Abstract
Objectives
To compare the demographic and clinical characteristics between women who chose elective
repeat Caesarean section (ERCS) versus trial of labour after Caesarean section (TOLAC)
in St. John's, Newfoundland and Labrador (NL).
Methods
We conducted a retrospective case control study of women with live singleton gestations
delivering at term in St. John's, NL between January 1, 2001 and December 31, 2014.
Inclusion criteria were women who had a previous single lower segment Caesarean section
(LSCS). TOLAC, successful TOLAC, and VBAC rates were calculated. Demographic and clinical
characteristics were compared between women who chose ERCS versus TOLAC. Univariate
analyses and multiple logistic regression analyses were performed, and adjusted odds
ratios (aOR) and 95% CIs were calculated.
Results
A total of 1579 women were included, of whom 160 (10.1%) chose TOLAC, with 107 resulting
in successful VBAC (67% successful TOLAC rate). The overall VBAC rate was 6.8%. Women
who chose ERCS compared with those who chose TOLAC were more likely to be obese (aOR
3.20, 95% CI 1.85–5.54, P < 0.001), less likely to have had GA at delivery greater than 40 weeks (aOR 0.13,
95% CI 0.08–0.21, P < 0.001), less likely to have had a previous vaginal delivery (aOR 0.40, 95% CI 0.20–0.80,
P < 0.001), and less likely to have had the previous CS for breech presentation (aOR
0.51, 95% CI 0.33–0.80, P = 0.003).
Conclusions
The overall TOLAC and VBAC rates in St. John's are low when compared with reported
national rates. The successful TOLAC rate is within the expected range reported in
the literature. Differences exist between women who chose ERCS compared with TOLAC.
Résumé
Objectifs
Comparer les caractéristiques démographiques et cliniques des femmes qui choisissent
de subir une césarienne itérative planifiée (CIP) à celles des femmes qui optent pour
un essai de travail après césarienne (TOLAC) à St. John's (Terre-Neuve-et-Labrador).
Méthodologie
Nous avons mené une étude cas-témoin rétrospective sur des femmes enceintes d'un seul
bébé ayant accouché à terme à St. John's entre le 1er janvier 2001 et le 31 décembre 2014. Pour être admissibles, les femmes devaient avoir
préalablement subi une seule césarienne du segment inférieur. Nous avons calculé les
taux de TOLAC et de TOLAC réussis donnant lieu à un AVAC, et comparé les caractéristiques
démographiques et cliniques des femmes ayant choisi la CIP à celles des femmes ayant
opté pour le TOLAC. Nous avons ensuite effectué des analyses univariées et des analyses
de régression logistique multiple, et calculé les rapports de cotes ajustés (RCA)
et les intervalles de confiance (IC) à 95 %.
Résultats
L'étude a porté sur un total de 1579 femmes. Parmi elles, 160 (10,1 %) avaient opté
pour le TOLAC, dont 107 avaient eu un AVAC réussi (taux de réussite : 67 %). Le taux
global d'AVAC était de 6,8 %. Comparativement aux femmes qui avaient opté pour le
TOLAC, celles qui avaient choisi la CIP étaient plus susceptibles d'être obèses (RCA
: 3,20; IC à 95 % : 1,85–5,54; P < 0,001) et étaient moins susceptibles d'avoir un âge gestationnel supérieur à 40
semaines à l'accouchement (RCA : 0,13; IC à 95 % : 0,08–0,21; P < 0,001), d'avoir préalablement subi un accouchement par voie vaginale (RCA : 0,40;
IC à 95 % : 0,20–0,80; P < 0,001) et d'avoir subi leur césarienne antérieure en raison d'une présentation
par le siège (RCA : 0,51; IC à 95 % : 0,33–0,80; P = 0,003).
Conclusions
Les taux globaux de TOLAC et d'AVAC sont plus faibles à St. John's qu'ailleurs au
pays. Le taux de TOLAC réussis correspond aux valeurs signalées dans la littérature.
Des différences ont été observées entre les femmes qui choisissent la CIP et celles
qui optent pour le TOLAC.
Key Words
Abbreviations:
ERCS (elective repeat Caesarean section), GA (gestational age), NL (Newfoundland and Labrador), PPNL (Perinatal Program Newfoundland and Labrador), SVD (spontaneous vaginal delivery), TOLAC (trial of labour after Caesarian section)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 27, 2018
Accepted:
October 10,
2017
Received:
July 27,
2017
Footnotes
Competing interests: The authors declare that they have no competing interests.
Identification
Copyright
Copyright © 2018 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
