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Are There Differences between Women who Choose Elective Repeat Caesarean Versus Trial of Labour in St. John's, NL?

Published:April 27, 2018DOI:https://doi.org/10.1016/j.jogc.2017.10.021

      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)
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      References

        • Canadian Institute for Health Information
        Health Indicators Interactive Tool Health Indicators 2016: Caesarean section.
        (Available at)
        http://yourhealthsystem.cihi.ca/epub/
        Date accessed: November 22, 2016
        • Kelly S.
        • Sprague A.
        • Fell D.B.
        • et al.
        Examining caesarean section rates in Canada using the Robson classification system.
        J Obstet Gynaecol Can. 2013; 35: 206-214
        • Rossignol M.
        • Moutquin J.M.
        • Boughrassa F.
        • et al.
        Preventable obstetrical interventions: how many caesarean sections can be prevented in Canada?.
        J Obstet Gynaecol Can. 2013; 35: 434-443
        • Canadian Institute for Health Information
        Highlights of 2011–2012 selected indicators describing birthing process in Canada.
        (Available at)
        • Martel M.J.
        • MacKinnon C.J.
        • Clinical Practice Obstetrics Committee
        Guidelines for vaginal birth after previous caesarean birth [SOGC clinical practice guideline no 155].
        J Obstet Gynaecol Can. 2005; 27: 164-174
        • Landon M.B.
        • Leindecker S.
        • Spong C.Y.
        • et al.
        The MFMU Cesarean Registry: factors affecting the success of trial of labor after previous cesarean delivery.
        Am J Obstet Gynecol. 2005; 193: 1016-1023
        • Brill Y.
        • Windrim R.
        Vaginal birth after Caesarean section: review of antenatal predictors of success.
        J Obstet Gynaecol Can. 2003; 25: 275-286
        • Srinivas S.K.
        • Stamilio D.M.
        • Stevens E.J.
        • et al.
        Safety and success of vaginal birth after cesarean delivery in patients with preeclampsia.
        Am J Perinatol. 2006; 23: 145-152
        • Grobman W.A.
        • Lai Y.
        • Landon M.B.
        • et al.
        Development of a nomogram for prediction of vaginal birth after cesarean.
        Obstet Gynecol. 2007; 109: 806-812
        • Chaillet N.
        • Bujold E.
        • Dube E.
        • et al.
        Validation of a prediction model for vaginal birth after caesarean.
        J Obstet Gynaecol Can. 2013; 35: 119-124
        • Metz T.D.
        • Stoddard G.J.
        • Henry E.
        • et al.
        How do good candidates for trial of labor after cesarean (TOLAC) who undergo elective repeat cesarean differ from those who choose TOLAC?.
        Am J Obstet Gynecol. 2013; 208 (e1-6): 458
        • Bernstein S.N.
        • Matalon-Grazi S.
        • Rosenn B.M.
        Trial of labor versus repeat cesarean: are patients making an informed decision?.
        Am J Obstet Gynecol. 2012; 207 (e1-6): 204
        • Russillo B.
        • Sewitch M.J.
        • Cardinal L.
        • et al.
        Comparing rates of trial of labour attempts, VBAC success, and fetal and maternal complications among family physicians and obstetricians.
        J Obstet Gynaecol Can. 2008; 30: 123-128
        • Statistics Canada
        2006 Census of Population, Community Profiles—St. John's Census metropolitan area, Newfoundland and Labrador.
        (Available at)
        • Twells L.K.
        • Gregory D.M.
        • Reddigan J.
        • et al.
        Current and predicted prevalence of obesity in Canada: a trend analysis.
        CMAJ Open. 2014; 2: E18-E26