Vaginal birth after cesarean delivery: results of a 5-year multicenter collaborative study

Article Abstract:

Almost one million cesarean deliveries are performed each year in the United States, making it the most common major operation in this country. As many as one-third of these procedures are performed only because the mother has a history of a previous cesarean operation. However, several research studies have indicated that labor can be safely attempted by women who have previously delivered by cesarean if they meet certain criteria, including the presence of a low transverse incision. In spite of this data, physicians rarely allow vaginal delivery after a cesarean. To explore this issue, researchers evaluated 5,733 middle-class women who attempted vaginal delivery after at least one previous cesarean operation. The study took place during a 5-year period and included patients from 11 hospitals. Sixty-three percent of the patients were white, while 13, 17 and 7 percent were black, hispanic, or Asian, respectively. Nine percent were indigent, and approximately one-third of the total were college graduates. The criteria for patient selection and approaches to patient monitoring during labor are discussed. Results showed that 75 percent of the women had successful vaginal deliveries. Sixty-nine percent of the 245 patients who had undergone more than one previous cesarean operation delivered vaginally. The incidence of uterine rupture (a feared complication of vaginal delivery after a previous cesarean) was 1.7 per 1,000 births; one of these babies died. (In this case, the mother began labor at home and was not monitored.) Perinatal mortality (death of the fetus/infant during the weeks just before and after birth) was equivalent to that of the general population (6 deaths per 1,000 births). There were no maternal deaths. These results support previous findings and demonstrate that vaginal delivery after cesarean operation is safe; tens of thousands of unnecessary surgical procedures would be avoided each year if this finding was accepted by physicians and patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Vaginal birth after cesarean

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Maternal and cord serum glycosylated protein in neonatal macrosomia and correlation with birth weight

Article Abstract:

Fetal macrosomia (abnormally large body) is the result of several factors, including hormonal effect. The most important of these is insulin. Although most macrosomic infants are not born to diabetics, diabetic women may be at risk of delivering macrosomic infants because of their abnormal glucose metabolism and insulin use. To evaluate which substances in the blood correlate with glucose utilization and can be used to predict macrosomia, three groups of women and their infants were studied. Group I included 20 normal women without a history of diabetes who delivered macrosomic infants (weight more than 4,000 grams or 8.8 pounds after 38 to 42 weeks' gestation), group II had 20 normal women whose infants were appropriate for gestational age (AGA), and group III consisted of 9 women with diabetes mellitus and their infants (including one set of twins). Blood samples were obtained from all mothers and infants immediately after birth, and one hour later from the macrosomic infants and the infants of diabetic mothers. Results indicated that macrosomia in infants born to non-diabetic mothers is apparently due to some factor other than glucose intolerance, since tests of glycosylated protein and glycosylated hemoglobin (protein or hemoglobin to which glucose is chemically joined), which indicate poor glycemic control, were not abnormal for this group. Glycosylated protein levels were higher in diabetic mothers and their neonates than in mothers of groups I or II; this test is a good measure of the extent of glycemic control (control of blood glucose levels) in these patients. The measures were not good predictors of birth weight, however; for this, the best predictor was maternal weight gain during pregnancy, as has been shown in previous studies. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Blood sugar, Blood glucose, Diabetes in pregnancy, Gestational diabetes, Glycosylated hemoglobin

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Vaginal birth after cesarean section: is suspected fetal macrosomia a contraindication?

Article Abstract:

Before 1982 it was assumed that pregnancies that followed a previous cesarean section were at risk for complications if delivered vaginally. Therefore, all subsequent pregnancies were also be delivered by cesarean section. In 1984, the College of Obstetrics and Gynecology issued a statement that lifted previous restrictions and revised guidelines to allow a trial-of-labor in selected patients with a history of cesarean section. The guidelines recommend against a trial-of-labor if the fetus is thought to weigh more than 8.8 pounds (4,000 grams), as the effects of labor on larger fetuses were unknown at that time. To see if this restriction is valid, 301 trials-of-labor with fetuses equal to or larger than 8.8 pounds were evaluated. There were 139 vaginal deliveries in the group of 240 fetuses weighing between 8.8 and 9.9 pounds (between 4,000 and 4,499 grams), or 58 percent. There were 26 vaginal deliveries in the groups of 61 fetuses weighing more than 9.9 pounds (4,500 grams), or 43 percent of the fetuses. There were no differences in infant or maternal mortality between the two groups. When compared to similarly matched pregnancies that delivered large fetuses with no history of cesarean, there were no differences in fetal or maternal death rate. With the possible exception of diabetic mothers, there was no evidence to support the policy of restricting women with a previous cesarean from subsequently delivering larger fetuses vaginally. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Childbirth, Delivery (Childbirth), Cesarean section, Labor, Complicated, Labor complications, Birth size

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