Mandatory trial of labor after cesarean delivery: an alternative viewpoint

Article Abstract:

Over the last several decades the use of cesarean section (an incision made in the abdomen and into the uterus) for delivering babies has increased. This is partially due to a tendency to use cesarean section to deliver all subsequent pregnancies, once a woman has undergone one cesarean delivery. Although it is considered safe for a woman to attempt a normal labor with vaginal birth after having a cesarean section, there are several complications that can occur during the vaginal delivery in these cases. Delivery by cesarean section involves cutting the uterus, and a scar forms where the cut was made. A normal labor with vaginal delivery can cause the scar in the uterus to rupture, and this can cause damage to the fetus, and can even threaten the life of the mother. It has been estimated that uterine scar rupture can occur in up to 2 percent of the women who attempt a normal labor. The cases are reported of 12 women who had cesarean sections and experienced rupture of the uterus while attempting normal labor with a subsequent pregnancy. Eleven of the women had a low transverse (horizontal) scar in their uterus and one had a vertical scar from the cesarean section. Uterine rupture resulted in the death of three infants and two of the newborns had significant nervous system damage. Two of the women required hysterectomies (removal of the female reproductive organs). These cases serve as a reminder that complications can arise when attempting a normal labor after once a cesarean section has been performed. Although vaginal delivery is considered safe in women who have had cesarean sections, the physician and patient should discuss the potential complications before selecting the route of delivery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cases, Vaginal birth after cesarean, Labor, Complicated, Labor complications

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Factors associated with postpartum hemorrhage with vaginal birth

Article Abstract:

The risk factors for postpartum hemorrhage, or bleeding after childbirth, were assessed. Postpartum hemorrhage was determined by measurement of hematocrit, the volume of red blood cells in a given volume of blood, and by the need for red-cell transfusion after childbirth. Patients with bleeding before birth were not included in the study. According to these criteria, postpartum hemorrhage occurred in 374 of 9,598 vaginal deliveries. Several risk factors for postpartum hemorrhage were identified. They included: prolonged third stage of labor; preeclampsia, a complication of pregnancy characterized by high blood pressure and other problems; episiotomy, or incision of the perineum, the outer female anogenital tissue; previous postpartum hemorrhage; twins; cessation of downward movement of infant; tears of the soft tissue; assisted labor; delivery aided by the use of forceps or vacuum; Asian or Hispanic ethnicity; and first delivery. Identification of these risk factors may help to predict the occurrence of postpartum hemorrhage. Such knowledge would be useful in counseling patients about home delivery, the use of intravenous administration of fluids or medications during delivery, and autologous donation of the mother's own blood to be used later for transfusion after future surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Vagina, Puerperal disorders, Vaginal bleeding

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Factors associated with hemorrhage in cesarean deliveries

Article Abstract:

The risk factors for hemorrhage in cesarean deliveries were assessed. Hemorrhage was defined by the measurement of hematocrit, the volume of red blood cells in a given blood volume, and by the need for red-cell transfusion. Patients who had bleeding before the delivery were not included in the study. Hemorrhage occurred in 196 of 3,052 cesarean deliveries. The factors associated with bleeding with cesarean deliveries included general anesthesia; amnionitis, or inflammation of the amnion, the inner fetal membrane; preeclampsia, a complication of pregnancy characterized primarily by high blood pressure; a protracted active phase of labor; cessation of labor in second stage; and Hispanic ethnicity. In addition, the incision into the uterus during a cesarean section was also associated with hemorrhage. Hemorrhage during cesarean deliveries was not associated with previous cesarean; number of previous childbirths; week of pregnancy when birth occurred; or other factors. Knowledge of which factors place a mother at risk for hemorrhage will help to prevent it during cesarean deliveries. This will also permit prior planning for the sufficient use of blood bank resources, including autologous blood donation (using one's own blood) for later use. (Consumer Summary produced by Reliance Medical Information, Inc.)

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