General obstetrics and gynecology: obstetricsTrial of labor in patients with a previous cesarean section: does maternal age influence the outcome?☆
Section snippets
Material and methods
The study was conducted at Ste-Justine Hospital, a tertiary care hospital, which has an attending obstetrician and attending anesthesiologist present in labor and delivery at all times. All women with a prior low-transverse cesarean section, who delivered infants more than 23 weeks' gestation with birth weights of 500 g or more and who underwent a TOL between December 1988 and December 2002, were analyzed. Three independent databases were used: Perinatal Database of Ste-Justine Hospital, the
Results
During the 14-year-study period, 2493 patients had a history of a previous low-transverse cesarean section and met inclusion criteria, 1750 patients had no prior vaginal delivery, and 743 patients had at least 1 prior vaginal delivery. Of the 1750 patients with no history of a prior vaginal delivery, there were 659 (37.6%) patients under 30 years old, 721 (41.3%) patients between 30 and 34 years old, and 370 (21.1%) patients 35 years or older. Of the 743 patients with at least 1 prior vaginal
Comment
In our study, we found that advanced maternal age was associated with a higher rate of failed TOL in patients with a prior cesarean section. In addition, older patients were more likely to have had a prior successful vaginal delivery. The rate of successful VBAC in these patients is more than 80%. However, we found no association between maternal age and the risk of uterine rupture. Furthermore, we found no association between the maternal age at the time of the prior cesarean section and the
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Cited by (49)
Middle eastern college of obstetricians and gynecologists (MCOG) practice guidelines: Role of prediction models in management of trial of labor after cesarean section. Practice guideline no. 05-O-22<sup>✰,✰✰,★,★★</sup>
2023, Journal of Gynecology Obstetrics and Human ReproductionTrial of Labor After Cesarean in Adolescents – A Multicenter Study
2020, Journal of Pediatric and Adolescent GynecologyNo-271-Delayed Child-Bearing
2017, Journal of Obstetrics and Gynaecology CanadaCitation Excerpt :The Caesarean section rate in women 40 to 45 approximates 50%, and this increases to approximately 80% in women aged 50 to 63 years, although the rate in the general obstetric population is about 25%.55,68,87 The reasons for the high rate of Caesarean section in older women include an increased prevalence of medical complications, fetal malposition, cephalopelvic disproportion, induction of labour, a failed trial of labour, and uterine rupture.88–93 In a study by Smith et al., a linear increase in ORs for Caesarean section with advancing maternal age (≥16 years) was demonstrated (adjusted OR for a 5-year increase in age:
N° 271-Report de la grossesse
2017, Journal of Obstetrics and Gynaecology CanadaCitation Excerpt :Chez les femmes dont l'âge se situe entre 40 et 45 ans, le taux de césarienne approche les 50 % et passe à environ 80 % chez les femmes dont l'âge se situe entre 50 et 63 ans, et ce, bien que le taux constaté au sein de la population obstétricale générale soit d'environ 25 %55,68,87. Parmi les raisons qui expliquent le taux élevé de césarienne chez les femmes plus âgées, on trouve une prévalence accrue de complications médicales, la malposition fœtale, la disproportion céphalo-pelvienne, le déclenchement du travail, un essai de travail s'étant soldé en échec et la rupture utérine88–93. Dans le cadre d'une étude menée par Smith et coll., une hausse linéaire des RC en ce qui concerne la césarienne en fonction du vieillissement maternel (≥ 16 ans) a été démontrée (RC corrigé pour une augmentation de cinq ans en matière d'âge : 1,49; IC à 95 %, 1,48 - 1,50)91.
Report de la grossesse
2016, Journal of Obstetrics and Gynaecology CanadaDo They Stand a Chance? Vaginal Birth after Cesarean Section in Adolescents Compared to Adult Women
2015, Journal of Pediatric and Adolescent GynecologyCitation Excerpt :The percentage of adolescents attempting a VBAC is lower in our study than in McMahon's study; however, the time periods and populations are very different. In the aforementioned studies,16–18 younger age was associated with successful VBAC whereas our findings were that adolescents and adults were equally successful and that maternal age was not an independent predictor of outcome. In the current study, we controlled for additional confounding factors and limited the analysis to women without any prior vaginal deliveries.
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This study was conducted at the Hôpital Ste-Justine in Montreal, Quebec, Canada.