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| 09/16/2006 7:52 AM |
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Dear Henci,
I recently attended (May) the Partners in Perinatal Health Conference and enjoyed listening to your presentation both in the workshop and the closing address. I had a question about a statistic you brought to our attention regarding vbac. You stated that the uterine rupture issue happened in 1% of the population and that is both during pregnancy and during labor combined… (I may not have quoted your exact wording there) and that the risk increased with induction. Can you tell me if I understood you correctly and if you have any of the data on this (more of the labor and pregnancy combined), that would be appreciated. Thanks so much for your time.
Warmly,
Diane Magalhaes, CHES
By: mamabear |
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Archived User
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| 09/18/2006 2:22 AM |
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I went back to my Powerpoint presentation, and what I said was that uterine scar rupture occurred at a rate of 1 per 1,000 in women with prior c/secs planning repeat c/sec according to a recent review (Guise JM, McDonagh M, Hashima JN et al. Vaginal birth after cesarean (VBAC) Report/Technology Assessment No. 71. AHRQ Publication No. 03-E018.Rockville, MD: Agency for Healthcare Research and Quality. March 2003.). This was to refute the myth that planning repeat c/sec can completely avoid uterine scar rupture in future pregnancies.
However, there is still an excess compared with planned VBAC, but it isn't as big as people think it is. Many large studies and reviews report rates less than 5 per 1000. This means we know what can be achieved, so studies that report rates higher than this have modifiable factors unnecessarily increasing uterine scar rupture rates.
This brings me to part II of your question: the effect of induction. To cite one example, a large, recent U.S. study (Landon MB, Hauth JC, Leveno KJ et al. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. N Engl J Med 2004;351(25):2581-2589.) reported a scar rupture rate of 4 per 1000 with spontaneous labor (no induction, no oxytocin augmentation) vs. 10 per 1000 with oxytocin induction. Other studies don't find an association, though. Differences between studies probably have to do with patient selection criteria and oxytocin dosing protocol.
-- Henci
By: Henci Goer |
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