Planned vaginal birth or elective repeat caesarean: patient preference restricted cohort with nested randomised trial

Crowther, Caroline A., Dodd, Jodie M., Hiller, Janet E., Haslam, Ross R., Robinson, Jeffrey S., and Birth After Caesarian Study Group, (2012) Planned vaginal birth or elective repeat caesarean: patient preference restricted cohort with nested randomised trial. PLoS Medicine, 9 (3). pp. 1-10.

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Abstract

Background: Uncertainty exists about benefits and harms of a planned vaginal birth after caesarean (VBAC) compared with elective repeat caesarean (ERC). We conducted a prospective restricted cohort study consisting of a patient preference cohort study, and a small nested randomised trial to compare benefits and risks of a planned ERC with planned VBAC.

Methods and findings: 2,345 women with one prior caesarean, eligible for VBAC at term, were recruited from 14 Australian maternity hospitals. Women were assigned by patient preference (n = 2,323) or randomisation (n = 22) to planned VBAC (1,225 patient preference, 12 randomised) or planned ERC (1,098 patient preference, ten randomised). The primary outcome was risk of fetal death or death of liveborn infant before discharge or serious infant outcome. Data were analysed for the 2,345 women (100%) and infants enrolled. The risk of fetal death or liveborn infant death prior to discharge or serious infant outcome was significantly lower for infants born in the planned ERC group compared with infants in the planned VBAC group (0.9% versus 2.4%; relative risk [RR] 0.39; 95% CI 0.19–0.80; number needed to treat to benefit 66; 95% CI 40– 200). Fewer women in the planned ERC group compared with women in the planned VBAC had a major haemorrhage (blood loss $1,500 ml and/or blood transfusion), (0.8% [9/1,108] versus 2.3% [29/1, 237]; RR 0.37; 95% CI 0.17–0.80).

Conclusions: Among women with one prior caesarean, planned ERC compared with planned VBAC was associated with a lower risk of fetal and infant death or serious infant outcome. The risk of major maternal haemorrhage is reduced with no increase in maternal or perinatal complications to time of hospital discharge. Women, clinicians, and policy makers can use this information to develop health advice and make decisions about care for women who have had a previous caesarean.

Item ID: 33659
Item Type: Article (Refereed Research - C1)
Additional Information:

© 2012 Crowther et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

ISSN: 1549-1676
Funders: National Health and Medical Research Council (NHMRC), Women's and Children's Hospital Foundation, South Australia, Australian Research Centre for Health of Women and Babies (ARCH)
Projects and Grants: NHMRC Neil Hamilton Fairley Clinical Fellowship (ID 399244), NHMRC Practitioner Fellowship (ID 627005)
Date Deposited: 25 Jun 2014 01:28
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1114 Paediatrics and Reproductive Medicine > 111402 Obstetrics and Gynaecology @ 100%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920114 Reproductive System and Disorders @ 100%
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