Abstract
Objective: To examine whether X-ray pelvimetry data to evaluate the likelihood of vaginal birth after previous cesarean section.
Design: Retrospective study
Setting: University hospital
Population: Patients with a previous cesarean delivery who underwent X-ray pelvimetry and gave birth at gestational age 37 weeks during a seven-year period.
Methods: 1190 patients with a scarred uterus were compared with 15,189 patients without a scarred uterus. In the scarred uterus group, 760 patients with a transverse pelvic diameter ≥12 cm were compared with 430 patients with a transverse pelvic diameter <12 cm.
Main outcome measures: The obstetrical outcomes were spontaneous or induced labor, and mode of delivery. The maternal morbidity outcomes were hemorrhage requiring transfusion of packed red cells, uterine rupture, bladder injury, and hysterectomy due to hemorrhage. The neonatal morbidity outcomes were the 5-min Apgar score, transfer to intensive care, and intubation.
Results: Patients with a scarred uterus had a significantly higher rate of cesarean section (35.5%) than those with no prior cesarean section (9%). Among patients with a scarred uterus who were selected for vaginal delivery, 81% delivered vaginally when the transverse diameter (TD) of the pelvic inlet was greater than 12 cm, 68% when the TD was between 11.5 and 12 cm, and 58% when the TD was less than 11.5 cm. Maternal morbidity was significantly higher in the patients with a scarred uterus. The neonatal results were comparable in the different groups.
Conclusion: X-ray pelvimetry tailors the information given to each patient about the likelihood of having a vaginal delivery. It can also be used to optimize the selection of patients allowed to enter labor.
References
1 Flamm BL, LA Newman, SJ Thomas, D Fallon, MM Yoshida: Vaginal birth after cesarean section: results of 5-year multicenter collaborative study. Obstet Gynecol76 (1990) 750Search in Google Scholar
2 Guise JM, M Berlin, M Mc Donagh, P Osterweil, B Chan, M Helfand: Safety of vaginal birth after cesarean: a systematic review. Obstet Gynecol103 (2004) 420Search in Google Scholar
3 Langer B, G Schlaeder: Que penser du taux de césarienne en France? J Gynecol Obstet Biol Reprod27 (1998) 62Search in Google Scholar
4 Lydon-Rochelle M, V Holt, T Easterling, P Diane: Risk of uterine rupture during labor among women with a prior cesarean delivery. N Engl J Med345 (2001) 3Search in Google Scholar
5 MacMahon M, E Luther, W Bowes, A Olshan: Comparison of a trial of labor with an elective second cesarean section. N Engl J Med335 (1996) 689Search in Google Scholar
6 Morzukewih E, E Hutton: Elective repeat cesarean delivery versus trial of labor: a meta-analysis of the literature from 1989 to 1999. Am J Obstet Gynecol183 (2000) 1187Search in Google Scholar
7 Ofir K, E Sheiner, A Levy, M Katz, M Mazor: Uterine rupture: risk factors and pregnancy outcome. Am J Obstet Gynecol189 (2003) 1042Search in Google Scholar
8 Phelan JP, SL Clark, F Diaz, RH Paul: Vaginal birth after cesarean section. Am J Obstet Gynecol157 (1987) 1510Search in Google Scholar
9 Ravasia D, S Wood, J Pollard: Uterine rupture during induced trial of labor among women with previous cesarean delivery. Am J Obstet Gynecol183 (2000) 1176Search in Google Scholar
10 Rosen MG, JC Dickenson, CL Westhoff: Vaginal birth after cesarean: a meta-analysis of morbidity and mortality. Obstet Gynecol77 (1991) 465Search in Google Scholar
11 Smith G, J Pell, R Dobbie: Cesarean section and risk of unexplained stillbirth in subsequent pregnancy. Lancet 362(9398) (2003) 1779Search in Google Scholar
12 Thubisi M, A Ebrahim, J Moodley, PM Shweni: Vaginal delivery after previous cesarean section: is X-ray pelvimetry necessary? Br J Obstet Gynaecol100 (1993) 421Search in Google Scholar
©2006 by Walter de Gruyter Berlin New York