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First Vaginal Birth after Cesarean: a retrospective cohort study

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posted on 2019-02-18, 21:45 authored by Zdenek RusavyZdenek Rusavy, Erika Francova, Lenka Paymova, Khaled Ismail, Vladimir KalisVladimir Kalis

Objective: The main aim of this study was to explore the course of labor and extent of perineal trauma at the first vaginal birth after cesarean section (fVBAC) in comparison to primiparous vaginal birth (PVB) in women without epidural analgesia.

Study design: All fVBACs without epidural analgesia and the subsequent PVBs (controls) between 2012 - 2016 were included in this retrospective cohort study. Data were collected from health records and included maternal characteristics and labor details in both groups as well as cervical dilation at the time of previous cesarean in fVBAC group.

Results: The study comprised 510 women; 255 fVBACs and 255 controls. The majority of fVBACs were after a pre-labor cesarean section – 177 (69.4%). There was a statistically significant difference in the recorded duration of first stage between the fVBACs and controls (289 vs. 347min respectively, p<.001). Women were less likely to have an intact perineum in the fVBAC group (29.8 vs. 43.1%, p<0.01), however, there was no statistically significant difference in anal sphincter injury rates between both groups (2.3 vs. 1.9%, p=0.76). The groups differed in rates of cervical tears requiring suturing (21.2 vs. 12.9%, p=0.01). On further subgroup analysis, the duration of first stage of labor shorter in women who previously had a caesarean section late in labor (≥ 8cm cervical dilatation) compared to a pre-labor cesarean section (uneffaced cervix), however, there were no differences in other outcomes.

Conclusion: Compared to primiparous women having a vaginal birth, women having their first vaginal birth after a cesarean section have a shorter 1st stage of labor, a higher risk of sustaining cervical lacerations and perineal trauma. However, the risk of anal sphincter injury does not seem to be increased.

Funding

The study was funded by National Sustainability Program I (NPU I) Nr. LO1503 provided by the Ministry of Education Youth and Sports of the Czech Republic and Charles University Research Fund (Progres Q39).

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