Prior C-Section, No Trial of Labor, Linked to Worse Outcome

RENO, NEV. — A prior cesarean delivery can have an adverse effect on maternal and neonatal postpartum outcomes in subsequent births, according to a retrospective study of 10,600 live births.

In the study, women who had undergone a prior cesarean and then did not have a trial of labor in their subsequent delivery were more likely to be admitted to an intensive care unit (odds ratio 4.5), require a blood transfusion (odds ratio 3.1), and be readmitted to the hospital within 30 days (odds ratio 1.7), compared with women who previously had a vaginal birth.

Women with a prior cesarean who had a trial of labor did not have these increased risks. They were, however, more likely to receive aminoglycosides for a postpartum infection (odds ratio 1.8), primary investigator Anna McKeown, M.D., said at the annual meeting of the Society for Maternal-Fetal Medicine.

Term neonates born to mothers with a prior cesarean were more likely to have prolonged hospitalization, defined as a stay of more than 7 days. That held true for the neonates born with a trial of labor (odds ratio 2.51) and those born with no trial of labor (odds ratio 6.7).

The study was intended to be a preliminary look at what the consequences of elective cesarean might be, said Dr. McKeown of the University of California, Irvine Medical Center, Orange.

Lacking from the study were details about the prior cesareans that might have influenced what was seen in the subsequent deliveries, such as why the individuals had undergone their cesareans and how many prior cesareans they had had.

But the study still provides important information because previous investigations of the impact of a prior cesarean on subsequent delivery have been studies of vaginal birth after cesarean and therefore have looked only at outcomes in women who have a repeat cesarean, compared with women who have a trial of labor, she said.

“This [current study] confirms the low-risk nature of delivery of the multiparous woman with only prior vaginal deliveries,” Dr. McKeown said. “These risks and benefits should be considered when counseling the patient requesting an elective primary cesarean who desires future childbearing,”

The study's 10,600 subjects included 8,000 who had given vaginal birth and 2,600 who had prior cesareans. All were delivered at one of four Southern California hospitals over a period of a year and a half.

The study found no impact of previous cesarean on increased risk of mortality within 28 days, or prevalence of neonatal seizure or encephalopathy.

While the study had no data on how many previous cesareans the women had, Dr. McKeown said the investigators sense was that the percentage of the subjects with multiple previous cesareans was fairly low. The mean number of previous births for the subjects was only 1.8.

RENO, NEV. — A prior cesarean delivery can have an adverse effect on maternal and neonatal postpartum outcomes in subsequent births, according to a retrospective study of 10,600 live births.

In the study, women who had undergone a prior cesarean and then did not have a trial of labor in their subsequent delivery were more likely to be admitted to an intensive care unit (odds ratio 4.5), require a blood transfusion (odds ratio 3.1), and be readmitted to the hospital within 30 days (odds ratio 1.7), compared with women who previously had a vaginal birth.

Women with a prior cesarean who had a trial of labor did not have these increased risks. They were, however, more likely to receive aminoglycosides for a postpartum infection (odds ratio 1.8), primary investigator Anna McKeown, M.D., said at the annual meeting of the Society for Maternal-Fetal Medicine.

Term neonates born to mothers with a prior cesarean were more likely to have prolonged hospitalization, defined as a stay of more than 7 days. That held true for the neonates born with a trial of labor (odds ratio 2.51) and those born with no trial of labor (odds ratio 6.7).

The study was intended to be a preliminary look at what the consequences of elective cesarean might be, said Dr. McKeown of the University of California, Irvine Medical Center, Orange.

Lacking from the study were details about the prior cesareans that might have influenced what was seen in the subsequent deliveries, such as why the individuals had undergone their cesareans and how many prior cesareans they had had.

But the study still provides important information because previous investigations of the impact of a prior cesarean on subsequent delivery have been studies of vaginal birth after cesarean and therefore have looked only at outcomes in women who have a repeat cesarean, compared with women who have a trial of labor, she said.

“This [current study] confirms the low-risk nature of delivery of the multiparous woman with only prior vaginal deliveries,” Dr. McKeown said. “These risks and benefits should be considered when counseling the patient requesting an elective primary cesarean who desires future childbearing,”

The study's 10,600 subjects included 8,000 who had given vaginal birth and 2,600 who had prior cesareans. All were delivered at one of four Southern California hospitals over a period of a year and a half.

The study found no impact of previous cesarean on increased risk of mortality within 28 days, or prevalence of neonatal seizure or encephalopathy.

While the study had no data on how many previous cesareans the women had, Dr. McKeown said the investigators sense was that the percentage of the subjects with multiple previous cesareans was fairly low. The mean number of previous births for the subjects was only 1.8.

RENO, NEV. — A prior cesarean delivery can have an adverse effect on maternal and neonatal postpartum outcomes in subsequent births, according to a retrospective study of 10,600 live births.

In the study, women who had undergone a prior cesarean and then did not have a trial of labor in their subsequent delivery were more likely to be admitted to an intensive care unit (odds ratio 4.5), require a blood transfusion (odds ratio 3.1), and be readmitted to the hospital within 30 days (odds ratio 1.7), compared with women who previously had a vaginal birth.

Women with a prior cesarean who had a trial of labor did not have these increased risks. They were, however, more likely to receive aminoglycosides for a postpartum infection (odds ratio 1.8), primary investigator Anna McKeown, M.D., said at the annual meeting of the Society for Maternal-Fetal Medicine.

Term neonates born to mothers with a prior cesarean were more likely to have prolonged hospitalization, defined as a stay of more than 7 days. That held true for the neonates born with a trial of labor (odds ratio 2.51) and those born with no trial of labor (odds ratio 6.7).

The study was intended to be a preliminary look at what the consequences of elective cesarean might be, said Dr. McKeown of the University of California, Irvine Medical Center, Orange.

Lacking from the study were details about the prior cesareans that might have influenced what was seen in the subsequent deliveries, such as why the individuals had undergone their cesareans and how many prior cesareans they had had.

But the study still provides important information because previous investigations of the impact of a prior cesarean on subsequent delivery have been studies of vaginal birth after cesarean and therefore have looked only at outcomes in women who have a repeat cesarean, compared with women who have a trial of labor, she said.

“This [current study] confirms the low-risk nature of delivery of the multiparous woman with only prior vaginal deliveries,” Dr. McKeown said. “These risks and benefits should be considered when counseling the patient requesting an elective primary cesarean who desires future childbearing,”

The study's 10,600 subjects included 8,000 who had given vaginal birth and 2,600 who had prior cesareans. All were delivered at one of four Southern California hospitals over a period of a year and a half.

The study found no impact of previous cesarean on increased risk of mortality within 28 days, or prevalence of neonatal seizure or encephalopathy.

While the study had no data on how many previous cesareans the women had, Dr. McKeown said the investigators sense was that the percentage of the subjects with multiple previous cesareans was fairly low. The mean number of previous births for the subjects was only 1.8.