The rate of cesarean delivery in th...

The rate of cesarean delivery in the United States is at a record high and continues to increase. reciprocally rates of vaginal birth after cesarean delivery (VBAC) have declined (to 127 percent in 2002 from 283 percent in 1996) Childbirth accounts for about united quarter of hospital admissions for U women Guise and colleagues leadershiped an extensive review to evaluate the benefits and harms of VBAC and elective repeat cesarean delivery. The authors searched electronic databases for relevant published articles, systematic reviews, clinical trials, and reports. They also sought evidence from intimation lists and contacted experts for recommendations. Relevant evidence arising since the 1980 National Institutes of Health Consensus increase Conference on VBAC was sought Clinical studies leadershiped in developed countries were eligible for inclusion if they contained at least 10 patients and provided data about uterine dissolution VBAC rates, and maternal and fetal issues and were not focused forward specific subgroups of patients like as those with specific medical or obstetric point to be solved [i]or[/i] settleds Two independent investigators rated the quality of each cogitation Data were abstracted from each investigation by two independent reviewers.

From more than 6800 citations, the researchers identified and nothing else two randomized controlled trials and 18 observational studies. In all studies, women attending tertiary care center were more likely to attempt VBAC. forward average, 80 percent of mothers who had spontaneous attack of labor delivered vaginally compared with 68 percent of those who received oxytocin, yet the difference was not statistically significant. Maternal hemorrhage requiring transfusion was reported in 11 percent of the VBAC arrange and 1.3 percent of women in the repeat cesarean assemblage in a large population-based investigation Although this difference was not statistically significant, like hemorrhage was significantly less for the use of all in the trial-of-labor group in a prospective cohort close attention (0.72 compared with 1.72 percent)

Hysterectomy was performed in 02 percent of women in the largest studies, with no difference between form into groupss Information on the reasons for hysterectomy were not well documented. Documentation question s and differences in definitions limited estimates of maternal infection. Data also were poorly and inconsistently recorded upon infant outcomes. Uterine rupture was more customary in the VBAC group.

The authors finish that the deficiencies in the scientific literature about the safety of VBAC are striking and that research is straited to help physicians select mothers with the optimal chance of prosperous VBAC.

ANNE D WALLING, MD Guise JM et al. Safety of vaginal birth after cesarean: a systematic review. Obstet Gynecol March 2004;103:420-9

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