Startseite Medizin Interinstitutional variations in mode of birth after a previous caesarean section: a cross-sectional study in six German hospitals
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Interinstitutional variations in mode of birth after a previous caesarean section: a cross-sectional study in six German hospitals

  • Mechthild M. Gross EMAIL logo , Andrea Matterne , Silvia Berlage , Annette Kaiser , Nicholas Lack , Susanne Macher-Heidrich , Björn Misselwitz , Franz Bahlmann , Jörg Falbrede , Peter Hillemanns , Constantin von Kaisenberg , Franz Edler von Koch , Ralf L. Schild , Holger Stepan , Declan Devane und Rafael Mikolajczyk
Veröffentlicht/Copyright: 14. November 2014
Journal of Perinatal Medicine
Aus der Zeitschrift Journal of Perinatal Medicine Band 43 Heft 2

Abstract

Aims: Regional and interinstitutional variations have been recognized in the increasing incidence of caesarean section. Modes of birth after previous caesarean section vary widely, ranging from elective repeat caesarean section (ERCS) and unplanned repeat caesarean section (URCS) after trial of labour to vaginal birth after caesarean section (VBAC). This study describes interinstitutional variations in mode of birth after previous caesarean section in relation to regional indicators in Germany.

Material and methods: A cross-sectional study using the birth registers of six maternity units (n=12,060) in five different German states (n=370,209). Indicators were tested by χ2 and relative deviations from regional values were expressed as relative risks and 95% confidence intervals.

Results: The percentages of women in the six units with previous caesarean section ranged from 11.9% to 15.9% (P=0.002). VBAC was planned for 36.0% to 49.8% (P=0.003) of these women, but actually completed in only 26.2% to 32.8% (P=0.66). Depending on the indicator, the units studied deviated from the regional data by up to 32% [relative risk 0.68 (0.47–0.97)] in respect of completed VBAC among all initiated VBAC.

Conclusions: There is substantial interinstitutional variation in mode of birth following previous caesarean section. This variation is in addition to regional patterns.

Keywords: Germany; mode of birth; regional variation; VBAC, vaginal birth after caesarean section
Corresponding author: PD Dr. Mechthild M. Gross, Hebamme, Head of Midwifery Research and Education Unit, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany, Tel.: +49-511-532-6116, Fax: +49-511-532-6191, E-mail:

Acknowledgments

This paper was revised during a publication workshop as part of the COST action ISO907: Childbirth, Cultures, Concerns, and Consequences: Creating a dynamic framework of maternity in Europe. The first author (MG) is most grateful for the comments of Professor Susanne Grylka-Baeschlin. The research leading to these results has received funding from the European Union’s Seventh Framework Programme (FP7/2007-2013) under grant agreement no. 305208, the OptiBIRTH study.

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The authors stated that there are no conflicts of interest regarding the publication of this article.

Received: 2014-3-31
Accepted: 2014-6-11
Published Online: 2014-11-14
Published in Print: 2015-3-1

©2015 by De Gruyter

Artikel in diesem Heft

  1. Frontmatter
  2. Academy’s Corner
  3. Obstetrical Doppler: the evidence today
  4. Review article
  5. Fetal complications due to intrahepatic cholestasis of pregnancy
  6. Original articles – Obstetrics
  7. Pre-pregnancy obesity compromises obstetric and neonatal outcomes
  8. Novel application of three-dimensional HDlive imaging in prenatal diagnosis from the first trimester
  9. Placental gene expression of inflammatory markers and growth factors – a case control study of obese and normal weight women
  10. Haemorrhagic and thrombotic complications in pregnant women with acquired and congenital cardiac disease
  11. Intrapartum ultrasound prior to Kristeller maneuver: an observational study
  12. Interinstitutional variations in mode of birth after a previous caesarean section: a cross-sectional study in six German hospitals
  13. Use of the angle of progression on ultrasonography to predict spontaneous onset of labor within 7 days
  14. Study of the relationship in pregnant women between hepatitis B markers and a placenta positive for hepatitis B surface antigen
  15. Sarcoidosis and pregnancy: obstetrical and neonatal outcomes in a population-based cohort of 7 million births
  16. Original articles – Fetus
  17. MR imaging of the fetal brain at 1.5T and 3.0T field strengths: comparing specific absorption rate (SAR) and image quality
  18. Sex differences in the fetal heart rate variability indices of twins
  19. Original articles – Newborn
  20. Correlation of neonatal weight with maternal serum levels of pregnancy-associated plasma protein-A during the first trimester of pregnancy: a retrospective study
  21. Antenatal testing in uncomplicated pregnancies: should testing be initiated after 40 or 41 weeks?
  22. Low total IgM values and high cytomegalovirus loads in the blood of newborns with symptomatic congenital cytomegalovirus infection
  23. Associated anomalies in congenital diaphragmatic hernia: perinatal characteristics and impact on postnatal survival
  24. The value of lipopolysaccharide binding protein for diagnosis of late-onset neonatal sepsis in very low birth weight infants
  25. Is there a stepwise increase in neonatal morbidities according to histological stage (or grade) of acute chorioamnionitis and funisitis?: effect of gestational age at delivery
  26. Commentary
  27. Thrombophilia testing in pregnancy: should we agree to disagree?
  28. Congress Calendar
  29. Congress Calendar
https://doi.org/10.1515/jpm-2014-0108
Schlagwörter für diesen Artikel
Germany; mode of birth; regional variation; VBAC, vaginal birth after caesarean section

Artikel in diesem Heft

  1. Frontmatter
  2. Academy’s Corner
  3. Obstetrical Doppler: the evidence today
  4. Review article
  5. Fetal complications due to intrahepatic cholestasis of pregnancy
  6. Original articles – Obstetrics
  7. Pre-pregnancy obesity compromises obstetric and neonatal outcomes
  8. Novel application of three-dimensional HDlive imaging in prenatal diagnosis from the first trimester
  9. Placental gene expression of inflammatory markers and growth factors – a case control study of obese and normal weight women
  10. Haemorrhagic and thrombotic complications in pregnant women with acquired and congenital cardiac disease
  11. Intrapartum ultrasound prior to Kristeller maneuver: an observational study
  12. Interinstitutional variations in mode of birth after a previous caesarean section: a cross-sectional study in six German hospitals
  13. Use of the angle of progression on ultrasonography to predict spontaneous onset of labor within 7 days
  14. Study of the relationship in pregnant women between hepatitis B markers and a placenta positive for hepatitis B surface antigen
  15. Sarcoidosis and pregnancy: obstetrical and neonatal outcomes in a population-based cohort of 7 million births
  16. Original articles – Fetus
  17. MR imaging of the fetal brain at 1.5T and 3.0T field strengths: comparing specific absorption rate (SAR) and image quality
  18. Sex differences in the fetal heart rate variability indices of twins
  19. Original articles – Newborn
  20. Correlation of neonatal weight with maternal serum levels of pregnancy-associated plasma protein-A during the first trimester of pregnancy: a retrospective study
  21. Antenatal testing in uncomplicated pregnancies: should testing be initiated after 40 or 41 weeks?
  22. Low total IgM values and high cytomegalovirus loads in the blood of newborns with symptomatic congenital cytomegalovirus infection
  23. Associated anomalies in congenital diaphragmatic hernia: perinatal characteristics and impact on postnatal survival
  24. The value of lipopolysaccharide binding protein for diagnosis of late-onset neonatal sepsis in very low birth weight infants
  25. Is there a stepwise increase in neonatal morbidities according to histological stage (or grade) of acute chorioamnionitis and funisitis?: effect of gestational age at delivery
  26. Commentary
  27. Thrombophilia testing in pregnancy: should we agree to disagree?
  28. Congress Calendar
  29. Congress Calendar
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