after CS (VBAC).MethodsPregnant women (n = 679) with scarred uteruses from Moulay Ali Cherif Provincial Hospital, Rashidiya, Morocco, were enrolled. Gestational age, comorbidity, fetal position, gravidity and parity, abnormal amniotic fluid, macrosomia, placenta previa or abruptio, abnormal fetal presentation, premature rupture of fetal membrane with labor failure, poor progression in delivery, and fetal outcomes were recorded.ResultsOut of 679 pregnant women ≥28 gestational weeks, 351 (51.69%) had a preference for CS. Pregnant women showed preference for CS if they were older (95% CI 1.010–1.097), had higher gestational age (95% CI 1.024–1.286), and a shorter period had passed since the last CS (95% CI 0.842–0.992). Prior gravidity (95% CI 0.638–1.166), parity (95% CI 0.453–1.235), vaginal delivery history (95% CI 0.717–1.818), and birth weight (95% CI 1.000–1.001) did not influence CS preference. In comparison with fetal preference, maternal preference was the prior indicator for CS. Correlation analysis showed that pregnant women with longer intervals since the last CS and history of gravidity, parity, and vaginal delivery showed good progress in the first and second stages of vaginal delivery.ConclusionsWe concluded that maternal and gestational age and interval since the last CS promoted CS preference among pregnant women with scarred uteruses.
Highlights
The delivery mode for pregnant women with uteruses scarred by prior caesarean section (CS) is a controversial issue, even though the CS rate has risen in the past 20 years
It is known that the incidence of uterine rupture (UR) is higher in women with uteruses scarred by CS or laparoscopic surgery for removing salpingectomy, uterine leiomyomas, and other lesions [6, 7]
There were no significant differences in CS preference among ages (p = 0.169; χ2 test), interval since the last CS (p = 0.535), and newborn Apgar score (p = 0.222) between the women assigned to the CS and vaginal birth after CS (VBAC) groups (Table 2)
Summary
The delivery mode for pregnant women with uteruses scarred by prior caesarean section (CS) is a controversial issue, even though the CS rate has risen in the past 20 years. We performed this retrospective study to identify the factors associated with preference for CS or vaginal birth after CS (VBAC). The CS rate has risen in most countries over the past 20 years Worldwide, it accounted for 5% of total deliveries in 1970 [1] and increased to over 30% in 2010 [2]. Despite the increased UR rate due to CS [6], CS shows advantages in newborn and maternal outcomes, in particular for pregnant women with protracted labor, abruptio placentae, placenta previa, fetal embarrassment, or macrosomia, as well as women with abnormal pelvis or poor progress in the first and second stages of labor [1, 13, 14]
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