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Am J Perinatol 2010; 27(10): 791-796
DOI: 10.1055/s-0030-1254238
© Thieme Medical Publishers

Maternal and Neonatal Outcomes of Repeat Cesarean Delivery in Women with a Prior Classical versus Low Transverse Uterine Incision

Tiki Bakhshi1 , Mark B. Landon2 , Yinglei Lai19 , Catherine Y. Spong20 , Dwight J. Rouse3 , Kenneth J. Leveno4 , Michael W. Varner5 , Steve N. Caritis6 , Paul J. Meis7 , Ronald J. Wapner8 , Yoram Sorokin9 , Menachem Miodovnik10 , 11 , Marshall Carpenter12 , Alan M. Peaceman13 , Mary J. O'Sullivan14 , Baha M. Sibai15 , Oded Langer16 , John M. Thorp17 , Brian M. Mercer18
  • 1Departments of Obstetrics and Gynecology, The University of Texas Health Science Center at Houston, Houston, Texas
  • 2The Ohio State University, Columbus, Ohio
  • 3University of Alabama at Birmingham, Birmingham, Alabama
  • 4University of Texas Southwestern Medical Center, Dallas, Texas
  • 5University of Utah, Salt Lake City, Utah
  • 6University of Pittsburgh, Pittsburgh, Pennsylvania
  • 7Wake Forest University Health Sciences, Winston-Salem, North Carolina
  • 8Thomas Jefferson University, Philadelphia, Pennsylvania
  • 9Wayne State University, Detroit, Michigan
  • 10University of Cincinnati, Cincinnati, Ohio
  • 11Columbia University, New York, New York
  • 12Brown University, Providence, Rhode Island
  • 13Northwestern University, Chicago, Illinois
  • 14University of Miami, Miami, Florida
  • 15University of Tennessee, Memphis, Tennessee
  • 16University of Texas Health Science Center at San Antonio, San Antonio, Texas
  • 17University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
  • 18Case Western Reserve University, Cleveland, Ohio
  • 19The George Washington University Biostatistics Center, Washington, DC
  • 20Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network, Bethesda, Maryland
Further Information

Publication History

Publication Date:
10 May 2010 (online)

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ABSTRACT

We compared maternal and neonatal outcomes following repeat cesarean delivery (CD) of women with a prior classical CD with those with a prior low transverse CD. The Maternal Fetal Medicine Units Network Cesarean Delivery Registry was used to identify women with one previous CD who underwent an elective repeat CD prior to the onset of labor at ≥36 weeks. Outcomes were compared between women with a previous classical CD and those with a prior low transverse CD. Of the 7936 women who met study criteria, 122 had a prior classical CD. Women with a prior classical CD had a higher rate of classical uterine incision at repeat CD (12.73% versus 0.59%; p < 0.001), had longer total operative time and hospital stay, and had higher intensive care unit admission. Uterine dehiscence was more frequent in women with a prior classical CD (2.46% versus 0.27%, odds ratio 9.35, 95% confidence interval 1.76 to 31.93). After adjusting for confounding factors, there were no statistical differences in major maternal or neonatal morbidities between groups. Uterine dehiscence was present at repeat CD in 2.46% of women with a prior classical CD. However, major maternal morbidities were similar to those with a prior low transverse CD.

KEYWORDS

Cesarean delivery - classical cesarean delivery - prior cesarean - maternal outcomes - neonatal outcomes

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Tiki BakhshiM.D. 

Department of OB/GYN, Tripler Army Medical Center

1 Jarrett White Road, Honolulu, HI 96859-5000

Email: tiki.bakhshi@amedd.army.mil

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