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Risks from labor after prior cesarean delivery low, study reports

The risks from vaginal delivery after a prior Cesarean delivery are low, but are slightly higher than for a repeat Cesarean delivery. This finding is from the largest, most comprehensive study of its kind ever conducted, undertaken by the National Institute of Child Health and Human Development of the National Institutes of Health.

The study appears in the December 16 New England Journal of Medicine.

"These findings provide women who have had a Cesarean delivery-and their physicians-with reliable information to take into account when deciding whether to undergo labor or to have a repeat Cesarean delivery," said Duane Alexander, M.D., Director of the NICHD.

Among the complications the study found in women who attempted a vaginal birth after prior Cesarean delivery were rupture of the uterus, infection of the uterine lining, lack of oxygen to the infant brain, and infant death. The study authors noted, however, that the risks of these complications were very low.

Cesarean delivery consists of delivering a baby through an incision made in the abdominal wall and through the uterus, rather than through the vagina. Reasons for Cesarean delivery include failure of labor to proceed normally, fetal heart rate abnormalities, and complications involving the placenta. Because cesarean delivery is a major surgical procedure, it carries the risks posed by any other major surgery, such as infection or complications from the anesthetic. Having a Cesarean delivery may also complicate future births.

Uterine rupture is the most well known complication of attempted vaginal delivery after a prior Cesarean delivery. Uterine rupture occurs when the scar in the uterine muscle opens. The rupture may result in part or all of the baby and perhaps the placenta leaving the uterus, which may cause fetal heart rate abnormalities and perhaps fetal death. A more severe, or catastrophic, rupture may result in heavy bleeding, which can enda
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Contact: Robert Bock or Marianne Glass Miller
bockr@mail.nih.gov
301-496-5133
NIH/National Institute of Child Health and Human Development
14-Dec-2004


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