Birth after Caesarean Section
type: CreativeWork
description: Birth after caesarean section (CS) is an issue of growing importance. As a consequence of increasing CS rates, more women having experienced a prior CS will need counselling about preferred second delivery mode. There are two choices: elective repeat caesarean section (ERCS) or trial of labour (TOL). It is well known, that a TOL ending in an emergency CS carries the largest risks for mother and child. We wanted to investigate for which women and infants it would be safest to recommend an ERCS or a TOL. We assumed, that underlying conditions/indications for the first CS performed would often recur in the second pregnancy and be important for the second delivery outcome. Therefore, a hierarchical system was developed, in which efforts were made to classify according to underlying conditions instead of focusing on conditions appearing during labour, in an attempt to diminish the subjective impact of diagnoses recorded after delivery. The hierarchical system was used through the four papers. We investigated women in the Swedish medical birth register with their first two deliveries 1987-2007 (Paper I-III), or giving birth at least twice, including one CS and at least one delivery after the CS 1992-2011 (Paper IV). In Papers I-III, we have shown that all first CS indications had a statistically significant risk to recur in the second pregnancy/ delivery. Women with a first CS were older, shorter, and had a higher body mass index than women with a first vaginal delivery. The risk for unplanned CS in TOL increased by the women’s age, body mass index, and smoking, while increasing height lowered the risk. Women with a prior CS had an all-over increased risk for unplanned CS in TOL, compared with primiparous women. Infants born to mothers with one prior CS had an almost doubled risk for low Apgar score and perinatal death compared with infants of women with one prior vaginal birth. The risk was lower but still statistically significant after adjustment for possible maternal …
abstract: Birth after caesarean section (CS) is an issue of growing importance. As a consequence of increasing CS rates, more women having experienced a prior CS will need counselling about preferred second delivery mode. There are two choices: elective repeat caesarean section (ERCS) or trial of labour (TOL). It is well known, that a TOL ending in an emergency CS carries the largest risks for mother and child. We wanted to investigate for which women and infants it would be safest to recommend an ERCS or a TOL. We assumed, that underlying conditions/indications for the first CS performed would often recur in the second pregnancy and be important for the second delivery outcome. Therefore, a hierarchical system was developed, in which efforts were made to classify according to underlying conditions instead of focusing on conditions appearing during labour, in an attempt to diminish the subjective impact of diagnoses recorded after delivery. The hierarchical system was used through the four papers. We investigated women in the Swedish medical birth register with their first two deliveries 1987-2007 (Paper I-III), or giving birth at least twice, including one CS and at least one delivery after the CS 1992-2011 (Paper IV). In Papers I-III, we have shown that all first CS indications had a statistically significant risk to recur in the second pregnancy/ delivery. Women with a first CS were older, shorter, and had a higher body mass index than women with a first vaginal delivery. The risk for unplanned CS in TOL increased by the women’s age, body mass index, and smoking, while increasing height lowered the risk. Women with a prior CS had an all-over increased risk for unplanned CS in TOL, compared with primiparous women. Infants born to mothers with one prior CS had an almost doubled risk for low Apgar score and perinatal death compared with infants of women with one prior vaginal birth. The risk was lower but still statistically significant after adjustment for possible maternal …
author: Carlsson Fagerberg, Marie
language: eng
keywords: Gynaecology, Obstetrics and Reproductive Medicine, caesarean section, prediction model, trial of labour, vaginal birth after caesarean
date published: 2014
date modified: 2026-07-24T03:00:02Z
provider: University of Lund
publisher: Networked Digital Library of Theses and Dissertations
type: WebPage
source organization: Department of Obstetrics and Gynecology, Lund University