Vaginal birth after cesarean section: X-ray pelvimetry at term is informative
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Olivier Sibony
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.
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©2006 by Walter de Gruyter Berlin New York
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Articles in the same Issue
- The chemical erosion of human health: adverse environmental exposure and in-utero pollution – determinants of congenital disorders and chronic disease
- Cesarean section in term breech presentations: do rates of adverse neonatal outcomes differ by hospital birth volume?
- Antibiotic therapy for preterm premature rupture of membranes – results of a multicenter study
- Relation between grief and subsequent pregnancy status 13 months after perinatal bereavement
- Vaginal birth after cesarean section: X-ray pelvimetry at term is informative
- Vaginal birth after cesarean section: X-ray pelvimetry at term is informative
- Dilatation of the abdominal umbilical vein is associated with increased risk of thrombotic complications
- Retrospective diagnosis of hypoxic myocardial injury in premature newborns
- Fetal brain injury in experimental intrauterine asphyxia and inflammation in Göttingen minipigs
- Intrauterine growth restriction induces increased capillary density and accelerated type I fiber maturation in newborn pig skeletal muscles
- Closing arguments for gastroschisis: management with silo reduction
- Mean platelet and red blood cell volume measurements to estimate the severity of hypertension in pregnancy
- Torsion of a pedunculated accessory hepatic lobe: differential diagnosis of projectile vomiting in a neonate
- Massive fetomaternal hemorrhage following failed external cephalic version: case report
- Resolution of peripheral tissue ischemia secondary to arterial vasospasm following treatment with a topical nitroglycerin device in two newborns: case reports
- Echocardiography and N-terminal pro BNP
- Frontal-dominant white matter lesions following congenital rubella and cytomegalovirus infection
- Perinatal Programming
- Congress Calendar
