Safety of childbirth after C-section examined

COLUMBUS The most definitive study to date of women who had previously undergone cesarean-section deliveries, but who later chose an attempt at vaginal delivery for subsequent births, shows that serious complications are possible, but that the absolute risk of these occurring is very small.

These new findings will appear tomorrow (12/16) in the current issue of the New England Journal of Medicine.

The multicenter study was sponsored by the National Institute of Child Health and Human Development Maternal Fetal Medicine Units Network a part of the National Institutes of Health.

"This study is significant in addressing an issue that continuously receives debate in obstetrics," said Mark Landon, vice chairman of obstetrics and gynecology at The Ohio State University Medical Center and principal investigator for the four-year study. "Until now, the information comparing a trial of labor and an elective repeat operation has been inadequate to counsel women concerning their options for childbirth following prior cesarean delivery."

Researchers at 19 academic medical centers joined forces to complete the research, which included cases between 1999 and 2002. Of the approximately 46,000 women in the study with a prior cesarean delivery, one in three, or about 16,000, underwent elective, repeat cesarean delivery without labor. Another 18,000 attempted "vaginal birth after cesarean section," (VBAC), while approximately 12,000 women had other maternal or fetal indications for a repeat cesarean delivery.

The study demonstrated that, when compared to elective repeat cesarean delivery, women attempting VBAC are at increased risk for maternal morbidity and serious obstetric complications, such as uterine rupture, endometritis, transfusion, or newborn hypoxic ischemic encephalopathy (newborn brain injury due to lack of oxygen).

About 39 percent of the women chose to attempt a vaginal delivery in spite of their previous cesarea

Contact: Betsy Samuels
Ohio State University

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