From the Journal of Maternal Fetal Neonatal Medicine: Gross overestimation of Uterine Rupture after 2 C/S on OBs part

J Matern Fetal Neonatal Med. 2010 Mar 17.

Vaginal birth after two previous c-sections: obstetricians-gynaecologists opinions and practice patterns.
Doret M, Touzet S, Bourdy S, Gaucherand P.

Hospices Civils de Lyon, H?pital Femme-M?re-Enfant, Service d’obst?trique,
F-69677 Bron, Lyon, France.
Objectives. To evaluate obstetricians’ practice patterns, opinions and
factors influencing decision-making about mode of delivery in women with two previous c-sections. Methods. A questionnaire was mailed to the 160
obstetricians from the Rhone-Alpes perinatal network. Questionnaires
included demographic, organisational information and questions about
physicians’ opinion, practice patterns and patient counseling concerning
vaginal birth after c-section (VBAC) after one and two caesarean sections.

Results. Response rate was 65.6%, 100% and 23.8% would offer VBAC to women with respectively one and two previous c-sections. Uterine rupture rate was largely overestimated in both women with one (2.8%) and two prior c-sections (14.2%).

Factors positively influencing obstetricians were cerebral palsy estimated
rate less than 20%, a minimal decision to birth delay less than 20 min when
emergency c-section would be required. Neonatal severe outcomes consecutive to trial of labour as well as placenta praevia or accreta risk and morbidity associated with multiple c-sections would be insufficiently discussed.

Conclusion. Obstetricians largely prefer a third planned c-section in women with two previous c-sections. This decision is partly based on a large
overestimation of immediate maternal and neonatal serious outcomes
consecutive to trial of labour as well documented serious long term outcomes of multiple c-sections are insufficiently considered.

PMID: 20233132

~ by mamamia713 on 05/04/2010.